U.S. Health department roles and challenges in conducting contact evaluation for tuberculosis aircraft contact investigations

Objectives: To describe the experiences of U.S. tuberculosis (TB) program officials participating in contact investigations after TB exposures on aircraft in order to 1) characterize barriers to participation and 2) better understand reasons for low return of outcomes data. Methods: We surveyed 51 TB professionals representing 47 jurisdictions about their experiences participating in TB aircraft contact investigations coordinated by the U.S. Centers for Disease Control and Prevention (CDC). Results: Most jurisdictions (43/47, 91%) reported that they attempt an evaluation for every contact in their jurisdiction, and a smaller proportion (33/47, 70%) reported that they always participate in voluntary return of outcomes to CDC. Approaches to distributing and completing requests for evaluation were highly variable, but in most cases (32/47, 68%) involved contributions by both state and local jurisdictions. Common challenges in evaluating contacts included difficulty reaching exposed individuals due to incorrect locating information or contact non-responsiveness (36/47, 76%), as well as limited staffing (24/47, 51%) and resources (17/47, 36%). Barriers to returning outcomes to CDC included (for states) difficulty getting responses from local jurisdictions (24/38, 63%), limited staff (17/47, 36%), and limited resources (16/47, 34%). Public health implications: Many high-income, low TB burden countries, including the United States, conduct TB aircraft contact investigations, but limited available data suggest that TB transmission on aircraft is likely rare and not well-documented. Given the substantial challenges many jurisdictions reported, it may be appropriate for CDC to reconsider its approach to investigating TB exposure events on aircraft.