Corrected: Investigation of U.S. Traveler with Extensively Drug Resistant Tuberculosis (XDR TB)
This message is being sent to correct the flight number of
the Czech Air flight on May 24, 2007 from Prague, Czech Republic to Montreal, Canada. The flight number was 0104 not 410.
Original information from CDC
Advisory #00261, transmitted May 29, 2007:
The Centers for Disease Control and Prevention (CDC) is
working with a number of international, state, and local partners on an
investigation involving a U.S. citizen recently diagnosed with extensively
drug-resistant tuberculosis (XDR TB). XDR TB has been recently defined as a
subtype of multidrug-resistant tuberculosis (MDR TB) with additional resistance
to the two most important second-line antibiotics (i.e., a fluoroquinolone and
an injectable agent [amikacin, kanamycin, or capreomycin]) in addition to the
two most important first-line drugs (i.e., isoniazid and rifampin).
CDC learned that a patient with XDR TB traveled to Europe
via commercial airline (Air France # 385) departing Atlanta on May 12 and
arriving in Paris on May 13, 2007, and returned to the United States after
taking a commercial flight on May 24 from Prague, Czech Republic to Montreal,
Canada (Czech Air # 410). The patient re-entered the U.S. on May 24 via
automobile. Since May 25, the patient has been hospitalized in respiratory
isolation and is undergoing additional medical evaluation.
CDC is collaborating with U.S. state and local health
departments, international Ministries of Health, the airline industry, and
the World Health Organization (WHO) regarding appropriate notification and
follow up of passengers and crew potentially at risk for exposure to XDR TB.
Each country involved in the investigation is determining the most appropriate
guidance for its residents. The following recommendations have been developed
for U.S. residents who may have been exposed to this patient.
This patient has radiographic evidence of pulmonary TB, is
culture-positive for XDR TB, but is sputum smear negative for acid fast bacilli
and is relatively asymptomatic. On the basis of the patient’s clinical and
laboratory status, and lack of receiving adequate treatment for XDR TB, this
patient was considered potentially infectious at the time of his airline
travel, and meets the criteria in the WHO guidelines for initiating an airline
contact investigation. http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.363_eng.pdf
In accordance with the WHO TB and Airline Travel Guidelines, to ensure
appropriate follow-up and care for persons who may have been exposed to XDR TB,
CDC is recommending the following for passengers and crew onboard Air France #
385 departing Atlanta on May 12 and arriving in Paris on May 13, and on Czech
Air # 410 departing from Prague and arriving in Montreal on May 24: passengers
seated in the same row as the index patient and those seated in the two rows
ahead and the two rows behind, as well as the cabin crew members working in the
same cabin should be evaluated for TB infection. This includes initial
evaluation and testing with follow up 8-10 weeks later for re-evaluation.
As there has never been an airline contact investigation for XDR TB, it
is not known if the current recommendations are adequate to determine the
possible range and risk of transmission of infection. Because of the serious
consequences of XDR TB and anticipated public concern, in addition to the
contacts listed above, all U.S. residents and citizens on these
flights should be notified and encouraged to seek TB testing and evaluation.
Drug-susceptible (regular) TB and XDR TB are thought to be
spread the same way. TB bacilli become aerosolized when a person with TB
disease of the lungs or throat coughs, sneezes, speaks, or sings. These bacilli
can float in the air for several hours, depending on the environment. Persons
who breathe air containing these TB bacilli can become infected.
The risk of acquiring any type of TB appears
to depend on several factors, such as extent of disease in the source
patient, duration of exposure, and ventilation. Transmission has been
documented in association with patients who have lung disease, and
bacteria seen or cultured in sputum. Persons who become infected usually have
been exposed for several hours (or days) in poorly ventilated or crowded
environments. An important way to prevent the spread and transmission is by
limiting an infectious person’s contact with other people. Thus,
people who have a confirmed diagnosis of TB or XDR TB are
placed on treatment and kept isolated until they are no
longer infectious.
Persons who believe they may have been exposed to TB or XDR
TB can call 1-800 CDC INFO for further information.
Where to go for information about:
Tuberculosis: http://www.cdc.gov/tb/default.htm
XDR TB: http://www.cdc.gov/tb/pubs/tbfactsheets/xdrtb.htm
http://www.cdc.gov/tb/pubs/tbfactsheets/xdrtb.htm
and http://www.cdc.gov/tb/pubs/tbfactsheets/cdcandxdrtb.htm
http://www.cdc.gov/tb/pubs/tbfactsheets/cdcandxdrtb.htm
TB Testing: http://www.cdc.gov/tb/pubs/tbfactsheets/skintesting.htm
http://www.cdc.gov/tb/pubs/tbfactsheets/skintesting.htm
and http://www.cdc.gov/tb/pubs/tbfactsheets/QFT.htm
http://www.cdc.gov/tb/pubs/tbfactsheets/QFT.htm
Infection control: http://www.cdc.gov/tb/pubs/tbfactsheets/ichcs.htm
http://www.cdc.gov/tb/pubs/tbfactsheets/ichcs.htm
and http://www.cdc.gov/tb/pubs/tbfactsheets/rphcs.htm
http://www.cdc.gov/tb/pubs/tbfactsheets/rphcs.htm
Tuberculosis and Air Travel:
http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.363_eng.pdf