Surveillance of air-travel-related tuberculosis incidents, England and Wales: 2007-2008

The potential spread of tuberculosis (TB) from infectious passengers during air travel has recently received increasing attention in the media and from public health authorities. We reviewed all air travel-related tuberculosis incidents reported to the Health Protection Agency Centre for Infections between January 2007 and February 2008 in England and Wales and investigated the effectiveness of contact investigation. Incidents involving air travel were defined according to the World Health Organization's guidelines on TB and Air Travel. We collected data on the index case, the incident and the outcome of contact investigation where available. We identified 24 incidents involving 39 flights. The median flight duration was 8.9 hours (inter-quartile range (IQR) 8 to 11.7). Most flights (36) were from or to a high burden country and 19 of the 24 incidents reported had a smear-positive index case. Two index cases had multidrug-resistant tuberculosis. In 17 incidents, no further investigation could be undertaken due to the lack of passenger information. In the remaining seven incidents, the quality of contact information obtained was variable. No further cases of TB infection or disease were identified. This study suggests that the process of investigating passenger contacts of a TB infected individual travelling by air is complicated and usually unsuccessful without dedicated resources and availability of high-quality contact information from airlines. Further research into the effectiveness of contact investigation in this setting is needed.