Tuesday, May 29, 2007

CDC ALERT: XDR-TB Patient on Air France Plane

Update #1: CDC now reports the Czech Air flight number was 0104, not 410.
Update #2: Here's a list of all flights taken by the U.S. traveler, now known to be Andrew Speaker, who is infected with XDR-TB.

Did you fly from Atlanta to Paris on May 12? How about from Prague to Montreal on May 24? If so, you may well have been exposed to a fellow passenger with extensively drug-resistant tuberculosis.

The U.S. Centers for Disease Control is reporting that the infected traveller flew on Air France Fl 385 from Atlanta to Paris on May 12 and then back to North America on May 24 on Czech Air Fl. 410 [acually Fl. 0140] from Prague to Montreal, returning to the U.S. by car.

Travellers and crew on both flights are potentially at risk for developing the extremely dangerous-but-still-treatable form of TB.

Here are the salient parts of the CDC alert:

(From the CDC) Since May 25, the patient has been hospitalized in respiratory isolation and is undergoing additional medical evaluation.

CDC is collaborating with U.S. state and local health departments, international Ministries of Health,the airline industry, and the World Health Organization (WHO) regarding appropriate notification and follow up of passengers and crew potentially at risk for exposure to XDR TB. Each country involved in the investigation is determining the most appropriate guidance for its residents.

The following recommendations have been developed for U.S. residents who may have been exposed to this patient.

This patient has radiographic evidence of pulmonary TB, is culture-positive for XDR TB, but is sputum smear negative for acid fast bacilli and is relatively asymptomatic. On the basis of the patient's clinical and laboratory status, and lack of receiving adequate treatment for XDR TB, this patient was considered potentially infectious at the time of his airline travel, and meets the criteria in the WHO guidelines for initiating an airline contact investigation. http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.363_eng.pdf

In accordance with the WHO TB and Airline Travel Guidelines, to ensure appropriate follow-up and care for persons who may have been exposed to XDR TB, CDC is recommending the following for passengers and crew onboard Air France # 385 departing Atlanta on May 12 and arriving in Paris on May 13, and on Czech Air # 410 [actually Fl. # 0104] departing from Prague and arriving in Montreal on May 24: passengers seated in the same row as the index patient and those seated in the two rows ahead and the two rows behind, as well as the cabin crew members working in the same cabin should be evaluated for TB infection.

This includes initial evaluation and testing with follow up 8-10 weeks later for re-evaluation.

As there has never been an airline contact investigation for XDR TB, it is not known if the current recommendations are adequate to determine the possible range and risk of transmission of infection.

Because of the serious consequences of XDR TB and anticipated public concern, in addition to the contacts listed above, all U.S. residents and citizens on these flights should be notified and encouraged to seek TB testing and evaluation.

Persons who believe they may have been exposed to TB or XDR TB can call 1-800 CDC INFO for further information.

Where to go for information about:
Tuberculosis: http://www.cdc.gov/tb/default.htm

XDR TB: http://www.cdc.gov/tb/pubs/tbfactsheets/xdrtb.htm

TB Testing: http://www.cdc.gov/tb/pubs/tbfactsheets/skintesting.htm and http://www.cdc.gov/tb/pubs/tbfactsheets/QFT.htm

Infection control: http://www.cdc.gov/tb/pubs/tbfactsheets/ichcs.htm and http://www.cdc.gov/tb/pubs/tbfactsheets/rphcs.htm

Tuberculosis and Air Travel:


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