Abstract
The risk of communicable disease transmission during air travel is of public health concern and has received much attention over the years. We retrospectively reviewed information from nine flights (≥ 8 hours) associated with infectious tuberculosis (TB) cases in Ireland between September 2011 and November 2014 to investigate whether possible transmission had occurred. Twenty-four flights notified in Ireland associated with sputum smear-positive pulmonary TB cases with a history of air travel were reviewed. Nine were suitable for inclusion and analysed. Six cases of infectious TB travelled on nine flights. A total of 232 passengers were identified for contact tracing; 85.3% (n = 198) had sufficient information available for follow-up. In total, 12.1% (n = 24) were reported as screened for TB. The results revealed no active TB cases among passengers and 16.7% (n = 4) were diagnosed with latent TB infection (LTBI) all of whom had other risk factors. Despite the limited sample size, we found no evidence of M. tuberculosis transmission from infectious passengers. This study identified challenges in obtaining complete timely airline manifests, leading to inadequate passenger information for follow-up. Receipt of TB screening results from international colleagues was also problematic. The challenge of interpreting the tuberculin skin test results in determining recent vs earlier infection was encountered.
Highlights
Tuberculosis (TB) remains a significant cause of mortality and morbidity with an estimated 9.6 million new TB cases reported worldwide each year [1]
Flights lasting less than 8 hours as well as flights where the 3-month period had elapsed between the date of the flight and the date of notification to public health authorities were excluded from the analysis
Four of the index cases were diagnosed with pan-sensitive strains of Mycobacteriumtuberculosis and two index cases were diagnosed with M. tuberculosis resistant to isoniazid (Table)
Summary
Tuberculosis (TB) remains a significant cause of mortality and morbidity with an estimated 9.6 million new TB cases reported worldwide each year [1]. Drug resistance is a major challenge with 3.3% of new TB cases and 20% of previously treated cases having multidrug-resistant TB (MDR-TB) globally [1]. Great progress has been made in the control of TB in recent years, it remains a public health concern in most countries in the World Health Organization (WHO) European Region with an estimated 360,000 incident TB cases occurring during 2013 [2]. The absolute number of incident TB cases fell by 20,000 in 2013, corresponding to a 5.6% decline compared with the previous year in Europe [2]. As TB remains a serious global public health issue, many interventions are aimed at preventing and controlling disease transmission nationally and internationally. Contact tracing is one of the key measures in the management and control of TB as early detection of new cases reduces the timeframe during which a person is infectious
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