ICAAC Highlights
Budget travelers at risk, Canadian study hints
[Editor’s note: The 38th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), held Sept. 24-27 in San Diego, included several sessions related to tuberculosis. Here are some of the highlights.]
In a study of tuberculosis skin-test conversions among travelers, Canadian researchers who’ve so far studied about 100 travelers have found a surprisingly high TB skin-test conversion rate: about 5%.
"Ten percent of Canadians leave and go overseas every year," says Kevin Kain, MD, FRCPC, director of the tropical disease unit at the Univer sity of Toronto. "Many of them are young, ranging from 18 to 25 years old, and they’re taking off on low-budget tours. They hang out for three or four months, and then they come back. There are tons of opportunities in budget travel for these young people to get exposed to TB."
So far, Kain, (along with his colleague Doug MacPherson of McMaster University in Hamilton, Ontario) have administered two-step TB skin tests to about 100 clients who attend a "travel clinic" before embarking on a vacation. Those who return with skin-test conversions are offered isoniazid prophylaxis. "In that situation, it’s a definite no-brainer," he adds.
Low-budget travel in particular may prove to be a risky proposition, Kain proposes. Certainly, prolonged jaunts to exotic ports of call offer more chances for exposure to TB than an encounter on an airline flight or other such instances of so-called "conveyance TB," he adds. "People get all excited about the dangers of contracting TB on an airplane flight, but the truth is that you go through a lot of grief for incremental improvements in peoples’ health in such situations.
"In budget travel, though, there may actually be high-risk groups that could be identified. It might be possible to do a risk-benefit analysis: Are there certain destinations, a certain budget, a certain duration that makes including a Mantoux skin test worthwhile?" he asks. Most likely, the risks, if present, will prove to include a combination of such factors, he says.
For the record, Americans are not as prone as their neighbors to the North to strike out for the open road. In the United States, only 2% of the population travels abroad every year, Kain says. But even if only a small percentage of those travelers return with positive skin tests, it could mean a Mantoux test ranks at least on a par with a trusty guidebook and a sturdy pair of jeans.
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