Flying with drug-resistant tuberculosis… not that there’s anything wrong with that

When you return with a burning sore throat from a grueling, sleepless 15-hour cross-country trip, which involved a series of cramped flights on discount airlines, the last thing you want to read is an interview with an author which notes the prevalence of people flying with drug-resistant tuberculosis. The following quote is from sci-fi author Seanan McGuire, whose most recent book, written under the pen name Mira Grant, is a political thriller set in post-zombie America.

McGuire: No one respects quarantine anymore! Nobody comprehends quarantine, and absolutely nobody comprehends the fact that sometimes your “rights” and “liberties” do not have any place in this conversation. We have totally drug-resistant tuberculosis! And what do people with totally drug-resistant tuberculosis do? Do they lock themselves in their houses for the rest of their lives? Do they eat a bullet? No! They get on airplanes. And then they get pissed off when the CDC yells at them. Quarantine exists so that we can continue as a species to exist. And yes, it sucks if I say to you, “Dude, really sorry, had to shoot your wife. Had the totally drug-resistant tuberculosis, yo.” But you know what sucks more? Killing an elementary school because you went outside with your totally drug-resistant tuberculosis…

Does anyone in the audience happen to know if this is true? Are there really no formal restrictions on flying with drug-resistent TB? Could that be possible? I mean, if we can put people on a no-fly list because they once called a distant relative in Egypt who donated to a Muslim charity that provided bandages to a suspected terrorist organization, can’t we put on people who are known to have deadly, highly-contageous diseases with no known cure? Personally, given how air is recirculated on flights, I’d rather take my chances with the would-be terrorist.

Oh, and while we’re on the subject of TB, I should mention that the Arbor Opera Theater’s recent production of Giacomo Puccini’s La bohème was quite good. I took Clementine, and we had a great time… or, at least as good of a time as one can have watching a woman die from consumption.

[note: I found this interview with Seanan McGuire though a post at Metafilter.]

This entry was posted in Civil Liberties, Health, Mark's Life, Uncategorized and tagged , , , , , , , , , , , , , , . Bookmark the permalink. Post a comment or leave a trackback: Trackback URL.

24 Comments

  1. Posted June 27, 2012 at 9:24 pm | Permalink

    The summary from the World Health Organization’s 2006 report entitled TUBERCULOSIS AND AIR TRAVEL:

    International travel has become increasingly easy and readily available. Ever greater numbers of people are using international air travel for many reasons including business, tourism, immigration, asylum seek-ing or humanitarian activities. There is a potential risk of transmission of tuberculosis (TB) and some other airborne or droplet-spread diseases on board commercial aircraft, particularly during long flights. Infections and in some instances outbreaks following exposure during a flight have been documented. Potential exposure to serious infectious diseases on commercial aircraft is of concern for passengers, crew and public health officials.

    Reported episodes of potential transmission of TB infection during air travel in 1992–1994, and more recently the outbreak of severe acute respiratory syndrome (SARS) in 2003, raised considerable anxiety among travellers, health authorities, airline companies and the mass media. On these occasions, medical authorities, airline representatives and mem- bers of the public sought guidance from WHO and other national and international agencies. There is evidence that transmission of Mycobacterium tuberculosis infection may occur during long flights from an infectious source (a passenger or crew with infectious pulmonary or laryngeal TB) to other passengers or crew members. However, no case of clinical or bacteriologically confirmed TB disease has been identified as a result of air travel-related exposure during flight.

    TB infection is acquired through inhalation of M. tuberculosis in aero- solized respiratory secretions from a contagious person coughing, talking or sneezing. The risk of infection is related to the infectiousness of the person with TB, the duration of exposure, the proximity to the source person, the ventilation and the degree of crowding. 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. On short flights, there is minimal risk of disease transmission. Prolonged journeys (i.e. more than eight hours) in a confined aircraft cabin may involve an increased risk of transmission of M. tuberculosis. This risk should be similar to that in other circumstances where people are together in other confined spaces.

    The revised guidelines address the concerns about transmission of TB during air travel and provide the following: (i) information on transmis- sion of TB on aircraft; (ii) a summary of the practices adopted for the management of patients with infectious TB associated with air travel, and of commonly encountered difficulties; (iii) suggestions on practical ways to reduce the risk of exposure to M. tuberculosis on board com- mercial aircraft, and (iv) guidance on procedures to follow and respon- sibilities when infectious TB is diagnosed in a patient who has a history of recent air travel, including contact tracing, notifying and screening for possible interventions. It also introduces the revised International Health Regulations, adopted by the World Health Assembly in May 2005, which will enter into force in June 2007, establishing basic rules for international coordination in the detection, investigation, and response to public health risks including the area of communication and information sharing.

    The guidelines include specific recommendations for passengers, air crews, physicians, health authorities and airline companies. They are applicable to all domestic and international airlines worldwide.

  2. Posted June 27, 2012 at 9:30 pm | Permalink

    OK, there is apparently a medical do-not-board list, which includes some individuals with drug-resistent TB. The following is from a 2008 issue of US News and World Report:

    Thirty-three would-be air travelers with suspected or confirmed infectious tuberculosis were placed on the U.S. government’s public health “Do Not Board” list in the first year of its existence, a federal report released Thursday showed.

    Authorized under the Aviation and Transportation Security Act of 2001, the list was instituted on June 1, 2007 by the U.S Centers for Disease Control and Prevention and the Department of Homeland Security, according to an article in the Sept. 19 issue of Morbidity and Mortality Weekly Report, a CDC publication.

    “Before June 2007, we had a system to prevent travel which was mostly based on local action,” explained Dr. Francisco Alvarado-Ramy, co-author of the report and a CDC quarantine public health officer based in San Juan, Puerto Rico. “We have moved from predominantly a decentralized system to a centralized one We’re formally tapping all U.S. government resources which add additional layers of protection to prevent persons with serious communicable diseases which pose a serious public health threat from boarding the plane.”

    In the year after institution of the list, U.S. state and local or territorial health departments asked the CDC to include 42 people on the list, all of whom had confirmed or suspected tuberculosis (TB), including multi-drug resistant (MDR) TB and extensively drug-resistant (XDR) TB. In the end, 33 individuals met the criteria to be placed on the list. The most requests (seven) came from Texas, followed by California (five)…

  3. Posted June 27, 2012 at 9:45 pm | Permalink

    I’m curious as to how this thread will develop as my readers at U-M’s School of Public Health start to chime in. My guess is that they’ll say that I’m being stupid, and that sufficient safe-guards are in place, given the statistical likelihood that the disease could spread onboard an airplane, but you never know. It’s possible, that, like the author, some could come forward suggesting that TB sufferers do us all a favor and “eat a bullet.”

  4. Erika
    Posted June 27, 2012 at 10:59 pm | Permalink

    I don’t know much about this particular situation, but I do know that my grandfather had to spend several months in a “sanitarium” in Lansing upon his return from Indo-China during WWII because he had contracted TB over there. It was a very dark time for him. The sanitarium is now known as Ingham Regional Medical Center.

  5. Edward
    Posted June 28, 2012 at 5:52 am | Permalink

    Terrorism is a bigger threat to mankind than TB because there’s no money to be had fighting TB. You can quote me on that.

  6. Posted June 28, 2012 at 6:16 am | Permalink

    It is very unlikely that you would contract TB on a flight. TB doesn’t transmit well, and requires several repeated reinfections before it finally takes hold. Tb transmits in place of high human density with many long term residents, like slums and prisons.

    While there’s no reason not to err on the side of caution and keep active cases off planes, there is little evidence to show that airplanes are hotbeds of TB infections. You should be more concerned about things like influenza on planes.

  7. Posted June 28, 2012 at 6:23 am | Permalink

    Thanks, Pete. That’s the response I was expecting.

  8. anonymoous
    Posted June 28, 2012 at 7:21 am | Permalink

    For those of you who don’t follow links, this author’s claim to fame is that she seems to have come up with a plausible scenario, through working with the CDC, to explain the existence of zombies. I’ve yet to read her book, but I imagine that she has them riding plains from coast to coast.

  9. Star Child
    Posted June 28, 2012 at 7:45 am | Permalink

    My grandfather died of TB about 10 years back… he originally went to a crappy Detroit hospital that totally missed the diagnosis and after spending a week in the hospital they sent him home. Within a day or two he was back in the hospital (a better one) and they diagnosed it within a few hours but it was too late at that point and it killed him after a week or so of them trying to fight it.

    He had a shop in Hamtramck so he probably got it from one of the European immigrants who would hang at his shop. TB is very real and dangerous.

  10. Elk Bottom
    Posted June 28, 2012 at 7:53 am | Permalink

    The last flight I was on, they made an announcement telling us that none of us could eat peanuts because someone on the flight was allergic. I guess they thought that a microscopic peanut particle may make its way into the air handling system. It seems odd that they would be concerned about that, and not someone hacking up aerosolized blood.

  11. cmadler
    Posted June 28, 2012 at 9:09 am | Permalink

    Just watched “Contagion” last night — I highly recommend it — and the best line was when a Department of Homeland Security guy asked a CDC administrator if the disease was the work of terrorists. “Someone doesn’t have to weaponize the bird flu.The birds are doing that.”

  12. Posted June 28, 2012 at 9:25 am | Permalink

    I think that Mr. Bottom doesn’t know much about peanut allergies. I have a good friend who is severely allergic to peanuts. When he merely passes by a McDonalds, which uses peanut oil for their fries, his throat starts to close up. Peanut allergies can be very, very serious.

    TB is also very real and very serious. Most people who contract the disease are very poor, very old, or live in places that noone really gives a shit about. Treatment is long, and sometimes ineffective. Given that the customers are poor, pharmaceutical companies aren’t motivated to create new drugs. Medicines to fight TB have not progressed since the 1950’s.

    It’s a real problem the world over, particularly in Sub-Saharan Africa and will only get worse from here on as more and more Africans move to live in squalid conditions in the cities.

    The guy on the plane is really small potatoes in the end. I’ve come into contact with probably many, many people who I knew to have TB and probably even more that have it, but are asymptomatic. I worry about a lot of things when hanging out in developing country hospitals and impoverished areas, but TB is low on that list. I’m well fed, not completely old and have access to decent medical care. Most of the world isn’t so lucky.

  13. Posted June 28, 2012 at 9:28 am | Permalink

    As an epidemiologist, I though Contagion was interesting, though pretty unrealistic in the end. It was cool to see though.

    I liked that they mentioned the birds. People really have no clue that serious, life threatening infectious agents often jump from animals. This is a serious problem given the manner in which we raise livestock now and only going to get worse.

  14. Knox
    Posted June 28, 2012 at 10:13 am | Permalink

    Peter, if TB is so difficult to catch, why does it keep spreading?

  15. Lynne
    Posted June 28, 2012 at 10:30 am | Permalink

    TB is difficult to catch but not impossible to catch. As mentioned earlier, certain populations are more likely to catch TB than others (i.e. people in dense living conditions who are exposed to each other repeatedly) Unfortunately, those people tend to be poor. So they can’t afford the long treatment. They’ll take the antibiotics until the symptoms disappear and then we have drug resistant TB. It is a serious issue but one that could be solved by rich countries paying for those in poorer countries to have full course of treatment at no cost to them. This would be foreign aid that seriously would be in our best interests as a nation.

  16. Posted June 28, 2012 at 2:11 pm | Permalink

    Knox,

    What a great question!

    The success or failure of infectious agents depends on two basic things (it’s actually more than that, but for purposes of this thread..):

    1) The likelihood of infection given a single contact (ex: handshake, touch, eating, getting puked on)
    2) The number (or length) of contact

    TB has a very, very low likelihood of infection during a single contact. In an airplane, contact will be few and of short duration.

    In a slum, homeless shelter or housing tenement, on the other hand, contacts will be many.

    Contrast this with influenza, which transmits very well, or measles which transmits very, very well. Since these diseases are so good at transmitting, even a few short contacts (like in a plane) can quickly infect many people. The average person infected with influenza transmits to about 1.6 people. Measles transmits to every non-immune person an infected person has contact with with almost 100% probability.

    I recognize (and respect) Lynne’s intent here, but I have to say that TB will NOT be solved by wealthy countries throwing money at poor countries. Access to meds is a serious problem, but doesn’t get at the root causes of TB.

    TB (as well as malaria, HIV and a host of other) will be solved by the elimination of extreme poverty, the creation of employment opportunities, sustainable economic development and improvements in basic health and housing conditions.

    It is no coincidence that TB in developed countries (ex: the US and Japan) is restricted to the poor, indigent and unemployed, despite wide availability of meds.

  17. Posted June 28, 2012 at 3:02 pm | Permalink

    If catching drug-resistant TB on a plane were a real problem, Samuel L Jackson would have made a movie about it by now.

  18. Mr. X
    Posted June 29, 2012 at 8:07 am | Permalink

    In the sequel, the snakes have tuberculosis.

  19. Edward
    Posted June 29, 2012 at 8:27 am | Permalink

    They were genetically modified by terrorists.

  20. Posted June 29, 2012 at 8:35 am | Permalink

    I was curious. Apparently, snakes do have a tuberculosis, Mycobacterium thamnopheos (among others), and it is transmittable to humans.

    Weaponized snakes on planes.

    What is a Mycobacterium infection?
    Mycobacterium infections in reptiles are uncommon and are caused be a bacterium that is related to the one that causes tuberculosis. These bacteria can infect numerous organs and most commonly cause the development of nodules at the site of infection.

    How is a Mycobacterium infection transmitted?
    How Mycobacterium is transmitted between reptiles is not well understood. It most likely enters through a break in the skin or through ingestion. Animals that have poorly functioning immune systems are most at risk. These would include animals that may be stressed, have poor nutrition, or are ill with other chronic diseases. Wild caught animals would be more likely to harbor the bacteria.

    What are the symptoms of a Mycobacterium infection in reptiles?
    Nodules can develop in the liver, lungs, bone, nervous system, mouth, and underneath the skin. The symptoms will vary depending on the location of the infection. Many reptiles or amphibians with a Mycobacterium infection will show weight loss even though the animal has a good appetite.

    How are reptiles with Mycobacterium infection treated?
    Because treatment is very expensive, must last up to 6 months, and the risk of transmission of Mycobacterium to people is present, most reptiles with this infection are euthanized.

    Can a Mycobacterium infection be transmitted from reptiles to people?
    It should be considered possible for a human to acquire a Mycobacterium infection from a reptile. Symptoms in humans may include nodules on the skin. Persons with suppressed immune systems could develop respiratory disease, swollen lymph nodes, bone infections, and arthritis. To prevent this and other infections, people should wear gloves when cleaning cages, wash their hands well after handling their herp, and have their herp examined if it shows any signs of illness.

    http://www.peteducation.com/article.cfm?c=17+1796&aid=3597

    http://www.jstor.org/discover/10.2307/30083680?uid=3739256&uid=2129&uid=2&uid=70&uid=4&sid=21100881670841

    http://www.jstor.org/discover/10.2307/20460168?uid=3739256&uid=2129&uid=2&uid=70&uid=4&sid=21100881670841

  21. Mr. X
    Posted June 29, 2012 at 12:46 pm | Permalink

    And people thought that I was nuts.

    Beware, people! Snake tuberculosis is jumping species!

  22. Posted June 29, 2012 at 12:57 pm | Permalink

    This is just secular propaganda against snake handling.

  23. Posted July 1, 2012 at 3:50 pm | Permalink

    Over the past five years, I had two kids on my caseload who lost their vision because of TB. Well, it started out as TB but (for whatever reason), it was not treated soon enough or not treated well enough or whatever, but the infection/bacteria went to the brain stem and optic nerve and boom boom boom, out go the lights. Both of these kids were from Detroit, living in poverty. I presume that somehow, that made an impact.

  24. Meta
    Posted July 10, 2012 at 3:40 pm | Permalink

    Speaking of TB.

    The CDC officer had a serious warning for Florida health officials in April: A tuberculosis outbreak in Jacksonville was one of the worst his group had investigated in 20 years. Linked to 13 deaths and 99 illnesses, including six children, it would require concerted action to stop.

    That report had been penned on April 5, exactly nine days after Florida Gov. Rick Scott signed the bill that shrank the Department of Health and required the closure of the A.G. Holley State Hospital in Lantana, where tough tuberculosis cases have been treated for more than 60 years.

    As health officials in Tallahassee turned their focus to restructuring, Dr. Robert Luo’s 25-page report describing Jacksonville’s outbreak — and the measures needed to contain it – went unseen by key decision makers around the state. At the health agency, an order went out that the TB hospital must be closed six months ahead of schedule.

    Read more:
    http://www.alternet.org/newsandviews/article/1026177/florida_squashed_news_of_worst_tb_outbreak_in_decades%2C_made_worse_by_budget_cuts

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Connect

BUY LOCAL... or shop at Amazon through this link Banner Initiative Linnette Lao