Miller M A, Valway S, Onorato I M
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Tuber Lung Dis. 1996 Oct;77(5):414-9. doi: 10.1016/s0962-8479(96)90113-6.
Domestic and international air-flights.
To estimate the risk of tuberculosis (TB) transmission aboard aircraft.
A contact investigation of passengers and crew from two flights was conducted following identification of a fellow passenger with pulmonary TB. Immediate post-exposure and follow-up tuberculin skin tests (TSTs) were obtained.
Of 120 contacts, 86 (72%) had a negative TST (< 5 mm); 29 (24%) a positive TST (> or = 5 mm), and 5 (4%) a TST conversion. Of the 29 persons with a positive TST, 27 had other identified risk factors for TB. Risk factors for positive TST included non-US birth (Relative Risk (RR) 9.7 P < 0.01) or history of Bacille Calmette-Guérin (BCG) vaccination (RR undefined; P < 0.01). Risk was not associated with specific aircraft or seat relative to the index case for US-born contacts. All five TST converters were born in countries where BCG vaccine is routinely given.
The positive TST reactions and conversions suggest boosting from BCG vaccination or prior exposure in TB-endemic countries. Since two positive contacts had no other identified risk factor, TB transmission on board the aircraft could not be excluded. Contact investigation of exposed aircraft passengers should be considered on a case-by-case basis, with consideration of the infectiousness of the ill passenger and the flight circumstances.
国内和国际航班。
评估飞机上结核病（TB）传播的风险。
在一名患有肺结核的乘客被确诊后，对两架航班上的乘客和机组人员进行了接触者调查。在接触后立即以及随访时进行了结核菌素皮肤试验（TST）。
在120名接触者中，86人（72%）TST结果为阴性（<5mm）；29人（24%）TST结果为阳性（≥5mm），5人（4%）TST结果发生转换。在29名TST结果为阳性的人中，27人有其他已确定的TB风险因素。TST结果为阳性的风险因素包括非美国出生（相对风险（RR）9.7，P<0.01）或卡介苗（BCG）接种史（RR未确定；P<0.01）。对于在美国出生的接触者，风险与特定飞机或相对于索引病例的座位无关。所有5名TST结果发生转换者均出生在常规接种BCG疫苗的国家。
TST结果呈阳性及结果转换表明是由BCG疫苗接种或在结核病流行国家先前接触过结核菌导致的增强反应。由于两名呈阳性的接触者没有其他已确定的风险因素，因此不能排除飞机上发生了TB传播。应根据具体情况考虑对飞机上的暴露乘客进行接触者调查，同时考虑患病乘客的传染性和飞行情况。
