- A simple check at the PubMed website using the key words
"tuberculosis and airplane" (and "tuberculosis and submarine")
- indicates that transmission of TB on airplanes is nothing
new. The CDC has known of the danger for a decade or more and, despite
this, public health officials did nothing definitive to prevent TB patients
from flying. Why should this 31-year-old lawyer bridegroom take all the
heat and media "hysteria", when the real blame belongs to health
officials.
-
- Below are reports (including one from the CDC in 1996)
in the medical literature clearly warning of the consequences of air
travel (and unavoidable submarine duty) when TB patients are aboard.
-
- Best regards,
- ALAN CANTWELL MD
-
- 1: N Engl J Med. 1996 Apr 11;334(15):933-8.? Links
- Comment in:
- N Engl J Med. 1996 Apr 11;334(15):981-2.
- N Engl J Med. 1996 Aug 29;335(9):675; author reply 675-6.
-
- Transmission of multidrug-resistant Mycobacterium tuberculosis
during a long airplane flight.
- Kenyon TA,
- Valway SE,
- Ihle WW,
- Onorato IM,
- Castro KG.
-
- Epidemiology Program Office, National Center for HIV,
STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta,
GA 30333, USA.
- BACKGROUND. In April 1994, a passenger with infectious
multi-drug resistant tuberculosis traveled on commercial-airline flights
from Honolulu to Chicago and from Chicago to Baltimore and returned one
month later. We sought to determine whether she had infected any of her
contacts on this extensive trip. METHODS. Passengers and crew were identified
from airline records and were notified of their exposure, asked to complete
a questionnaire, and screened by tuberculin skin tests. RESULTS. Of the
925 people on the airplanes, 802 (86.7 percent) responded. All 11 contacts
with positive tuberculin skin tests who were on the April flights and
2 of 3 contacts with positive tests who were on the Baltimore-to-Chicago
flight in May had other risk factors for tuberculosis. More contacts
on the final, 8.75-hour flight from Chicago to Honolulu had positive skin
tests than those on the other three flights (6 percent, as compared with
2.3, 3.8, and 2.8 percent). Of 15 contacts with positive tests on the
May flight from Chicago to Honolulu, 6 (4 with skin-test conversion) had
no other risk factors; all 6 had sat in the same section of the plane
as the index patient (P=0.001). Passengers seated within two rows of the
index patient were more likely to have positive tuberculin skin tests
than those in the rest of the section (4 of 13, or 30.8 percent, vs. 2
of 55, or 3.6 percent; rate ratio, 8.5; 95 percent confidence interval,
1.7 to 41.3; P=0.01). CONCLUSIONS. The transmission of Mycobacterium tuberculosis
that we describe aboard a commercial aircraft involved a highly infectious
passenger, a long flight, and close proximity of contacts to the index
patient.
-
- PMID: 8596593 [PubMed - indexed for MEDLINE]
-
- 1: Am J Infect Control. 2000 Jun;28(3):233-8.? Links
-
- Two-step tuberculin testing of passengers and crew on
a commercial airplane.
- Wang PD.
- Department of Internal Medicine and Deputy Superintendent,
Taipei Municipal Chronic Disease Hospital, Taiwan.
- OBJECTIVES: We investigated the risk of tuberculosis
transmission from a person with highly infectious pulmonary tuberculosis
to fellow passengers and crew members on a 14-hour commercial flight.
The 2-step tuberculin testing was used to minimize the effects of the
booster phenomenon. METHODS: Passengers and flight crew members identified
from airline records were contacted by letter, telephone, or both to notify
them of their potential exposure to Mycobacterium tuberculosis. The subjects
were advised to undergo Mantoux tuberculin skin testing within the required
time period to assess a conversion. In addition, information regarding
tuberculosis history and other sources of potential exposure was solicited
by means of a questionnaire. RESULTS: Of the 277 passengers and crew members
on the aircraft, 225 (81.2%) responded. Of these, 173 (76.9%) had positive
tuberculin results on the first test (induration > 10 mm). Thirteen
subjects with negative results refused further testing; 11 (28%) of the
remaining 39 exhibited the booster phenomenon on the second test. Subjects
who exhibited the booster phenomenon were significantly more likely to
have received previous BCG vaccination. Nine contacts with negative results
on the initial test had positive results on a third test administered
at 12 weeks after the flight exposure Of these, 6 contacts had previous
BCG vaccination, old tuberculosis, or a family member with tuberculosis;
the remaining 3 reported on other risk factors for positive reactions.
None of these 3 contacts had sat in the same section of the plan as the
index patient. CONCLUSIONS: The 2-step tuberculin testing procedure is
an effective tool for minimization of the booster effect, thus allowing
accurate monitoring of subsequent tuberculin conversion rates. Moreover,
the clustering of tuberculin skin test conversions among passengers in
this study demonstrates the possible risk of M tuberculosis transmission
during air travel.
-
- PMID: 10840343 [PubMed - indexed for MEDLINE]
-
-
-
- 1: Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Jan;35(1):61-6.
Links
-
- [Tuberculosis in the crew of a submarine]
- [Article in Japanese]
- Suzuki S,
- Nakabayashi K,
- Ohkouchi H,
- Hatada J,
- Kawaguchi S,
- Sakai M,
- Sasaki N,
- Ito A.
-
- Maritime Self-Defense Force Undersea Medical Center,
Yokosuka, Japan.
- We report the apparent spread of mycobacterial tuberculosis
among a submarine crew from a crew member with a low grade of infectivity.
The air-conditioning system of submarines requires completely closed
recirculation of ambient air. If a person with pulmonary tuberculosis
were in a submarine, one would expect to find a high incidence of tuberculosis
among others on the ship. The index patient was a 35-year-old member of
a submarine crew. An abnormal shadow was found on a chest roentgenogram
during an annual medical checkup, and he was hospitalized for examination.
Acid-fast bacilli were found in his gastric secretions, but he did not
complain of coughing and no tuberculosis bacilli were found in his sputum.
All members of the submarine crew were examined, and some who were on
board with the index patient reacted strongly. Because those who were
also suspected to be infected were usually not close to the index patient's
living quarters and had little contact with the patient in the submarine,
we strongly suspect that the closed ventilation system contributed to
the spread of the infection. Control of tuberculosis in a sealed environment
requires detailed investigation of the environment and completion of
chemoprophylaxis. Adequate ventilation and ultraviolet radiation are more
effective than decontamination with disinfectants for the control of infectious
droplet nuclei. Ships should be equipped with those systems.
-
- PMID: 9071158 [PubMed - indexed for MEDLINE]
-
- ALAN CANTWELL MD
- http://www.ariesrisingpress.com
- FOUR WOMEN AGAINST CANCER:
- Bacteria, Cancer and the Origin of Life
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