India Post News Service

CHICAGO: A widely circulated report in media about American Airlines flying a TB infected passenger on board from New Delhi to Chicago has created anxiety and apprehensions among travelers on non-stop or long haul flights.

According to reports, the US Centers for Disease Control and Prevention (CDC) was informed that a woman passenger who was recently diagnosed with multidrug-resistant tuberculosis (MDR TB) has traveled in company with other passengers on AA's 14 hour long haul flight # 293 on DEC 13, 2007. Shortly after her arrival, the patient sought treatment for hemoptysis (coughing up blood), fever, and chest pain at a hospital.

These and other findings indicated a potential for transmission of drug-resistant TB infection to others. The patient has been hospitalized in airborne isolation and is receiving treatment for TB. Soon CDC was tracking down 44 other passengers who had flown with the infected passengers and were believed to be seated in same or close rows with the patient.

Who were those 44 passengers? According to Health Officials these persons should receive an initial evaluation and testing for TB infection, with follow-up 8 to 10 weeks. In accordance with the World Health Organization (WHO) TB and Airline Travel Guidelines, CDC is ensuring appropriate follow-up and care for persons who may have been exposed to TB on an aircraft. CDC recommends testing of these passengers and crew on only the international flight from New Delhi to Chicago because this flight was longer than the eight hour duration criteria specified by WHO for passenger testing for exposure to tuberculosis.

WHO and CDC do not recommend notification or medical evaluation of passengers on briefer flights because the risk of transmission is minimal. The incident has once again focused a widely debated question often discussed by medical experts how safe it is to travel on long haul flights of eight hours or more duration? Earlier research has indicated that traveling long haul flights generate potential risk of getting a blood clot (venous thromboembolism) (VTE) or a deep vein thrombosis (DVT).

A DVT is where a blood clot or thrombus occurs in a deep vein, usually in the lower part of the leg. The WHO notification on the hazards of travel suggests that travelers who sit immobile for four hours or more, for example in a plane, train, bus or car, are doubling their risk of getting VTE or DVT.

The latest incidence of acquiring TB infection on board added to the risk of flying long haul flights. TB bacilli become aerosolized when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These bacilli can float in the air for several hours, depending on the environment. Persons who breathe air containing these TB bacilli can become infected.

Transmission has been documented in association with patients who have TB lung disease, and bacteria seen or cultured in sputum. Persons who become infected usually have been exposed for several hours (or days) in poorly ventilated or crowded environments (such as long haul flight)! Since more and more airlines are now planning non stop or long haul flights to Indian destinations it is important to know what are the health risks or precautions?

Health conscious travelers prefer flying long distance on flights taking a break for ground walk after 8 or 10 hours as it gives momentum to body and blood circulation. Several medical expert guidelines are now available on health safety for long haul flight travelers.

Experts advise that travelers should move their feet up and down at the ankle to exercise their calf muscles and get the blood circulating in their lower legs. Also, travelers should not wear tight clothes during travel because they encourage blood stagnation.

Here are few more guidelines from health experts for passengers traveling on non-stop or long haul flights: Wear flight socks, make sure they are the correct size. Do not buy them based on shoe size; you can be overweight with small feet. You need to measure your ankle and calf to get the correct size.

Don't drink alcohol before and during the flight, but drink plenty of water. Don't eat fatty food a few days before and during the flight. Don't sleep for long periods. Get up at least once an hour and move around the cabin.

Do the exercises demonstrated in the flight magazine, including the deep breathing ones. Don't put a bag under the seat in front of you; it takes up valuable leg room. Don't bother taking aspirin. Research has shown it has absolutely no effect on preventing DVT.