• International Travel Information: Tuberculosis

    IMAGETuberculosis (TB) is a contagious disease that often affects the lungs. It is caused by bacteria called Mycobacterium tuberculosis. Every year there are about nine million cases worldwide. If you are planning to travel abroad, how can you reduce your risk of TB?

    What Is the Risk to Travelers?

    If you are an international traveler, you may be at an increased risk for contracting TB because:
    • You may be visiting countries where TB is prevalent.
    • Your mode of transportation is a confined area (such as an airplane), where you may share air space with someone who has active TB.
    The World Health Organization lists profiles for the 22 high burden countries that account for 80% of all new TB cases each year. The countries are:
    • India
    • China
    • Indonesia
    • Nigeria
    • South Africa
    • Bangladesh
    • Ethiopia
    • Pakistan
    • Philippines
    • Democratic Republic of Congo
    • Afghanistan
    • Brazil
    • Cambodia
    • Kenya
    • Mozambique
    • Myanmar
    • Russian Federation
    • Thailand
    • Uganda
    • United Republic of Tanzania
    • Vietnam
    • Zimbabwe

    How Is TB Transmitted?

    When someone with active TB coughs, the bacteria are transmitted through the air and may be inhaled by people nearby. TB is more likely to spread from person-to-person in enclosed places because:
    • Water droplets carrying the bacteria are more widely dispersed outdoors
    • Ultraviolet radiation from the sun kills TB
    Fortunately, exposure to TB bacteria does not automatically mean the disease will develop. If you have a normal immune system, your body's defenses will immediately build a "fortress" around the bacteria. This may keep TB dormant in your body for years, possibly a lifetime. If the bacteria remain inactive, a person is considered infected, but does not have active tuberculosis and cannot infect others.
    TB becomes active and symptomatic when the immune system's fortress can no longer contain the growth of the bacteria. Usually, this happens when the immune system is weakened, due to certain conditions, such as poorly controlled diabetes, HIV, and cancer.
    When TB becomes active in the lungs, the body begins to exhibit symptoms, such as:
    • Severe cough lasting more than two weeks
    • Coughing up blood or sputum (mucus from deep inside the lungs)
    • Weakness or fatigue
    • Loss of appetite
    • Weight loss
    • Night sweats
    • Fever

    What Are the Testing Guidelines for Travelers?

    Screening for TB infection is done with a skin test. In North America, the tuberculin skin test (often called PPD for purified protein derivative) is generally used. A small amount of testing fluid is injected into the skin in the lower part of the arm, and the reaction is measured 2-3 days later.
    A positive reaction, characterized by a raised bump, indicates TB infection, but it does not diagnose active disease. A negative reaction indicates the absence of infection; however, if exposure was recent, it is recommended that another skin test be done 8–10 weeks after the time of exposure.
    If you are staying for an extended period in a location where TB common, it is recommended that testing be done before leaving and after returning from your trip.

    What Is the Treatment?

    Preventive Therapy

    If you are have a positive skin test results without symptoms, the drug isoniazid may be prescribed for nine months of treatment. Another treatment option is a combination of isoniazid and rifapentine for 12 weeks. Alternative treatments include rifampin for four months, or rifampin plus pyrazinamide for two months.
    A vaccine for TB, called BCG, is available in many countries, but is not routinely used in the US.

    Medicines for Active TB

    If you have active TB, your treatment will most likely include a combination of medicines, such as:
    • Isoniazid
    • Rifampin
    • Pyrazinamide
    • Ethambutol
    • Streptomycin
    For active pulmonary TB, you will need to isolate yourself during treatment from coworkers, friends, and family to prevent the disease from spreading.

    What Kind of Protection Should You Choose?

    There are no simple answers, but risk is lowest in the open air and in situations where your distance from a potentially infected person is greater.
    Enclosed environments such as hospitals and prisons should be avoided. If you will be spending time in this type of setting, it may be appropriate to wear a special mask that prevents TB.
    Remember that tuberculosis is not exclusively a respiratory disease. It can also be transmitted by unpasteurized milk and milk products. When traveling in regions where TB is common, avoid drinking of unpasteurized or uncooked milk and milk products.
    In general, tuberculosis is not easily transmitted. But, international travelers should take preventive measures if they are at heightened risk of exposure.

    RESOURCES

    Centers for Disease Control and Prevention http://www.cdc.gov/

    StopTB Partnership http://www.stoptb.org/

    CANADIAN RESOURCES

    The Canadian Lung Association http://www.lung.ca/

    Health Canada http://www.hc-sc.gc.ca

    References

    Active tuberculosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 19, 2012. Accessed August 20, 2012.

    Advice for travelers. Treat Guidelines Med Lett. 2004;2:33.

    Al-Jahdali H, Memish ZA, Menzies D. Tuberculosis in association with travel. Int J Antimicrob Agents . 2003;21:125-30.

    Country profiles. World Health Organization website. Available at: http://www.who.int/tb/publications/global%5Freport/2011/gtbr11%5Fa2.pdf. Published 2011. Accessed August 20, 2012.

    Exposure of passengers and flight crew to Mycobacterium tuberculosis on commercial aircraft, 1992-1995. Morbidity and Mortality Weekly Report. 1995;44:175.

    Francis J. Curry National Tuberculosis Center. Tuberculosis infection control: a practical manual for preventing TB. Available at: http://www.ndhealth.gov/disease/tb/Documents/Infection%20Control.pdf. Published 2007. Accessed August 20, 2012.

    Frank GJ, Cobelens, et al. Risk of infection with Mycobacterium tuberculosis in travelers to areas of high tuberculosis endemicity. Lancet . 2000;356:461-465.

    Hill, DR. The burden of illness in international travelers. N Engl J Med. 2006;354:115.

    Human tuberculosis caused by Mycobacterium bovis. 2001-2004. MMWR Morb Mortal Wkly Rep . 2005;54:605-608.

    Latent tuberculosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 31, 2012. Accessed August 20, 2012.

    LoBue P. Tuberculosis. Centers for Disease Control and Prevention website. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/tuberculosis.htm. Updated July 1, 2011. Accessed August 20, 2012.

    Tuberculosis. World Health Organization website. Available at: http://www.who.int/mediacentre/factsheets/fs104/en/ . Updated March 2012. Accessed August 20, 2012.

    Tuberculosis country profiles. Stop TB Partnership website. Available at: http://www.stoptb.org/countries/tbdata.asp . Accessed August 20, 2012.

    Tuberculosis testing and diagnosis. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/tb/topic/testing/default.htm. Updated April 30, 2012. Accessed August 20, 2012.

    12/16/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Sterling T, Villarino E, Borisov A, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365(23):2155.

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