Investigation of U.S. traveler with extensively drug resistant tuberculosis (XDR TB)
Source:HAN ; 261
Corporate Authors:Centers for Disease Control and Prevention (U.S.)
Series:HAN ; 261
Description:Tuesday, May 29, 2007, 0:40 EDT (12:40 PM EDT)
The Centers 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 (MDRTB) 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 # 410). The patient reentered 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 followup 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 on board Air France # 385 departing Atlanta on May 12 and arriving in Paris on May 13, and on Czech Air # 410departing 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.
Supporting Files:No Additional Files
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