Tuberculosis and air travel: WHO guidance in the era of drug-resistant TB

ArticleinTravel Medicine and Infectious Disease 6(4):177-81 · August 2008with9 Reads
DOI: 10.1016/j.tmaid.2007.10.004 · Source: PubMed
Abstract
Air travel provides opportunities for infectious diseases to spread rapidly between countries and continents. There may be a potential risk of transmission during the flight, notably with airborne and droplet-borne respiratory infections. Seven episodes of potential transmission of TB infection during air travel reported in 1992--1994 caused widespread concern. Contact investigations revealed evidence of transmission of infection in two instances but active TB disease was not found in any of the infected individuals, or in subsequently published cases. In recent years, multidrug-resistant TB (MDR-TB) has become an increasingly important public health problem in many countries, exacerbated by the emergence of extensively drug-resistant TB (XDR-TB). The potential risk of transmission of particularly dangerous forms of TB requires renewed vigilance. The revised International Health Regulations (1995) include new provisions which are relevant to the transmission of TB on aircraft. WHO published a second edition of Tuberculosis and air travel: guidelines for prevention and control in 2006, providing updated information and specific guidance for passengers and crew, physicians, public health authorities and airline companies. Following several recent incidents involving MDR-TB and XDR-TB in airline passengers, the 2006 recommendations will be amplified in the light of experience gained and the evolving epidemiological situation.
    • "En siete estudios hechos por los CDC sólo en dos casos confirmaron el contagio en cabina, los demás generaron muy alta sospecha del hecho (20) . El riesgo de contagio, aunque no se ha podido determinar, es bajo aun en vuelos que involucran países endémicos, y es el mismo o menor que en cualquier otro lugar confinado (19,39) . Sin embargo, es crucial diagnosticar y hacerle seguimiento a los posibles viajeros contagiados y tipificar la bacteria para determinar su resistencia antibiótica (20,39) . "
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    • "MDR-TB can be defined as TB resistant to initial TB therapy (isoniazid and rifampicin) whilst XDR-TB can be defined as being resistant to isoniazid, rifampicin, to any of the fluoroquinolones and to at least one injectable drug such as capreomycin, kanamycin, or amikacin. This problem can be seen to extend to developed countries as resistant strains can easily spread from region to region through a host of travel mediums such as commercialised flights, trade routes through both sea and air transport agents and even travel holidays (WHO, 2004WHO, , 2006 Martinez et al., 2007). "
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