Tuberculosis :: CDC updates on XDR TB public health investigation

The Centers for Disease Control and Prevention (CDC) provides the following update regarding its investigation and public health actions related to a patient with extensively drug-resistant tuberculosis (XDR TB).

CDC is recommending that passengers and crew on two trans-Atlantic flights taken by the patient be notified of potential exposure to tuberculosis and evaluated for TB.

On May 12, the patient flew from Atlanta to Paris on Air France flight #385/Delta Airlines flight #8517.

On May 24, the patient flew from Prague, Czech Republic, to Montreal, Canada, on Czech Air flight #0104. There were 276 U.S. residents or citizens on the Air France/Delta flight and two on the Czech Air Flight (the patient and his wife).

CDC communicated with most of the U.S. passengers who were on the patient’s flights. As of today, CDC officials have directly contacted 255 of the 274 U.S. passengers (93%) on the May 12 Air France/Delta flight from Atlanta to Paris.

As a reminder, CDC is recommending that passengers on the affected flights receive evaluation for signs and symptoms of TB, and a TB skin test or blood test for TB infection as soon as possible, and another TB test eight to 10 weeks after the flight. The first test will help determine whether passengers had pre-existing TB infection prior to the flight in question. The second test will help assess whether passengers may have become infected with TB while on the affected flight. An initial positive TB skin test doesn’t necessarily mean that a person got TB infection on this flight.

An estimated 9.6 to 14.9 million United States residents (or about 3 to 5 percent of the population) have latent TB infection and would test positive on a TB skin test. A positive TB skin test indicates a person has TB germs in their body. When a skin test is positive, a person may need to get a chest x-ray or give a phlegm sample. These extra tests help determine if the person has TB disease or TB infection.

People who have recently come in contact with someone with active TB disease may not initially test positive, as it can take anywhere from 2 to 10 weeks after TB exposure before a person’s immune system reacts to the test. It is therefore extremely important that passengers on the affected flights be retested eight to 10 weeks after the flight if their initial test comes back negative. CDC is asking all passengers to contact their State TB Control Program to ensure appropriate follow up.

Tuberculosis can take two forms: active TB disease and latent TB infection. People with active TB disease are sick and may be infectious to others. Those with latent TB infection are not sick and have no signs and symptoms. People with latent TB infection are not infectious and cannot spread TB infection to others. In latent cases, the body is able to fight the bacteria and stop the bacteria from growing and multiplying. However, people with latent TB infection may develop active TB disease in the future. Overall, about 5 to 10 percent of infected people will develop active TB disease at some time in their lives. For people whose immune systems are weak, especially those with HIV infection, the risk of developing active TB disease is considerably higher than for people with normal immune systems. If a person never develops active TB, it can be difficult to determine the specific strain and source of their TB infection. Determining the strain, for example, requires having a bacteria sample that can be tested. Determining the source of a person’s infection involves identifying a person’s possible exposures to tuberculosis. Sometimes, people may have been exposed to TB from more than one place or person.

For additional information, please call 1- 800-CDC-INFO (1-800-232-4636).

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