Dealing with threat of drug-resistant tuberculosis: background information for interpreting the Andrew Speaker and related cases

The Potential Impact of Border Security Upon Prevalence of Infectious Disease

In the U.S., migration has been documented to affect the prevalence of infectious disease. As a mitigation entity, border security has been recorded by numerous scholarly works as being essential to the support of the health of the U.S. population. Consequently, the lack of current health care monitoring of the permeable U.S. border places the U.S. population at risk in the broad sectors of infectious disease and interpersonal violence. Visualizing border security in the context of public health mitigation has significant potential to protect migrant health as well as that of all populations on both sides of the border. Examples of how commonly this philosophy is held can be found in the expansive use of security-focused terms regarding public health. Using tools such as GIS to screen for disease in people before their entrance into a nation would be more efficient and ethical than treating patients once they have entered a population and increased the impact on the healthcare system. (Disaster Med Public Health Preparedness. 2018;12:554-562).

Mother Nature versus human nature: public compliance with evacuation and quarantine

Effectively controlling the spread of contagious illnesses has become a critical focus of disaster planning. It is likely that quarantine will be a key part of the overall public health strategy utilised during a pandemic, an act of bioterrorism or other emergencies involving contagious agents. While the United States lacks recent experience of large-scale quarantines, it has considerable accumulated experience of large-scale evacuations. Risk perception, life circumstance, work-related issues, and the opinions of influential family, friends and credible public spokespersons all play a role in determining compliance with an evacuation order. Although the comparison is not reported elsewhere to our knowledge, this review of the principal factors affecting compliance with evacuations demonstrates many similarities with those likely to occur during a quarantine. Accurate identification and understanding of barriers to compliance allows for improved planning to protect the public more effectively.

Tuberculosis and air travel: a systematic review and analysis of policy

WHO international guidelines for the control of tuberculosis in relation to air travel require-after a risk assessment-tracing of passengers who sat for longer than 8 h 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 this Review I examine the evidence put forward to support these recommendations and assess whether such an approach is justifiable. A systematic review identified 39 studies of which 13 were included. 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.

Microbial burden and diversity of commercial airline cabin air during short and long durations of travel

Total microbial burden and diversity associated with commercial airliner cabin air was assessed by molecular methods in 125 air samples from the business-class sections of 16 domestic and international flights. Viable microbial burden within these cabin air parcels constituted only 1–10% of the total microbial population and ranged from below detection limits to 1.2 × 10⁴ cells m^–3 as determined with a validated ATP-based technology. Cultivable bacterial diversity was almost entirely limited to Gram-positive bacteria such as Staphylococcus and Bacillus. In contrast, cloning and sequencing 16S rRNA gene directly from the samples without cultivation indicated a significantly broader diversity, as sequences representing more than 100 species, and encompassing 12 classes of bacteria, were retrieved in varying abundance. Sequences of proteobacterial and Gram-positive lineage were retrieved most frequently (58% and 31% of all clone sequences, respectively), with Gram-positive and α-proteobacterial sequences dominating international flight samples and β- and γ-proteobacterial sequences comprising the largest portion of those retrieved from domestic flights. Significant differences in bacterial load and diversity were noted between samples obtained on domestic and international flights. The disparities observed in microbial abundance and diversity further underscore the immense value of state-of-the art molecular assays in augmenting traditional culture-based techniques.