CDC Investigation of Traveler with Extensively
Drug-Resistant Tuberculosis (XDR TB):
Questions and Answers
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What happened?
CDC is currently investigating a case of
extensively drug resistant tuberculosis (XDR TB). The case involves
a U.S. citizen with potentially infectious XDR TB who traveled to
and from Europe on commercial flights between May 12 and May 24, and
then re-entered the U.S. at the Canada-U.S. border via automobile.
Since May 25, the patient has been hospitalized in airborne
isolation or wearing an appropriate mask, and is now receiving
medical therapy for XDR TB.
What are the dates and flight numbers for this investigation?
- Air France # 385 / Delta # 8517, departing
Atlanta May 12th; arriving in Paris May 13th
- Czech Air # 0104, departing from Prague
and arriving in Montreal May 24th
What is XDR TB?
XDR TB is a rare type of tuberculosis that is resistant to nearly
all drugs used to treat TB disease.
What is CDC doing?
CDC is working with U.S. state and local health departments,
International Ministries of Health, the airline industry, and the
World Health Organization to notify and follow up passengers and
crew who may be at risk for exposure to XDR TB. Each country
involved in the investigation is determining guidance for its own
residents.
Did the patient know he had TB before he got on these flights?
Our understanding from the county health officials, who were
responsible for managing the patient when he initially presented
with TB, is that he was aware of his diagnosis. When he departed, he
may not have been aware of the fact that he had
extensively drug resistant
tuberculosis (XDR TB).
Why did the patient travel?
Normally, when a patient has tuberculosis, he
or she is influenced through a covenant of trust to ensure that they
don't put themselves in situations where they could potentially
expose others. In this case, the patient had compelling personal
reasons for traveling and made the decision to go ahead and meet
those personal responsibilities.
Were public health officials aware that this man was leaving the
country?
The local health officials have been involved
in the care of this patient from the moment that they were aware of
the TB diagnosis and he was being seen in the clinic. Our
understanding, from conversations with the health officials, is that
the issue of travel was discussed. The patient was advised that it
was not appropriate to travel when you have TB. This situation comes
up often when people have TB or other communicable diseases. We have
a high success record using voluntary means of information and
advice. CDC was not aware that the patient had decided to leave the
country.
How did the patient return to the United States and then
Georgia?
On May 12, the patient departed Atlanta on and
arrived in Paris on May 13 on Air France # 385 / Delta # 8517. On
May 24, the patient flew to Canada on Czech Air # 0104 and then
entered the United States by car.
It was not safe for the patient to fly on
commercial aircraft, so government resources were used to bring the
patient from New York back to Georgia in the safest and quickest
possible way. In New York, the patient was put into isolation fairly
soon after his arrival he was later flown to Georgia, his state of
residence, on the CDC aircraft, a step that we were not obligated to
take under our quarantine authorities, but one that we felt was fair
and appropriate given that he is a citizen of Georgia. His family
members are here and his disease does require prolonged treatment.
How many people were on the planes?
The airlines involved in the investigation are
large transcontinental airlines and they are generally full of
passengers. Air France # 385/Delta # 8517 had 433 passengers and 18
crew members. The Czech Air # 0104 had 191 passengers and 9 crew
members.
Who should be tested?
The World Health Organization has guidelines
for follow-up and care of persons who may have been exposed to
someone with TB during air travel. In accordance with these
guidelines, CDC recommends that all U.S. citizens and residents who
were passengers or crew on these flights be evaluated and tested for
TB infection.
The following persons are the highest priority
for evaluation:
- Passengers seated in rows 28-32 on Air
France # 385/Delta # 8517, departing Atlanta May 12th; arriving
in Paris May 13th
- Passengers seated in rows 10-14 on Czech
Air # 0104, departing from Prague and arriving in Montreal May
24th
- Flight crew members working in the same
cabin on each of the flights listed above
Why is CDC not following up with passengers who were on the
shorter flights with the XDR TB patient?
Both CDC and the World Health Organization
(WHO) consider the risk of infection to travelers on flights under
eight hours to be very low. However, if you were a passenger on one
of the flights that were shorter than 8 hours and are concerned,
check with your local public health department or your primary care
physician about being tested for TB.
Can a person who was on the same flight with the XDR TB patient
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 XDR 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.
Am I at risk for exposure if I took the same flight the
following day as the XDR TB patient, or was in the same boarding
area?
Persons who become infected usually have been
exposed for several hours (or days) in poorly ventilated or crowded
environments. Boarding the same plane the next day or being in the
same boarding area would not warrant evaluation. TB is not spread
through countertops, chairs, doorknobs, or other surfaces where a TB
patient has been.
However, if travelers are concerned about
exposure, check with your state or local health department or your
primary care provider about being tested for TB.
Where did the patient become infected with XDR TB?
The source of the patient's TB is still under
investigation. CDC is conducting something called an Epi Aid, which
means our epidemic intelligence service officers are actively
participating and investigating not only opportunities for exposure
to passengers, crew, family members, and others, but also looking
backward to try to determine where the original infection occurred.
That is an ongoing investigation.
Why was a federal order of isolation issued?
After the patient had left the jurisdiction,
the TB organism was identified as extensively drug resistant. A
federal order of isolation under the Public Health Service Act that
gives CDC statutory responsibility for issuing quarantine orders was
executed to protect the public.
This patient was ordered to be in isolation and
is required to stay in isolation until the responsible public health
official deems that he is no longer infectious to others. The
patient currently is in airborne isolation and is undergoing medical
evaluation.
Under what circumstances was the federal isolation order
executed?
After speaking to CDC authorities on May 25,
the patient voluntarily drove himself to the isolation hospital in
New York City to be evaluated. He was given instructions on how to
do that safely without putting public health at risk. He was
admitted and served a provisional quarantine order that held for 72
hours while this assessment was going on. The patient was asked if
he preferred to remain in New York City for his treatment or if he
wanted to come home to Atlanta. He preferred to come home and we
ensured the safe transport for that return to Atlanta on Monday, May
28 via the CDC plane.
He was issued a federal isolation order on
arrival in Atlanta to cover the period of time for us to hand over
the jurisdiction and public health management of this case to the
state and local authorities in Fulton County in the State of Georgia
where he is a resident.
The order is in effect until it is either
rescinded and the responsibility is transferred over to the local
jurisdiction or until determined by the CDC Director that he is no
longer a public health threat.
Has a federal order of isolation been issued at any other time?
Taking a measure such as issuing an order of
isolation is unusual. The last order was issued in 1963.
What was the isolation order that was issued in 1963?
In 1963, the statute was used for quarantine,
not isolation, of someone who had been exposed to smallpox. The
decision was made to err on the side of caution and implement a
federal quarantine requirement for the person until they were
outside of their period of incubation.
Who should I contact for additional information?
- If you were a passenger on the flights in question, please
contact your city TB
control office, state TB control
office, or CDC at
800-CDC-INFO (800-232-4636).
- For general inquiries, contact CDC INFO:
- 800-CDC-INFO (English and Spanish)
- 800-243-7889 (TTY)
- Visit CDC’s TB websites:
- Read educational booklets:
If I was on the same flight with the XDR TB patient, can I give
TB to others?
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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