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MDR-TB in the Skies!

December 31, 2007

Airline Cabin There’s yet another report of a case of a patient infected with MDR-TB flying the friendly skies.  I heard about this one from the CDC’s Clinician Outreach and Communication Activity (COCA) listserv.  This is a great resource, and I encourage everyone to sign up to receive these alerts here.

So, yet again, we’re packing super-bugged people onto flying tubes of aluminum and shipping ’em off.  According to Google News, health officials first released word of Andrew Speaker’s flight just a few days after it happened, urging fellow travelers to get tested.  Today, we find out that a person infected with MDR-TB took two flights, one from New Delhi, India to Chicago, Illinois and then another, shorter flight in the United States.

The flights took place on December 13, after which the patient presented to a hospital with hemoptysis, fever and chest pain.  The local health agency alerted the CDC shortly thereafter, and on December 28, CDC issued an Epi-X notification to health officials in the states that might have an exposed traveler.  Those state officials are to get in contact with those passengers on the flight from India that were seated close to the infected patient.  The intra-state flight, the CDC assures its readers, was too short for any substantial risk of disease spread.

Two things about this case frighten me.  The first is that someone was infected with MDR-TB disease on this flight from India and will find out nearly a month after the infection took place.  When that happens (and it will, maybe not from this flight, but on some flight, it will), what happens?

Obviously, companies like SkyMall will make a fortune selling “anti-TB” filters every time someone coughs on a flight.

But, seriously, who will take the fall?  Is the airline liable?  Is the infected person liable?  Is TSA liable, or the CDC?  What will be the reaction?  Will we be required to submit to a TB test for each flight, in addition to taking off our shoes, cataloguing our liquids and bagging our laptop batteries?  Will “coughers” get “randomly” searched more often?  What if someone gets coughed on in flight – can they be charged with assault pending a TB test?  Should the pilot divert a flight if a patient undergoes an uncontrolled coughing fit to minimize the time in flight?  It’s a brave new world, and the legal system, CDC and TSA had better get ready – quickly.

The second thing that scares me is the irrational fear that CNN and Fox News trumpet.  This is a primary vector route for a bioterror attack, so they say.  Releasing some biological agent on a flight is a sure-fire way to get a hundred folks sick, then release them into a crowded airport filled with connections to every corner of the world.

And you know what?  We’ve just proved that we cannot handle that scenario.  We don’t even let the local health agencies know about it for weeks!  Yes, I know, the risk of this is infinitesimally small, but hey, it’s only got to work once, right? 

On a less fear-mongering note, what if the person was infected with highly-pathogenic H5N1 avian influenza instead of MDR-TB?  Would that have caused an uproar?  What if it introduced the disease to North American fowl?  Think of the exasperated calls for culling that would ensue.  What I’m trying to get at here is that for all of our security theatre, our transportation system is still highly vulnerable to public health threats, be they man-made or natural.

Today’s short lesson?  Cover your mouth when you cough – for all our sakes.

Photo credit:  SoStark

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