Archived - CDC Investigation of Traveler with Multidrug-Resistant
Tuberculosis (MDR TB): Questions and Answers for Passengers and
Flight Crew on the Same Flight
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and content are no longer being updated.
What happened?
CDC is currently working on an investigation involving an
international traveler to the U.S. recently diagnosed with
multidrug-resistant
tuberculosis (MDR TB). The patient with MDR TB traveled from New
Delhi, India to Chicago, Illinois on a commercial flight arriving
December 13, 2007. Shortly after arrival in the U.S., the patient
went to a hospital for treatment.
What are the date and flight number for this investigation?
- American Airlines # 293, departing New Delhi, India on
December 12th; arriving in Chicago, Illinois on December 13th
What is CDC doing?
Shortly after being notified about the patient’s travels,
officials of CDC’s Division of Global Migration and Quarantine
contacted American Airlines and U.S. Customs and Border Protection
to obtain the information needed to contact passengers who may have
been exposed to the traveler with tuberculosis. CDC is collaborating
with U.S. state and local health departments and the Indian Ministry
of Family Welfare to ensure notification and follow-up of passengers
and crew who may have been exposed to MDR TB.
Who should be tested?
In accordance with the
World Health Organization (WHO) TB and Airline Travel Guidelines,
CDC is ensuring appropriate follow-up and care for persons who may
have been exposed to TB on an aircraft. This includes recommending
the evaluation and testing of passengers and crew with closest
contact to the patient on board American Airlines #293. These
include:
- passengers seated in the same row as the patient (row
35),
- passengers seated in the two rows ahead of the patient
(rows 33 and 34)
- passengers seated two rows behind the patient (rows 36
and 37)
- crew members working in the same cabin
These persons should receive an initial evaluation and testing
for TB infection, with possible follow-up 8 to 10 weeks after the
December 13 flight for re-evaluation depending on initial test
results.
CDC recommends testing of these passengers and crew on the
international flight from New Delhi to Chicago because this flight
meets the 8 hour duration criteria specified by WHO for passenger
testing for exposure to tuberculosis. WHO and CDC do not recommend
notification or medical evaluation of passengers on briefer flights
because the risk of transmission is minimal.
How many people were exposed to the MDR TB patient during the
flight?
Forty-four passengers may have been exposed to MDR TB during
American Airlines flight #293 from New Delhi, India to Chicago,
Illinois.
What is the risk of acquiring TB on an airplane?
The risk of acquiring any type of TB depends on several factors,
such as extent of disease in the patient with TB, duration of
exposure, and ventilation. Most important, there must be someone
with infectious TB disease on the same flight to present any risk.
If I was on the same flight with the MDR TB patient, can I give
TB to others?
Only a person with active TB disease can transmit TB germs to
others. If you have been around someone with TB disease (or MDR TB
disease), you can get TB infection. However, not everyone infected
with TB germs becomes sick. As a result, two TB-related conditions
exist: latent TB infection and
active TB
disease.
A person with latent TB infection cannot spread germs to other
people, but can develop active TB disease in the future. People with
medical conditions or on medications that suppress the immune system
are at higher risk to become ill with active TB disease.
What should I do if I was seated in the affected rows on
American Airlines flight 293?
If you were a passenger on the flight in question and seated in
the rows specified, please contact your
state TB control
office, your health care provider, or CDC at 800-CDC-INFO (800-232-4636).
You should be evaluated for signs and symptoms of TB disease, and
get a TB skin test or the QuantiFERON®TB Gold blood test (QFT-G) to
test for TB infection. In some locations, the QFT-G test may not be
available so the TB skin test may be the only option. According to
CDC guidelines, either test is acceptable for testing contacts of
persons with tuberculosis.
It is important to get a TB test as soon as possible. Because it
can take 8 to 10 weeks after infection for your immune system to
react to the TB skin test or QFT-G, you will need to get a second TB
test 8 to 10 weeks after your air flight if your first test is
negative. For an explanation of what a positive test means,
please see the question and answer below.
I was seated in one of the affected rows of the flight. My skin
test (or QFT-G test) is positive. What does this mean?
If your skin test (or QFT-G test) is positive, you will need to
get other tests to determine if you have latent TB infection (LTBI)
or active TB disease.
For someone with a positive skin test (or QFT-G), a chest x-ray
should be obtained to determine if active pulmonary TB may be
present. Acid-fast bacilli (AFB) smears and cultures should be
performed on sputum specimens of all persons who have symptoms of TB
or whose chest x-ray suggests TB.
In addition, your doctor will need to determine whether the
positive test is due to infection from exposure to the MDR TB
patient on the flight, or from another exposure that occurred in the
past.
A number of factors will be used to make this determination.
These factors include risk of previous TB exposure and whether the
positive result occurred with the first skin test (or QFT-G test) or
the second test (done 8-10 weeks after the airline flight with the
MDR TB patient).
Related Fact: An estimated 9.6 to 14.9 million persons
residing in the United States have latent TB infection (LTBI), but
are unaware since there are no signs or symptoms.
If you have never been treated for TB disease or latent TB
infection, your doctor may recommend taking medications to prevent
getting TB disease. Or, your doctor may recommend that you be
followed with medical visits for up to 2 years such that if you
should become sick with TB disease, it can be detected quickly.
The decision to provide preventive treatment or to provide
follow-up exams for 2 years will in part depend on whether your
doctor believes your infection resulted from exposure to the MDR TB
patient or from a previous exposure to TB. This is because
preventive treatment given to persons infected by someone with
regular TB disease (not drug resistant) is proven to be effective
and is generally well tolerated, but preventive treatment for MDR TB
may have more side effects and has not been proven to be effective.
What Is Latent TB Infection?
In most people who breathe in TB bacteria and become infected,
the body is able to fight the bacteria to stop them from growing.
The bacteria become inactive, but they remain alive in the body.
This is called latent TB infection.
Persons with latent TB infection do not feel sick and do not have
any symptoms, but usually have a positive reaction to the tuberculin
skin test (or QFT-G test). They are infected with M. tuberculosis,
but do not have active TB disease. Persons with latent TB
infection are not infectious and cannot spread TB infection to
others.
However, persons with latent TB infection may develop active TB
disease at some time in the future. Overall, about 5 to 10% of
infected persons will develop active TB disease at some time in
their lives. About half of those people who develop active TB will
do so within the first two years of infection. For persons whose
immune systems are weak, especially those with HIV infection, the
risk of developing active TB is considerably higher than for persons
with normal immune systems. Of special concern are persons infected
by someone with MDR TB who later develop active TB disease; these
persons will have MDR TB, not regular TB disease.
A Person with latent TB Infection (LTBI) |
- Has inactive TB bacteria in his/her body
|
- Does not feel sick and is not infectious
|
- Cannot spread TB bacteria to others
|
- Needs treatment for latent TB infection to prevent
TB disease; however, if exposed and infected by a person
with MDR TB, preventive treatment may not be an option.
|
The Difference Between Latent TB Infection and Active TB Disease
A Person with Latent TB Infection |
A Person with Active TB Disease |
|
- Has symptoms that may include:
- a bad cough that lasts 3 weeks or longer
- pain in the chest
- coughing up blood or sputum
- weakness or fatigue
- weight loss
- no appetite
- chills
- fever
- sweating at night
|
- Cannot spread TB to others
- Usually has a positive skin test or QuantiFERON-TB®
Gold test
- Has a normal
chest x-ray and a negative sputum test
|
|
Where can I get additional information?
- Visit CDC’s TB websites:
- Call CDC:
- 800-CDC-INFO (English and Spanish)
- 800-243-7889 (TTY)
- Read educational booklets:
Last Modified: 04/18/2007
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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