Travel ‘ban’ on TB patients

The guidelines that were issued last Friday, June 28, have two categories of TB patients; those that might be allowed to travel at some stage and those who may not travel at all. People suffering from other contagious diseases have also not been spared.

“WHO today (June 28 ) issued updated guidelines for the airline industry that will further minimise the risk of tuberculosis (TB) and other infectious diseases being passed from passenger to passenger on board aircraft. The ‘Tuberculosis and Air Travel’ guidelines stipulate that people with infectious TB must postpone long-distance travel, while those with multidrug-resistant tuberculosis (MDR-TB) must postpone any air travel,” said the statement by WHO.

However WHO notes that to date, no case of active TB has been identified as a result of exposure on a commercial aircraft. The quality of the air on board commercial aircraft is high and under normal conditions cabin air is cleaner than the air in most buildings.

WHO says longer distances with journeys exceeding eight hours pose more exposure risks than short distances. It urges that air ventilation should remain operational when planes are delayed.

“Prolonged journeys of more than eight hours in a confined aircraft cabin may involve an increased risk of transmission, but the risk should be similar to that in other circumstances where people are together in other confined spaces. The guidelines also advise that aircraft ventilation systems should continue to operate when the aircraft is delayed on the ground and the doors are closed. If not in operation, ground delays should be kept to less than 30 minutes,” says the statement.

It says the International Air Transport Association (IATA) and its partners, including WHO, are actively looking at ways to improve the accuracy and availability of passenger information.

Airline companies are expected to comply with the International Health Regulations (IHR), which are designed to prevent the international spread of disease while interfering as little as possible with travel and trade.

As an interim measure, a locator card has been developed. If there is a suspected case of a communicable disease of international importance on board, designated passengers would be asked to fill it out. The card records the name, seat number and emergency contact information.

“Increasing global TB incidence and the emergence of drug resistant strains of the disease has raised concerns about the international spread of particularly dangerous strains. We need clear and effective procedures in place to reduce the risk of transmission of infection on board flights, and to ensure the appropriate follow up when necessary,” said WHO’s Director of Stop TB, Dr Mario Raviglione.

The new regulations could compel travellers to undergo medical examinations before being allowed to board to plane.

Some exceptions of the Guidelines

o States Parties may require, for public health purposes, travellers on arrival or on departure to undergo a medical examination to determine whether or not they constitute a public health risk (Article 23 of International Health Regulation (IHR) 2005. This would include a sputum test, when justified.

States Parties shall treat travellers with respect for their dignity, human rights and fundamental freedoms and minimize any discomfort or distress associated with such measures (IHR Article 32).

o Charges for health measures regarding travellers

If a passenger is obviously very ill and with signs and/or symptoms suggesting an infectious disease, a medical consultation may be obtained before boarding. National laws vary significantly in different countries and air crew may be hesitant to deny boarding when privacy concerns may protect the individual passenger and discrimination charges may be an issue. However, many countries have laws or regulations to prevent people known to have infectious TB from boarding commercial aircraft.

Boarding can and should be denied to individuals with an infectious form of TB. When a physician is aware that a person with an infectious form of TB is planning to travel on a commercial carrier, he or she should inform the public health authority, who in turn should inform the airline concerned. To avoid false reports of a malicious nature, airlines should require a written notification from the public health authorities.

WHO says other potentially serious airborne or droplet-spread infections include SARS, measles, avian flu and meningitis.

Below is WHO description of the diseases.

AVIAN INFLUENZA (bird flu) is an acute viral disease of the respiratory tract spread predominantly by large respiratory droplets. Symptoms include rapid onset of fever, headache, myalgia (muscle pain), sore throat, cough and often coryza (nasal mucus). Since December 2003, cases of highly pathogenic avian influenza affecting humans (mostly influenza A, H5N1) have been reported in countries in Asia, Europe and the Middle East. No sustained person-to-person transmission of avian influenza has been identified.

MEASLES is an acute, highly infectious airborne viral disease. The characteristic rash appears on the body between the third and seventh day of symptoms. Measles can be transmitted from 4 days before to 4 days after appearance of the rash. Non-immunized people, especially young children, are at highest risk for measles and its complications, including death.

MENINGOCOCCAL DISEASE (including meningococcal meningitis and septicaemia)

is an acute bacterial disease caused by Neisseria meningitidis transmitted from person to person through droplets, either by inhalation or by direct contact with respiratory secretions (e.g. during mouth-to-mouth resuscitation) or infected blood. Early signs and symptoms are nonspecific and difficult to differentiate from influenza or other common diseases.

SARS is a recently recognized severe acute pneumonia caused by a SARS associated coronavirus; it manifested as a single epidemic affecting 8000 people in 29 countries in 2002-2003, constituting a major international public health emergency. The epidemic originated in southern China, and the virus is considered to have an unconfirmed animal reservoir. The epidemic was spread globally by air travellers and possible cases of in-flight transmission were reported.


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