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Tuberculosis risk after exposure on airplanes

M A Miller1, S Valway, I M Onorato

  • 1National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

Tubercle and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease
|October 1, 1996
PubMed
Summary

Tuberculosis (TB) transmission risk on aircraft is low, but cannot be excluded. Positive TB tests were linked to BCG vaccination or travel from endemic countries, not proximity to an infected passenger.

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Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Aviation Medicine

Background:

  • Air travel facilitates the global spread of infectious diseases.
  • Assessing the risk of tuberculosis (TB) transmission during air travel is crucial for public health surveillance.

Purpose of the Study:

  • To estimate the risk of TB transmission among passengers and crew on commercial flights.
  • To identify factors associated with TB infection or transmission in an air travel setting.

Main Methods:

  • A contact investigation was performed on passengers and crew from two flights with a known infectious TB case.
  • Tuberculin skin tests (TSTs) were administered immediately post-exposure and during follow-up.
  • Risk factors for positive TST results and conversions were analyzed, including country of birth and BCG vaccination history.

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Main Results:

  • Of 120 contacts, 24% had a positive TST and 4% showed TST conversion.
  • Positive TST results were significantly associated with non-US birth (RR 9.7) and BCG vaccination.
  • No association was found between TST results and seating proximity to the index case for US-born contacts.

Conclusions:

  • Positive TST reactions and conversions may be influenced by BCG vaccination or prior exposure in TB-endemic regions.
  • While TB transmission on aircraft could not be definitively ruled out, especially in two cases with no other identified risk factors, the risk appears low.
  • Contact investigations for air travel should be considered case-by-case, evaluating the infectiousness of the index case and flight specifics.