Background In April 1994, a passenger with infectious multidrug-resistanttuberculosis traveled on commercial-airline flights from Honoluluto Chicago and from Chicago to Baltimore and returned one monthlater. We sought to determine whether she had infected any ofher contacts on this extensive trip.
Methods Passengers and crew were identified from airline recordsand were notified of their exposure, asked to complete a questionnaire,and screened by tuberculin skin tests.
Results Of the 925 people on the airplanes, 802 (86.7 percent)responded. All 11 contacts with positive tuberculin skin testswho were on the April flights and 2 of 3 contacts with positivetests who were on the Baltimore-to-Chicago flight in May hadother risk factors for tuberculosis. More contacts on the final,8.75-hour flight from Chicago to Honolulu had positive skintests than those on the other three flights (6 percent, as comparedwith 2.3, 3.8, and 2.8 percent). Of 15 contacts with positivetests on the May flight from Chicago to Honolulu, 6 (4 withskin-test conversions) had no other risk factors; all 6 hadsat in the same section of the plane as the index patient (P= 0.001). Passengers seated within two rows of the index patientwere more likely to have positive tuberculin skin tests thanthose in the rest of the section (4 of 13, or 30.8 percent,vs. 2 of 55, or 3.6 percent; rate ratio, 8.5; 95 percent confidenceinterval, 1.7 to 41.3; P = 0.01).
Conclusions The transmission of Mycobacterium tuberculosis thatwe describe aboard a commercial aircraft involved a highly infectiouspassenger, a long flight, and close proximity of contacts tothe index patient.
Source Information
From the Epidemic Intelligence Service, Epidemiology Program Office (T.A.K.), and the Division of Tuberculosis Elimination (T.A.K., S.E.V., W.W.I., I.M.O., K.G.C.), National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta.
Address reprint requests to Dr. Kenyon at 1600 Clifton Rd., Mailstop E-10, Atlanta, GA 30333.
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