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Letter
Antibiotics and Airline Emergency
Medical Kits
Benjamin Bar-Oz* and Bernadette Loughran*
*Hadassah Medical Center, Jerusalem, Israel
Suggested citation for this article: Bar-Oz B,
Loughran B. Antibiotics and airline emergency medical kits. Emerg Infect
Dis [serial online] 2003 Jun [date cited]. Available from: URL:
http://www.cdc.gov/ncidod/EID/vol9no6/03-0097.htm
To the Editor: Medical events during airline flights have drawn
some attention in recently published articles and letters (1-4).
We would like to share our experience of meningococcemia and meningococcal
meningitis during a transatlantic flight.
In June 2000, a 20-year-old student with a mild viral illness (diagnosed
before the flight) boarded a flight from Tel-Aviv, Israel, to Newark,
New-Jersey, USA (approximate flight time, 11–12 hours), with a tour group
of college-age students and their chaperones. We, a neonatologist and
a neonatal intensive care nurse, were on the same flight to later transport
a prematurely born infant from the United States back to Israel.
About 90 minutes before landing in New Jersey, the chief flight attendant
asked me (B.B-O.) to check the passenger, who said he did not feel well.
His medical history indicated no past illness, which was corroborated
by the director of the tour group. The patient reported general malaise
and numbness in his feet. In the 2 weeks before the flight, he had traveled
in Israel, visiting cities, caves, and mountains. He and his group had
slept in different hostels in those areas.
On examination, he was fully conscious, and his blood pressure and pulse
rate were normal. He had a blue-purple skin rash, particularly on the
upper extremities. The rash worsened in the course of 20 minutes and resembled
the “blueberry muffin–like” rash described in other pathologic conditions.
Considering a diagnosis of either tick-borne or meningococcal disease,
I decided to give the patient the first dose of antibiotics after obtaining
a verbal consent from him and from the head of the group. I also asked
the crew to have an ambulance and a physician waiting for us at the destination
airport.
When we checked the emergency medical kit, we found that it did not contain
any antibiotics. For our transport mission, we had two ampules of cefotaxime,
2 g each, one of which we gave the patient. After we landed, an ambulance
crew (which did not include a physician) took the patient to the nearest
hospital. The patient died 2 hours later in the hospital emergency department.
His laboratory tests showed meningococcal meningitis and meningococcemia.
The Centers for Disease Control (CDC), the airline company, and Israel’s
Ministry of Health notified all close contacts of the patient in Israel
and during the transatlantic flight, including everyone in the tour group,
and recommended that they be given chemoprophylaxis.
CDC has received 21 reports about air travel–associated meningococcal
disease in 2 years; in 5 reports, the symptoms began before the plane
arrived at its destination (5). However, advance notice
of the symptoms was given only in our case. Although one case is not enough
to substantiate recommendations, we believe that the appropriate authorities
should require airline companies to add a broad-spectrum antibiotic preparation
to the emergency kit. This drug should be used only when aircraft diversion
is not possible and when the diagnosis is clinically identified or highly
suspected.
We still wonder whether an earlier intervention and treatment with a
more appropriate on-board antibiotic would have saved this young man.
References
- Gendreau MA, DeJohn C. Responding
to medical events during commercial airline flights. N Engl J Med
2002;346:1067–73.
- Baevsky R. Medical
events during airline flights. N Engl J Med 2002;347:535.
- Ross SC. Medical
events during airline flights. N Engl J Med 2002;347:535.
- Roth WT. Medical
events during airline flights. N Engl J Med 2002;347:535.
- Centers for Disease Control and Prevention. Exposure to patients with
meningococcal disease on aircrafts—United States, 1999–2001. MMWR Morb
Mortal Wkly Rep 2001;50:485–9.
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