Tuberculosis
Information for International Travelers
Updated: April 2007
What is tuberculosis
(TB)?
Tuberculosis
(TB) is a disease caused by germs that are spread from person to
person through the air. TB usually affects the lungs, but it can
also affect other parts of the body, such as the brain, the kidneys,
or the spine. In most cases, TB is treatable and curable; however,
persons with TB can die if they do not get proper treatment.
What is multidrug
resistant tuberculosis (MDR TB)?
Multidrug-resistant
TB (MDR TB) is TB that is resistant to at least two of the best
anti-TB drugs, isoniazid and rifampin. These drugs are considered
first-line drugs and are used to treat all persons with TB disease.
What is extensively
drug resistant tuberculosis (XDR TB)?
Extensively
drug resistant TB (XDR TB) is a rare type of MDR TB. XDR TB is defined
as TB which is resistant to isoniazid and rifampin, plus resistant
to any fluoroquinolone and at least one of three injectable second-line
drugs (i.e., amikacin, kanamycin, or capreomycin).
Because XDR
TB is resistant to first-line and second-line drugs, patients are
left with treatment options that are much less effective.
XDR TB is of
special concern for persons with HIV infection or other conditions
that can weaken the immune system. These persons are more likely
to develop TB disease once they are infected, and also have a higher
risk of death once they develop TB.
How does drug
resistance happen?
Resistance to
anti-TB drugs can occur when these drugs are misused or mismanaged.
Examples include when patients do not complete their full course
of treatment; when health-care providers prescribe the wrong treatment,
the wrong dose, or length of time for taking the drugs; when the
supply of drugs is not always available; or when the drugs are of
poor quality.
How is TB spread?
TB germs are
put into the air when a person with TB disease of the lungs or throat
coughs, sneezes, speaks, or sings. These germs can float in the
air for several hours, depending on the environment. Persons who
breathe in the air containing these TB germs may become infected.
TB is not spread
by
- shaking someone’s
hand
- sharing food
or drink
- touching
bed linens or toilet seats
- sharing toothbrushes
- kissing
- smoking or
sharing cigarettes
Are international
travelers at risk for getting MDR or XDR TB while traveling?
Although MDR
and XDR TB are occurring globally, they are still rare. HIV-infected
travelers are at greatest risk if they come in contact with a person
with MDR or XDR TB.
All travelers
should avoid high risk settings where there are no infection control
measures in place. Documented places where transmission has occurred
include crowded hospitals, prisons, homeless shelters, and other
settings where susceptible persons come in contact with persons
with TB disease.
Air travel itself
carries a relatively low risk of infection with TB of any kind.
How can TB
be prevented?
Travelers should
avoid close contact or prolonged time with known TB patients in
crowded, enclosed environments (for example, clinics, hospitals,
prisons, or homeless shelters).
Travelers who
will be working in clinics, hospitals, or other health care settings
where TB patients are likely to be encountered should consult infection
control or occupational health experts. They should ask about administrative
and environmental procedures for preventing exposure to TB. Once
those procedures are implemented, additional measures could include
using personal respiratory protective devices.
Is there a
vaccine to prevent TB?
Yes, there is
a vaccine for TB disease called Bacille Calmette-Guérin (BCG). It
is used in some countries to prevent severe forms of TB in children.
However, BCG is not generally recommended in the United States because
it has limited effectiveness for preventing TB overall.
What should
I do before traveling internationally?
Travelers who
anticipate possible prolonged exposure to persons with TB (for example,
those who expect to come in contact routinely with clinic, hospital,
prison, or homeless shelter populations) should have a tuberculin
skin test (TST) before leaving the United States. If the test reaction
is negative, they should have a repeat test 8 to10 weeks after returning
to the United States. Additionally, annual testing may be recommended
for those who anticipate repeated or prolonged exposure or an extended
stay over a period of years. Because persons with HIV infection
are more likely to have an impaired response to the TST, travelers
who are HIV positive should tell their physicians about their HIV
infection status.
What should
I do if I think I have been exposed to someone with TB disease?
If you think
you have been exposed to someone with TB disease, you should contact
your doctor or local health department about getting a TB skin test
or the QuantiFERON®-TB Gold test (QFT-G), a blood test. And tell
the doctor or nurse when you spent time with this person.
What are the
symptoms of TB disease?
The general
symptoms of TB disease include feelings of sickness or weakness,
weight loss, fever, and night sweats. The symptoms of TB disease
of the lungs also include coughing, chest pain, and the coughing
up of blood. Symptoms of TB disease in other parts of the body depend
on the area affected. If you have these symptoms, you should contact
your doctor or local health department.
Where can I
find other health information about my travel destination?
CDC’s
Travelers’ Health website lists health information
for travelers by destination.
CDC
issues travel notices when
there is a health threat to travelers. These notices describe levels
of risk for the traveler and recommended preventive measures to
take at each level of risk. Travel notices are organized by disease
and by travel destination.
Source
Centers for Disease Control and Prevention
http://www.cdc.gov/
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