UNITED NATIONS: WHO guidelines on tuberculosis and air travel, 98.12.18

UNITED NATIONS: WHO guidelines on tuberculosis and air travel, 98.12.18

The following is an executive summary of a WHO report "Tuberculosis and Air Travel:Guidelines for Prevention and Control" published on Thursday 17 December 1998. The full report can be obtained on the WHO website at: http:\\

Approximately one third of the world's population is infected with Mycobacterium tuberculosis, and tuberculosis (TB) is the leading cause of death from a single infectious agent in adults worldwide. In 1996, 3.8 million new cases of TB were reported to the World Health Organization (WHO), but it is estimated that nearly eight million cases might have occurred worldwide.

Effective TB control is based on proper detection of cases and appropriate treatment until cure. The WHO strategy for TB control, Directly Observed Treatment, Short-course (DOTS), ensures that cases are detected and treated with proper regimens. DOTS remains the highest priority in order to achieve TB control throughout the world. Over the past few years, technology has made travelling easy and readily available. Increasingly larger numbers of people are using international air travel for business, tourism, and other reasons such as immigration or asylum seeking. Several outbreaks of communicable diseases, such as staphylococcal food poisoning, measles, influenza, and others, following exposure within a commercial aircraft, have been documented. Likewise, exposure to infectious TB on commercial aircraft is a real concern for both passengers and crew.

To date, no case of active TB has been identified as a result of exposure while on a commercial aircraft. However, there is some evidence that transmission of M. tuberculosismay occur during long (i.e. more than eight hours) flights, from an infectious source (a passenger or crew member) to other passengers or crew members.

TB infection is acquired through inhalation of M. tuberculosisin aerosolized respiratory secretions from an infectious person coughing, talking or sneezing.. The risk of infection is related to the proximity and the duration of exposure to the source patient. Decreased ventilation in crowded and confined environments is often a contributing risk factor. Although a single flight carries the risk of a relatively limited exposure, prolonged sojourn in a confined aircraft cabin may increase the risk of transmission of M. tuberculosis.

In the past few years, several episodes of potential transmission of TB infection during air travel have been reported, some of which raised great anxiety among the general population, health authorities, mass media and airline companies. On these occasions, health and airline representatives have sought guidance from WHO and other national agencies.

This report addresses the growing concern about TB transmission during air travel (including its prevention, management of infectious passengers, contact tracing, and passenger information procedures) within the broader context of TB control efforts.

WHO, in collaboration with international TB experts, civil aviation authorities, and representatives of airline companies, has produced guidelines to provide airline companies, health authorities, physicians and air passengers with: 1) the available scientific background on the issue of TB transmission on aircraft; 2) a review of the past practices adopted for the management of patients with infectious TB and history of air travel, and of the most commonly encountered difficulties; 3) suggestions on practical ways to reduce the risk of exposure to M. tuberculosis on board; and 4) guidance on procedures to follow when a case of infectious TB is diagnosed with a history of air travel, including tracing and screening of contacts for possible interventions.

These guidelines will apply to all domestic and international airline carriers throughout the world.


Date: Fri, 18 Dec 1998 15:39:43 +0000 (GMT) From: UN IRIN - West Africa <> Subject: UNITED NATIONS: WHO guidelines on tuberculosis and air travel, 98.12.18

Editor: Ali B. Ali-Dinar

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