U.S. Barred 33 TB-Infected People From Flying Over Past Year

THURSDAY Sept. 18, 2008 -- Thirty-three would-be air travelers with suspected or confirmed infectious tuberculosis were placed on the U.S. government's public health "Do Not Board" list in the first year of its existence, a federal report released Thursday showed.

Authorized under the Aviation and Transportation Security Act of 2001, the list was instituted on June 1, 2007 by the U.S Centers for Disease Control and Prevention and the Department of Homeland Security, according to an article in the Sept. 19 issue of Morbidity and Mortality Weekly Report, a CDC publication.

"Before June 2007, we had a system to prevent travel which was mostly based on local action," explained Dr. Francisco Alvarado-Ramy, co-author of the report and a CDC quarantine public health officer based in San Juan, Puerto Rico. "We have moved from predominantly a decentralized system to a centralized one We're formally tapping all U.S. government resources which add additional layers of protection to prevent persons with serious communicable diseases which pose a serious public health threat from boarding the plane."

In the year after institution of the list, U.S. state and local or territorial health departments asked the CDC to include 42 people on the list, all of whom had confirmed or suspected tuberculosis (TB), including multi-drug resistant (MDR) TB and extensively drug-resistant (XDR) TB. In the end, 33 individuals met the criteria to be placed on the list. The most requests (seven) came from Texas, followed by California (five).

The issue gained prominence in 2007 after a Georgia man who flew to Europe for his wedding was subsequently quarantined after it was discovered that he had XDR TB. That highly visible case "highlighted some of the vulnerabilities to the existing system," said Dr. Martin Cetron, director of the CDC's director of division of global migration and quarantine.

Almost half of those barred from flights over the past year were citizens of countries designated by the World Health Organization as TB "high-burden" countries. Two of the individuals on the list were known to have attempted to evade U.S. air travel restrictions, although it is unclear what, exactly, this meant.

The CDC reviews the list on a monthly basis, determining who is eligible for removal -- once a person is deemed to be no longer contagious, his or her name is removed from the Do Not Board list within 24 hours, the report's authors said. Between June 2007 and May 2008, 55 percent of the 33 people on the list were removed either because they were no longer contagious or did not have TB. Those removed had been on the list for a median of 26 days. Those persons not removed from the list had been on the list for a median of 72 days.

Officials said they are on the look-out for "diseases of consequence," such as SARS, TB, a pandemic strain of influenza and hemorrhagic fevers such as Ebola, Cetron said.

Many experts were unaware of the existence of such a list and were divided in their reaction. (The agencies involved did not publicly announce the formation of the list, although it was discussed at a variety of open and professional organization meetings, Cetron said.)

Some public health experts found the very idea troubling.

"It's slightly reassuring that the list hasn't been used very much but I have grave reservations about this sort of collaboration between agencies who are charged with protecting the public from real disease threats and agencies -- and here I'm talking about Homeland Security -- that capitalize on people's fears in the name of protecting the public from unnamed dangers," said Philip Alcabes, an epidemiologist and associate professor at Hunter College's School of Health Sciences in New York City.

"Is there a legitimate need to control tuberculosis? Absolutely. Is there a legitimate need to have a DNB list in order to do so? I don't see how that adds to what the CDC already does," continued Alcabes, who said he had not known of the existence of such a list. "The CDC knows very well how to control tuberculosis with existing rules and procedures. In fact, they have done a superb job."

"I think the previous system did need bolstering," countered Dr. Martin Blaser, chairman of medicine at New York University's Langone Medical Center and former president of the Infectious Diseases Society of America. "The case from Atlanta . . . was a wake-up call," he said. " We live in a smaller world where air travel is very important and also carries the risk of moving contagious diseases from one part of the world to another very rapidly. This, in a sense, is just an extension of the concept of quarantine, which is an old concept and is well-established."

Posted: September 2008


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