Contact investigation after a fatal case of extensively drug-resistant tuberculosis (XDR-TB) in an aircraft, Germany, July 2013

Abstract

In July 2013, a passenger died of infectious extensively drug-resistant tuberculosis (XDR-TB) on board of an aircraft after a 3-hour flight from Turkey to Germany. Initial information indicated the patient had moved about the aircraft coughing blood. We thus aimed to contact and inform all persons exposed within the aircraft and to test them for newly acquired TB infection. Two-stage testing within 8 weeks from exposure and at least 8 weeks after exposure was suggested, using either interferon gamma release assays (IGRAs) or tuberculin skin test (TST). The TST cut-off was defined at a diameter > 10 mm; for differentiation between conversion and boosting, conversion was defined as increase of skin induration > 5 mm. Overall, 155 passengers and seven crew members were included in the investigation: the questionnaire response rate was 83%; 112 (69%) persons were tested at least once for TB infection. In one passenger, who sat next to the area where the patient died, a test conversion was registered. As of March 2017, no secondary active TB cases have been reported. We describe an unusual situation in which we applied contact tracing beyond existing European guidelines; we found one latent tuberculosis infection in a passenger, which we consider probably newly acquired.

Potential transmission of SARS-CoV-2 on a flight from Singapore to Hangzhou, China: An epidemiological investigation

“…Although infrequently reported and difficult to assess accurately, respiratory agents may be easily transmitted to passengers during air travel owing to limited ventilation, high occupant density and a long exposure time [9,10]. Multiple outbreaks of respiratory diseases, such as severe acute respiratory syndrome (SARS), measles, tuberculosis, and influenza, associated with air travel have been reported [11][12][13][14]. Recent studies suggest that SARS-CoV-2 may be more transmissible than severe acute respiratory syndrome (SARS) coronavirus and Middle East respiratory syndrome (MERS) coronavirus [15].…”

Does 2×2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence

“…Figure 1: PRISMA 2009 Flow Diagram [18] Respiratory pathogens included in our review included SARS-CoV (n=5) [19][20][21][22][23], MERS virus (n=12) [24][25][26][27][28][29][30][31][32][33][34][35], Mycobacterium tuberculosis (n=20) [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55], measles virus (n=27) , mumps virus (n=2) [83,84], rubella virus (n=1) [85], Corynebacterium diphtheriae (n=1) [55], H1N1 influenza A virus (n=10)[10, [86][87][88][89][90][91][92]…”

Ending tuberculosis in risk groups in Europe: challenges from travel and population movement

“…For example, the yield of active TB among migrants from high- to low-burden countries ranged from 7 to 10,186 per 100,000 people screened, depending on various factors including the TB prevalence in the country of origin [ 2 ]. In this World TB Day issue of Eurosurveillance , four papers describe the risks of TB infection and disease in two potentially high-risk groups: migrants [ 4 , 5 ] and airline passengers [ 6 , 7 ].…”

“…While the World Health Organization (WHO) and European Centre for Disease Prevention and Control (ECDC) recommend contact investigations among passengers seated within two rows of an infectious case on flights lasting 8 hours or longer [ 11 , 12 ], both organisations and others [ 13 ] acknowledge that there is only limited evidence to quantify the risk of transmission on aircraft. Two papers in this issue discuss screening of airline contacts for latent TB infection (LTBI): one is an intensive contact investigation following a fatal case of extensively drug-resistant (XDR)-TB [ 7 ], while the other reports the overall yield based on multiple investigations conducted in Japan [ 6 ]. Both report very low yields.…”

“…However, even in the absence of solid evidence of the benefit of screening air passenger contacts of active TB, and especially in situations which appear to pose a particularly high-risk, a precautionary approach may be adopted. This was part of the rationale for investigating the apparently dramatic XDR-TB incident despite a relatively short flight duration [ 7 ].…”