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Tuberculosis and Air Travel Ibrahim Abubakar, MBBS, PhD, FFPH Consultant Epidemiologist

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Tuberculosis and Air Travel Ibrahim Abubakar, MBBS, PhD, FFPH Consultant Epidemiologist

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    1. Tuberculosis and Air Travel Ibrahim Abubakar, MBBS, PhD, FFPH Consultant Epidemiologist / Section Head Tuberculosis Section Respiratory and Systemic Infections Department Centre for Infections Colindale, London

    2. Talk outline Rationale Evidence base WHO Guidelines NICE HPA Interpretation

    3. Rationale

    4. Evidence No cases of TB disease reported among those known to have been infected with M. tuberculosis during air travel All instances of transmission involved highly infectious (smear positive) cases 2 of whom had MDR disease Overall notification rate of 0.05 per 100 000 long haul passengers (BA)

    5. Evidence

    6. UK incidents

    7. WHO Guidelines

    8. Infectious or potentially infectious • Infectious TB. All cases of respiratory (pulmonary or laryngeal) TB which are sputum smear-positive and culture-positive (if culture is available). • Potentially infectious TB. All cases of respiratory (pulmonary or laryngeal) TB which are sputum smear-negative and culture-positive (susceptible, MDR-TB or XDR-TB). • Non-infectious TB. All cases of respiratory TB which have two consecutive negative sputum-smear and negative culture (if culture is available) results.

    9. WHO guidelines For travellers, Public Health Authorities, Physicians and Airlines Pre and post travel For Travellers • People with infectious or potentially infectious TB should postpone all travel by commercial air transportation of any flight duration until they become non infectious.

    10. Physicians: Pre and Post travel* Pre-travel • Inform all infectious and potentially infectious TB patients that they must not travel by air on any commercial flight of any duration until non infectious* - 2 weeks of adequate treatment and they are sputum smear negative on at least two occasions - 2 consecutive negative sputum-culture results – if MDR or XDR. • Promptly inform the relevant public health authority when if such a TB patient intends to travel against medical advice. • Inform the public health authority of exceptional circumstances Post-travel • Inform the public health authority when an infectious or potentially infectious TB patient has a history of commercial air travel within the previous 3 months.

    11. Public Health Authorities: Pre travel* • Inform the concerned airline of infectious and potentially infectious passengers travelling against medical advice and request that boarding be denied. • If patient has exceptional circumstances, ensure that the airline(s) and all involved authorities have agreed the procedures for travel.

    12. Public Health Authorities: Post Travel* • Undertake risk assessment • Inform all countries involved (departure and landing). • Coordination between countries necessary. • Share passenger information. • Inform the National IHR Focal Point. • Collaborate on research concerning TB and air travel.

    13. Assessing whether contact tracing is needed*

    14. Aircraft air flow*

    15. Airline companies* Pre-travel • Deny boarding to infectious or potentially infectious TB when requested. • Ensure ventilation is on after 30 minutes ground delay. • Requirements and standards for filtration systems. • Training for cabin crews. • Adequate emergency supplies on board Post-travel • Airline companies should provide all available contact information, in accordance with applicable legal requirements including the IHR.

    16. NICE

    17. ……………. Public health authorities may refine criteria on infectiousness according to national guidelines Public health authorities may follow national policies and guidelines regarding TB contact investigation involving potentially exposed travellers in their jurisdiction, in accordance with requirements under the IHR

    18. HPA Interpretation: Pre travel Discourage all passengers with infectious or potential infectious TB from travel and inform local HPU Where there are exceptional personal circumstance discuss with HPU

    19. HPA Interpretation: Post travel

    20. HPA Interpretation: During Flight Passengers and crew should be reassured Airline should be encouraged to keep contact details to support subsequent public health action

    21. HPA Interpretation Draft agreed To be published by the National Knowledge Service for TB after further review

    22. Thank you ……………………and now I am off to take my 8 hour train to London

    23. * References

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