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TB Elimination

Tuberculosis Information for 

International Travelers 

What is tuberculosis (TB)?

Tuberculosis (TB) is a disease caused by bacteria 

that are spread from person to person through 

the air. TB usually affects the lungs, but it can also 

affect other parts of the body, such as the brain, the 

kidneys, or the spine. In most cases, TB is treatable 

and curable; however, persons with TB can die if 

they do not get proper treatment.

What is multi-drug resistant 

tuberculosis (MDR TB)?

Multidrug-resistant TB (MDR TB) is TB that is 

resistant to at least two of the best anti-TB drugs, 

isoniazid and rifampin. These drugs are considered 

first-line drugs and are used to treat all persons with 

TB disease.

What is extensively drug-resistant 

tuberculosis (XDR TB)?

Extensively drug resistant TB (XDR TB) is a rare type 

of MDR TB. XDR TB is defined as TB which is resistant 

to isoniazid and rifampin, plus resistant to any 

fluoroquinolone and at least one of three injectable 

second-line drugs (i.e., amikacin, kanamycin, or 

capreomycin).

Because XDR TB is resistant to the most powerful 

first-line and second-line drugs, patients are left 

with treatment options that are much less effective. 

XDR TB is of special concern for persons with HIV 

infection or other conditions that can weaken the 

immune system. These persons are more likely to 

develop TB disease once they are infected, and also 

have a higher risk of death once they develop TB.

How is TB spread?

Drug-susceptible TB and drug-resistant TB are 

spread the same way. TB bacteria are put into the 

air when a person with TB disease of the lungs or 

throat coughs, sneezes, speaks, or sings. These 

bacteria can float in the air for several hours, 

depending on the environment. Persons who 

breathe in the air containing these TB bacteria can 

become infected. 

TB is not spread by

• shaking someone’s hand 

• sharing food or drink 

• touching bed linens or toilet seats 

• sharing toothbrushes 

• kissing 

How does drug resistance happen?

Resistance to anti-TB drugs can occur when these 

drugs are misused or mismanaged. Examples include 

when patients do not complete their full course of 

treatment; when health-care providers prescribe the 

wrong treatment, the wrong dose, or length of time 

for taking the drugs; when the supply of drugs is 

not always available; or when the drugs are of poor 

quality.

Are international travelers at risk 

of getting drug-resistant TB while 

traveling?

Although MDR and XDR TB are occurring globally, 

they are still rare. HIV-infected travelers are at greatest 

risk if they come in contact with a person with MDR 

or XDR TB. All travelers should avoid high risk settings 

where there are no infection control measures in 

place.

Documented places where transmission has occurred 

include crowded hospitals, prisons, homeless shelters, 

and other settings where susceptible persons come in 

contact with persons with TB disease. 

Air travel itself carries a relatively low risk of infection 

with TB of any kind.

What is the risk of acquiring TB on 

an airplane?

The risk of acquiring any type of TB depends on 

several factors, such as extent of disease in the patient 

with TB, duration of exposure, and ventilation. Most 

important, there must be someone with infectious 

TB disease on the same flight to present any risk. If 

someone on the flight does have TB disease, persons 

on flights lasting 8 hours or longer are at greater risk 

than persons on shorter flights.
How can TB be prevented?

Travelers should avoid close contact or prolonged 

time with known TB patients in crowded, enclosed 

environments (for example, clinics, hospitals, 

prisons, or homeless shelters).

Travelers who will be working in clinics, hospitals, 

or other health care settings where TB patients are 

likely to be encountered should consult infection 

control or occupational health experts. They should 

ask about administrative and environmental 

procedures for preventing exposure to TB. Once 

those procedures are implemented, additional 

measures could include using personal respiratory 

protective devices.

Is there a vaccine to prevent TB?

Yes, there is a vaccine for TB disease called Bacille 

Calmette-Guérin (BCG) (http://www.cdc.gov/tb/

publications/factsheets/prevention/BCG.htm). It 

is used in some countries to prevent severe forms 

of TB in children. However, BCG is not generally 

recommended in the United States because it has 

limited effectiveness for preventing TB overall.

What should I do before traveling 

internationally?

Travelers who anticipate possible prolonged 

exposure to persons with TB (for example, those 

who expect to come in contact routinely with clinic, 

hospital, prison, or homeless shelter populations) 

should have a tuberculin skin test (TST) or TB 

blood test before leaving the United States. If the 

reaction to the TST or TB blood test is negative, 

they should have a repeat test 8 to 10 weeks 

after returning to the United States. Additionally, 

annual testing may be recommended for those 

who anticipate repeated or prolonged exposure or 

an extended stay over a period of years. Because 

persons with HIV infection are more likely to have 

an impaired response to both the TST and TB blood 

test, travelers who are HIV positive should tell their 

physicians about their HIV infection status.

What should I do if I think I have 

been exposed to someone with TB 

disease?

If you think you have been exposed to someone 

with TB disease, you should contact your doctor or 

local health department about getting a TB skin test 

or TB blood test. And tell the doctor or nurse when 

you spent time with this person.

What are the symptoms of TB disease?

The general symptoms of TB disease include feelings 

of sickness or weakness, weight loss, fever, and night 

sweats. The symptoms of TB disease of the lungs also 

include coughing, chest pain, and the coughing up of 

blood. Symptoms of TB disease in other parts of the 

body depend on the area affected. If you have these 

symptoms, you should contact your doctor or local 

health department. 

Where can I find other health 

information about my travel 

destination? 

CDC’s Travelers’ Health website (http://wwwn.cdc.gov/

travel/destinationList.aspx) lists health information for 

travelers by destination. 

CDC issues travel notices (http://wwwnc.cdc.gov/

travel/notices.htm) when there is a health threat to 

travelers. These notices describe levels of risk for the 

traveler and recommended preventive measures to 

take at each level of risk. Travel notices are organized 

by disease and by travel destination.

Additional Information

1. CDC. Questions and Answers About TB. http://

www.cdc.gov/tb/publications/faqs/default.htm

2. CDC. Tuberculosis: General Information. 

http://www.cdc.gov/tb/publications/factsheets/

general/tb.htm

3. CDC. Tuberculin Skin Testing. 

http://www.cdc.gov/tb/publications/factsheets/

testing/skintesting.htm

4. CDC. BCG Vaccine. http://www.cdc.gov/tb/

publications/factsheets/prevention/BCG.htm

5. CDC. Health Information for International 

Travel—The “Yellow Book”: Chapter 3 Infectious 

Diseases Related to Travel: Tuberculosis (2012).

http://wwwnc.cdc.gov/travel/yellowbook/2012/

chapter-3-infectious-diseases-related-to-travel/

tuberculosis.htm

6. WHO. Tuberculosis and Air Travel: Guidelines for 

Prevention and Control. http://whqlibdoc.who.int/

hq/2006/WHO_HTM_TB_2006.363_eng.pdf

http://www.cdc.gov/tb

April 2012