Traveling disease

In my early to mid career it fell to me to teach large lecture courses that surveyed all of environmental health. Everything. Air polllution. Wastewater. Food sanitation. Radiation protection. Over the years I learned a lot beyond my particular specialty (environmental epidemiology) and it has stood me in good stead in many ways. Students seemed to enjoy learning about it, too, and one of their most frequent reactions was surprise at how suddenly newspapers had all sorts of stories about environmental topics. Of course those stories had always been there. They just never noticed them. I am reminded of this now because I am seeing lots of stories about TB and other diseases on airplanes in the wake of the Atlanta lawyer TB extravaganza. I'm not sure if the stories are new, but one thing for sure, these cases are not. Here is a sampling from just the last week:

Taiwan issues alert for TB patient who flew to China via Hong Kong

Taiwan health authorities on Wednesday issued an alert after a Taiwan man quarantined with a drug-resistant form of tuberculosis (TB) flew to China via Hong Kong, possibly infecting some passengers on the same flight. The 55-year-old, named only as Mr Lee, was diagnosed with a drug- resistant form of TB in 2003 and has been told by doctors not to take flights.l

This was a one hour flight and it isn't likely he infected anyone. But he's getting fined $4500 anyway. Here's another one:

Bus passengers notified of possible TB exposure

Passengers on bus from Boston to Montreal may have been exposed to tuberculosis but it's unlikely they were infected, Massachusetts health officials said Tuesday.

The passengers of the May trip were being notified that another passenger on the bus had the disease.

Dr. Al DeMaria, director of communicable disease control for the Massachusetts Department of Public Health, said these types of notifications of passengers happen "all the time."

"We almost never find anyone with infection as a result," he said.

[snip]

"I think people because of the Speaker case think this is an unusual circumstance, but in fact what was unusual was all the publicity about that case," said DeMaria. "Even with 16 hour plane rides, it's rare we find anyone who's infected."

Had enough TB? Have some meningitis:

AirTran seeks passengers on flight with meningitis-afflicted teen

A teenager who fell seriously ill on an AirTran Airways flight was diagnosed with bacterial meningitis, and the airline notified all passengers who sat near her, a spokesman said Monday.

The girl, whose identity wasn't released, was in critical condition Monday at Wesley Medical Center, a hospital spokeswoman said.

The teen had traveled Saturday from Orlando, to Atlanta on Flight 862 and then to Wichita on Flight 687, AirTran spokesman Dave Hirschman said. The crew called for an ambulance to meet the plane at the gate after the girl became sick on the second flight and unresponsive, he said. The airline notified the Centers for Disease Control and Prevention on Sunday.

The point is not that we should not worry about this. On the contrary, what this shows is that this happens all the time. You can't stop it from happening and it won't just be TB. It will be meningitis and influenza and any other contagious disease you can think of. In most cases it won't infect others (e.g., TB or meningitis) but in some it will. But you can't really prevent it from happening. You can only hope to have a resilient enough public health and medical care system to manage the consequences.

Unfortunately that's the real problem. The US doesn't have either should a truly contagious disease be afoot.

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Once you have a story with large interest and headlines, I beleive editors / producers are more likely to (re)join the media feeding because of the results (sales / ratings) that the initial story produced. Same seems true with Hollywood and movies.

For now the inverse holds true about H5N1. It's doing the Energizer bunny thing as it keeps going (and going), but the MSM ignores it. If a young U.S. lawyer on his honeymoon in Viet Nam caught bird flu maybe it would start getting more ink.

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I am of two minds on this and partially because I want government to be very limited and all people are responsible for taking care of themselves and not being a burden to others.

I think there is a major difference in having a disease such as TB and knowing it, then climbing onto a public transportation and possibly infecting someone. The same applies but in a more limited scale with the flu. You dont generally die of flu, but active TB your chances start heading down pretty quickly. You can die of TB, flu or meningitis or any number of things. But the difference is that if you are sick you shouldnt on your OWN put yourself into proximity of other people. If some guy was in the back of the plane and it was determined that he had flaming Ebola and he knew it before enplanement, I would be very angry. Same with TB. Flu yeah but to a lesser degree. Fact is that they rarely find anyone infected, but people do get infected and even one is crossing the line. .

There are three ways of doing this. The Vietnamese take your temp after you deplane in their country. Might be a good idea to do it before they enplane here perhaps during your security check. And then there is the final straw when people are getting sick with say bird flu and they mandate something akin to a quick physical. If people dont use their own good common sense and deliberately place other people in jeopardy, then the system kicks in.

In the future that system might be everything from a single pass MR to infrared and ultra sensitive bomb and bio detectors. All because someone thought that they had the right to impinge on the rights of others.

Trying to fix it post of a flight Revere after say a BF infection, is front line capitulation. Its like taking a beachhead. If they push you back into the sea then it doesnt matter that you have superior firepower on the ocean. You still lose and its very doubtful you will get a second chance. IMO.

By M. Randolph Kruger (not verified) on 26 Jul 2007 #permalink

Randy: Airport temp checks do nothing, by experience. Fageddaboudit. Viruses will travel. We won't stop them. We should put our efforts elsewhere. Too big an emphasis on this just drives TB patients underground, like quarantine.

To understand why all the reporting on travellers with infectious diseases, the answer lies in this article.

http://www.washingtonpost.com/wp-dyn/content/article/2007/07/27/AR20070…

Personal data, including health status will be routinely communicated to and by foreign governments under the pretext of security.

The media events were staged to provide justification for this.

By Paul Todd (not verified) on 28 Jul 2007 #permalink

True. However, I think that preventing those things to happen is much better. If we know that there is someone with a disease on board, it's only appropriate to inform everyone.

Airline companies should ask questions to their passengers about these communicable diseases. They don't have to surprise the people by suddenly announcing to everyone that there is someone with TB on board.

"You can only hope to have a resilient enough public health and medical care system to manage the consequences."

And a healthy, well-educated population...which we also don't have.

Anyone who travels gets sneezed and coughed on regularly. Transmission of infections can sometimes be slowed, but there is really no way it can be prevented (remember the Masque of the Red Death!) We really need to plan on that basis.