Managing Outbreaks of TB On Board a Vessel

Preventing Outbreaks

The World Health Organisation estimates that up to one third of the world’s population are currently infected with either active Tuberculosis (TB) or more commonly Latent Tuberculosis Infection (LTBI) where those infected are non-contagious carriers of the disease without any active symptoms. Around 10% of those with LTBI will go on to develop active TB at some point in their lives.

The WHO Reported that in 2015:

TB was among the top 10 causes of death worldwide las year.
10.4 million people fell ill from TB.
1.8 million people died from TB.

TB or LTBI is present throughout the world however they have a significant prevalence across developing nations in Africa, Central and South East Asia. Some of the most notable countries affected by TB are India, Pakistan, Nigeria, China and South Africa. Screening crewmembers through a skin test (TST) or blood test (IGRA) as part of the employer’s pre-employment medical examination (PEME) is key to the prevention of outbreaks on board a vessel. Annual screening should also be considered for those frequenting high risk areas.

Managing Cases of Active TB on board

It is important that a ships designated medic or medical officer is aware of the early signs and symptoms of TB.

Common symptoms of active TB are:

Cough with sputum and blood at times,
chest pains,
weakness
weight loss,
fever and
night sweats.

Any crew presenting symptoms of active TB, particularly a productive cough lasting for more than two weeks, should be isolated and provided with an N95 rated face mask to prevent further possible spread of infection. The crew member should be disembarked at the next appropriate port to receive a chest x-ray and treatment with anti-biotics. If active TB (contagious) is confirmed, then it is important to have all crew who have been exposed to the infection (which will likely be most in the confined nature of a vessel) tested for TB to prevent further spread. This process should then be repeated 8-10 weeks after the initial test as subsequent infections may not produce a positive result immediately.

Repatriation of Crewmembers Diagnosed with Active TB

Generally, treatment for TB is swift and effective, one exception to this however is in the occurrence of a multi-drug resistant (MDR) TB which can be very difficult to treat and involve extended treatment regimens of 6 – 12 months in many cases.

Patients will often be asymptomatic after 14 days of treatment with antibiotics and will be well enough to return home un assisted. Airlines are understandably cautious about accepting passengers recently diagnosed with active TB and all will usually request a certificate from the treating doctor confirming that a passenger is not contagious.

For a passenger to be considered non-contagious they must meet all of the below criteria;

A minimum of 14 days appropriate treatment with antibiotics
To be asymptomatic
Have three negative sputum smear tests confirmed on separate days

Many airlines will also require the submission of a Medif (medical clearance form) for authorisation prior to travel. It is important to check the requirements for each respective airline or employ the services of a specialist medical assistance operator to do this to avoid refused boarding or in a worst case scenario spread of the infection on board and the potential litigation associated with this.