Health authorities have launched a nationwide search for 44 airplane passengers who were sitting near a Northern California woman who flew from India to the U.S. with infectious multi-drug-resistant tuberculosis.
The sick traveler, a 30-year-old Sunnyvale resident who was not identified, took two flights on Dec. 13. Health officials are concentrating on American Airlines Flight 293, a 16-hour flight between New Delhi and Chicago, because trips over eight hours pose the greatest risk for transmission.
The woman's multi-drug-resistant TB, or MDR TB, is less dangerous than a virtually untreatable form known as extensively drug-resistant tuberculosis, or XDR TB. But authorities are particularly concerned because during the flight the patient showed symptoms that increased the chances of spreading the disease.
"Coughing, fever, that kind of stuff," said Joy Alexiou, a spokeswoman for the Santa Clara County Public Health Department. "So she potentially could have exposed someone."
Tuberculosis can be slow to develop, and the CDC has recommended that airline passengers in the row of the sick woman and the two rows on either side of her get an immediate test for tuberculosis and a second one eight to 10 weeks later.
Health officials have already tracked down the two California residents sitting near the woman, and neither appears to be sick, Alexiou said.
The other passengers have been tracked to Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, New Jersey, North Carolina, Ohio, Oklahoma, Tennessee, Texas, Vermont and Virginia. A spokeswoman for the national Centers for Disease Control and Prevention said she was not sure how many had been reached.
A similar incident occurred last year when an Atlanta man flew to and from Europe with what authorities believed was XDR TB.
The man, Andrew Speaker, never showed symptoms of tuberculosis, but his travels sparked an international uproar, launching health authorities on a search for the 270 U.S. residents who sat in his vicinity.
After Speaker was isolated in a hospital and tested more thoroughly, doctors eventually downgraded the infection to MDR TB.
The MDR variety of the disease is resistant to two first-line antibiotics, compared with XDR's resistance to the most powerful first- and second-line drugs. There were 111 cases of MDR TB and three cases of XDR TB in the U.S. in 2006, according to the CDC.
Authorities discovered the latest case after the woman went to the emergency room of Stanford Hospital in Palo Alto on Dec. 19, Alexiou said.
The county has contacted family members who might have been exposed, and Stanford Hospital has also contacted the small number of people who were in the emergency room with the Sunnyvale woman.
The sick woman has been kept in isolation and is expected to stay in the hospital for a few weeks, said Shelley Hebert, the hospital's executive director for public affairs.
"Things are going well at this point," Hebert said. "She will not be discharged until it is absolutely safe for her and the public and for the staff."
It was unclear how much the woman knew about her condition or her risk to others when she boarded a plane in New Delhi, Alexiou said.