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Flight related tuberculosis contact investigations in the United States: comparative risk and economic analysis of alternate protocols.
Travel Med Infect Dis. 2014 Jan-Feb; 12(1):54-62.TM

Abstract

BACKGROUND

In-flight transmission risk of Mycobacterium tuberculosis is not well defined, although studies suggest it is low. The impact of flight-related tuberculosis (TB) contact investigations (TBCIs) on TB prevention and control is not well established, and they compete for resources with activities with established benefits. We sought to determine the risks and cost-benefits of using more restrictive criteria in comparison to the Centers for Disease Control and Prevention (CDC) 2008 protocol for TBCIs.

METHODS

The risk-benefits of a modified CDC protocol were analyzed in comparison to the 2008 CDC protocol using data from flight-related TBCIs conducted in the United States from 2007 through 2009. We predicted the numbers and characteristics of case-travelers that would be identified using each protocol's criteria, and results of the associated passenger-contacts' TB screening tests. The economic analysis compared the costs of TBCIs to avoided costs of TB treatment and mortality using a Return on Investment model.

RESULTS

The estimated in-flight transmission risk using a modified CDC protocol was 1.4%-19% versus 1.1%-24% for the 2008 protocol. Numbers of TBCIs and immediate costs to health departments were reduced by half. Long-term cost-benefits were comparable.

CONCLUSIONS

CDC's modified protocol appears to be a feasible alternative that will conserve public health resources without jeopardizing the public's health.

Authors+Show Affiliations

Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic, Infectious Diseases, Division of Global Migration and Quarantine, Atlanta, GA, USA. Electronic address: marienauk@yahoo.com.Global Health Sector, SRA International, Atlanta, GA, USA.Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic, Infectious Diseases, Division of Global Migration and Quarantine, Atlanta, GA, USA.Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic, Infectious Diseases, Division of Global Migration and Quarantine, Atlanta, GA, USA.Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic, Infectious Diseases, Division of Global Migration and Quarantine, Atlanta, GA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24206902

Citation

Marienau, Karen J., et al. "Flight Related Tuberculosis Contact Investigations in the United States: Comparative Risk and Economic Analysis of Alternate Protocols." Travel Medicine and Infectious Disease, vol. 12, no. 1, 2014, pp. 54-62.
Marienau KJ, Cramer EH, Coleman MS, et al. Flight related tuberculosis contact investigations in the United States: comparative risk and economic analysis of alternate protocols. Travel Med Infect Dis. 2014;12(1):54-62.
Marienau, K. J., Cramer, E. H., Coleman, M. S., Marano, N., & Cetron, M. S. (2014). Flight related tuberculosis contact investigations in the United States: comparative risk and economic analysis of alternate protocols. Travel Medicine and Infectious Disease, 12(1), 54-62. https://doi.org/10.1016/j.tmaid.2013.09.007
Marienau KJ, et al. Flight Related Tuberculosis Contact Investigations in the United States: Comparative Risk and Economic Analysis of Alternate Protocols. Travel Med Infect Dis. 2014 Jan-Feb;12(1):54-62. PubMed PMID: 24206902.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Flight related tuberculosis contact investigations in the United States: comparative risk and economic analysis of alternate protocols. AU - Marienau,Karen J, AU - Cramer,Elaine H, AU - Coleman,Margaret S, AU - Marano,Nina, AU - Cetron,Martin S, Y1 - 2013/10/08/ PY - 2013/07/11/received PY - 2013/09/26/revised PY - 2013/09/27/accepted PY - 2013/11/12/entrez PY - 2013/11/12/pubmed PY - 2014/9/30/medline KW - Air travel KW - Contact investigation KW - Cost–benefit analysis KW - TB KW - Transmission risk KW - Tuberculosis SP - 54 EP - 62 JF - Travel medicine and infectious disease JO - Travel Med Infect Dis VL - 12 IS - 1 N2 - BACKGROUND: In-flight transmission risk of Mycobacterium tuberculosis is not well defined, although studies suggest it is low. The impact of flight-related tuberculosis (TB) contact investigations (TBCIs) on TB prevention and control is not well established, and they compete for resources with activities with established benefits. We sought to determine the risks and cost-benefits of using more restrictive criteria in comparison to the Centers for Disease Control and Prevention (CDC) 2008 protocol for TBCIs. METHODS: The risk-benefits of a modified CDC protocol were analyzed in comparison to the 2008 CDC protocol using data from flight-related TBCIs conducted in the United States from 2007 through 2009. We predicted the numbers and characteristics of case-travelers that would be identified using each protocol's criteria, and results of the associated passenger-contacts' TB screening tests. The economic analysis compared the costs of TBCIs to avoided costs of TB treatment and mortality using a Return on Investment model. RESULTS: The estimated in-flight transmission risk using a modified CDC protocol was 1.4%-19% versus 1.1%-24% for the 2008 protocol. Numbers of TBCIs and immediate costs to health departments were reduced by half. Long-term cost-benefits were comparable. CONCLUSIONS: CDC's modified protocol appears to be a feasible alternative that will conserve public health resources without jeopardizing the public's health. SN - 1873-0442 UR - https://www.unboundmedicine.com/medline/citation/24206902/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-8939(13)00168-3 DB - PRIME DP - Unbound Medicine ER -