Review Casts Doubt on Screening Air Passengers for TB Infection

The World Health Organization (WHO)’s international guidelines for the control of tuberculosis in relation to air travel require (after a risk assessment) the tracing of passengers who sat for longer than eight hours in rows adjacent to people with pulmonary tuberculosis who are smear-positive or smear-negative. A further recommendation is that all commercial air travel should be prohibited until the person has two consecutive negative sputum smears for drug-susceptible tuberculosis or two consecutive cultures for multidrug-resistant tuberculosis.

In a new literature review published in the March issue of The Lancet Infectious Diseases, epidemiologist Dr. Ibrahim Abubakar examines the evidence put forward to support these recommendations and assesses whether such an approach is justifiable. His systematic review identified 39 studies of which 13 were included, and the majority of studies found no evidence of transmission. Only two studies reported reliable evidence of transmission. The analysis suggests that there is reason to doubt the value of actively screening air passengers for infection with Mycobacterium tuberculosis and that the resources used might be better spent addressing other priorities for the control of tuberculosis.

Reference: Abubakar I. Tuberculosis and air travel: a systematic review and analysis of policy. The Lancet Infectious Diseases. 10(3):176-183. March 2010.