Overview

The emergence of MDdR-TB and extensively drug-resistant TB (XDdR-TB) has raised special concerns in relation to the international spread of particularly dangerous strains of Mycobacterium tuberculosis. Since the 2006 edition was published, several incidents have occurred involving air travel and potential transmission of TB. The revision of the International Health Regulations (IHR), which entered into force in June 2007, provides for the introduction of new measures that might potentially apply to international events involving TB. The IHR provide a legal framework for a more effective and coordinated international response to public health emergencies and risks, including those caused by outbreaks of communicable diseases. Several IHR provisions are relevant to the detection and control of TB during air travel, strengthening the role of WHO and of national public health authorities in this domain.

Following these important recent developments, WHO has prepared this third edition to address current public health risks that may arise from the potential transmission of TB during air travel, and new approaches to international collaboration. This edition builds upon the 2006 edition and adds to it in providing: (i) greater clarity in the definition of infectious index cases; (ii) procedures for the follow-up of contacts of infectious cases; and (iii) a more detailed definition of the roles and responsibilities of the agencies involved. The recommendations recognize that the response needs to be proportional to the risk, so that public confidence is preserved and unnecessary restrictions are avoided.

The guidelines were developed with the collaboration of public health authorities and international experts in the prevention and control of TB, travel medicine and air travel. Implementing the recommendations will help to reduce the international spread of TB and decrease the risk of infection among individual travellers. Although the role of air travel-related transmission of TB is minimal compared with the overall transmission of TB worldwide, these guidelines may nevertheless be useful for national authorities, especially in countries with a low TB burden, and for the airline industry, to facilitate procedures involving multiple actors.

Contents

• Preface
• Acknowledgements
• Methodology
• Summary
• Glossary and abbreviations
• 1. Background information
• 2. Tuberculosis on aircraft
• 3. Aircraft ventilation
• 4. Cabin air quality
• 5. Reducing the risk of exposure to M. tuberculosis on aircraft
  • 5.1 Definition of infectious TB for air travel purposes
  • 5.2 Precautions before travel
  • 5.3 Precautions during travel
• 6. Contact investigation following potential exposure to M. tuberculosis
  • 6.1 Criteria for deciding whether to initiate a contact investigation
  • 6.2 Recommended roles and responsibilities when exposure to infection is suspected
  • 6.3 Informing close contacts
  • 6.4 Practical issues for contact investigation after potential exposure to M. tuberculosis
  • 6.5 Procedures for follow-up of contacts
• 7. Legal and regulatory issues
  • 7.1 International Health Regulations (2005)
  • 7.2 Selected activities of WHO under the IHR concerning TB-related events
  • 7.3 Privacy/confidentiality of personal health information
  • 7.4 Denying boarding
• 8. Airline employee health
• 9. Role of WHO in prevention and control of tuberculosis associated with air travel
• 10. Recommendations
  • For travellers
  • For physicians
  • For public health authorities (see also requirements under the IHR)
  • For airline companies
• Appendix 1 Literature search strategy
• Annex 1 International Health Regulations (2005): Selected provisions
• Annex 2 Sample letter from a national public health authority to an airline company requesting information for contact identification after possible exposure to M. tuberculosis
• Annex 3 Proposed procedure for contact investigation following exposure to tuberculosis from an infectious source during air travel
• References

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.