Bacterial meningitis exposure during an international flight: lessons for communicable pathogens.

Air transport of infectious patients presents challenges for screening, post-exposure follow-up of fellow passengers, and international coordination issues. This report illustrates how an index case may not receive a clear diagnosis until days after the flight of interest, complicating treatment and fellow passenger tracking. This patient was diagnosed with meningococcal meningitis after a transatlantic flight with over 200 other passengers. In such cases, prompt initiation of public health measures and rapid coordination between various agencies may be required to limit outbreaks. Similar concerns will likely complicate intentional pathogen exposures; however, there may also be additional challenges related to unfamiliar pathogens and legal or political limitations to information sharing. For meningococcal disease, published guidelines exist to assist in determining which passengers and health-care workers meet criteria for antimicrobial chemoprophylaxis.