Contact investigation after a fatal case of extensively drug-resistant tuberculosis (XDR-TB) in an aircraft, Germany, July 2013

Abstract

In July 2013, a passenger died of infectious extensively drug-resistant tuberculosis (XDR-TB) on board of an aircraft after a 3-hour flight from Turkey to Germany. Initial information indicated the patient had moved about the aircraft coughing blood. We thus aimed to contact and inform all persons exposed within the aircraft and to test them for newly acquired TB infection. Two-stage testing within 8 weeks from exposure and at least 8 weeks after exposure was suggested, using either interferon gamma release assays (IGRAs) or tuberculin skin test (TST). The TST cut-off was defined at a diameter > 10 mm; for differentiation between conversion and boosting, conversion was defined as increase of skin induration > 5 mm. Overall, 155 passengers and seven crew members were included in the investigation: the questionnaire response rate was 83%; 112 (69%) persons were tested at least once for TB infection. In one passenger, who sat next to the area where the patient died, a test conversion was registered. As of March 2017, no secondary active TB cases have been reported. We describe an unusual situation in which we applied contact tracing beyond existing European guidelines; we found one latent tuberculosis infection in a passenger, which we consider probably newly acquired.

Keywords: Contact Tracing; Extensively Drug-Resistant Tuberculosis; Interferon-gamma Release Assay; Tuberculin Test; XDR-TB.

Figure 1

Criteria for initiating contact tracing after tuberculosis exposure on aircraft [3] vs TB contact tracing after XDR-TB-exposure in an aircraft, Germany, 2013

Figure 2

Affected aircraft (A) without labelling; (B) with labelling of passengers and crew, by high and medium exposure risk groups for tuberculosis progression and by LTBI case definition categories, tuberculosis contact tracing after XDR-TB-exposure on aircraft, Germany, 2013