The Center for Disease
Control and Prevention (CDC) is working with a number of international,
state, and local partners on an investigation involving a U.S. citizen
recently diagnosed with extensively drug-resistant tuberculosis (XDR
TB). XDR TB has been recently defined as a subtype of
multidrug-resistant tuberculosis (MDR TB) with additional resistance to
the two most important second-line antibiotics (i.e., a fluoroquinolone
and an injectable agent [amikacin, kanamycin, or capreomycin]) in
addition to the two most important first-line drugs (i.e., isoniazid
and rifampin).
CDC learned that a patient with XDR TB traveled to Europe via commercial
airline (Air France # 385) departing Atlanta on May 12 and arriving in
Paris on May 13, 2007, and returned to the United States after taking a
commercial flight on May 24 from Prague, Czech Republic to Montreal,
Canada (Czech Air # 0104). The patient re-entered the U.S. on May 24 via
automobile. 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
<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 # 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.
Drug-susceptible (regular) TB and XDR TB are thought to be spread the
same way. TB bacilli become aerosolized when a person with TB disease of
the lungs or throat coughs, sneezes, speaks, or sings. These bacilli can
float in the air for several hours, depending on the environment.
Persons who breathe air containing these TB bacilli can become infected.
The risk of acquiring any type of TB appears to depend on several
factors, such as extent of disease in the source patient, duration of
exposure, and ventilation. Transmission has been documented in
association with patients who have lung disease, and bacteria seen or
cultured in sputum. Persons who become infected usually have been
exposed for several hours (or days) in poorly ventilated or crowded
environments. An important way to prevent the spread and transmission is
by limiting an infectious person's contact with other people.
Thus,
people who have a confirmed diagnosis of TB or XDR TB are placed on
treatment and kept isolated until they are no longer infectious.
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:
XDR TB
factsheet
XDR TB
factsheet 2
XDR TB
factsheet 3
TB
Testing factsheet 1
TB Testing
factsheet 2
Infection
Control factsheet 1
Infection
Control factsheet 2
Tuberculosis
and Air Travel
Clinical
Resources:
Targeted
Tuberculin Testing and Treatment of Latent Tuberculosis Infection -
MMWR rr4906
Guidelines
for the Investigation of Contacts of Person with Infectious TB -
MMWR rr5415 2005
Controlling
Tuberculosis in the United States Recommendations from the
American Thoracic Society, CDC, and IDSA - MMWR rr5412 2005
Treatment
of Tuberculosis - MMWR 2003; 52 (No. RR-11)
Multi-Drug
Resistant (MDR) & Extensively Drug Resistant (XDR) TB:
Extensively
Drug-Resistant Tuberculosis - United States, 1993-2006 - MMWR 2007;
56 (No. 11)
Revised
Definition of Extensively Drug-Resistant Tuberculosis - MMWR
November 3, 2006 Vol. 55, No. 43
Information
for patients:
Tuberculosis
Facts - Exposure to TB
Tuberculosis
Facts - The TB Skin Test
Tuberculosis Facts
- TB Exposure
Tuberculosis
Facts - You can prevent TB
Multidrug-Resistant
Tuberculosis (MDR TB)
Extensively
Drug-Resistant Tuberculosis (XDR TB) (2007)
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