When you hear hoofbeats, think horses, not zebras: Monkeypox or bed bug bites quarantine a plane.


In a previous post, we discussed the power of tiny creatures (alleged to be head lice) so mighty that they briefly shuttered Newark’s Penn Station. For this installment, we’ll discuss a small crisis presumably involving other pests and their impressive ability to ground an airliner.

In this case it was a Delta commuter jet (with passengers) that was quarantined on the tarmac at Chicago’s Midway airport for a few hours because of fears that a one passenger had a dreaded infectious disease. The passenger, a 50 year old Minnesota woman, was returning from Uganda. Apparently, a child she was visiting and trying to adopt there manifested with pus-filled red bumps on the skin. This prospective adoptive parent also complained of some skin lesions of her own.

During a layover in Detroit, she innocently triggered what turned into a reality TV version of the ‘telephone game’ we may recall from our own childhood. In a telephone call to her mother, the traveler described the skin lesions. Her mother then phoned a local hospital for advice. Hospital workers, in turn, contacted the CDC. When Delta commuter flight 3163 landed in Chicago, it was surrounded by phalanx of police cars, fire trucks and ambulances. Local health officials wearing protective garb and masks boarded to inspect and interview the traveler, and to capture digital images of her lesions. Initial suspicions focused on monkeypox (caused by a virus related to smallpox). Monkeypox is a real public health threat and can cause considerable morbidity and mortality.

monkeypox lesions

Close-up of monkeypox lesions on the arm and leg of a female child.
(image courtesy of CDC Public Health Image Library, 1971)

The monkeypox presumption represents the ‘zebra’ conclusion in response to the sound of hoofbeats. Whereas exotic pathogens should, indeed, be considered (being the travel history involved), the more mundane ‘horse’ conclusion is a safer bet. The federal and local health experts quickly ruled out monkeypox as the cause, and the passengers were released, having been inconvenienced for just a few hours. That’s a fairly remarkable turnaround considering the circumstances involved. Many readers likely have experienced their own delays, some considerably longer, because of poor weather, maintenance issues or other events at the airport. So, kudos to CDC and the local health officials for their remarkable efforts to protect the public health. Perhaps, they applied this well-devised and useful algorithm in their assessment.

Ah, but if it wasn’t monkeypox, then what caused this traveler’s irritation? An outbreak of news reports mentioned that health authorities or others postulated that the lesions most likely resulted from bed bug bites. Yet other reports suggested scabies mites as the cause of the lesions. What were the bases for these alternative conclusions, and with what assurance could they be delivered?

Bed bugs (or the fear of encountering them) are the modern day plague of travelers. Populations of the more cosmopolitan bed bug (Cimex lectularius) have, indeed, resurged recently throughout North America and Europe, but they’ve always been somewhat frequent bed companions elsewhere around the globe. To add insult to injury, their closely related old world cousins, Cimex hemipterus, also list human beings as menu entree choices. Could this traveler have had strange encounters of the bed bug kind during her visit to Uganda? Absolutely, and she could have also encountered these at virtually every other stopover along her journey.

Had the lesions resulted from bed bug bites? Without a confirmed sighting of a bona fide bed bug, one is limited to speculating the cause based on the appearance of the lesions and activities of the injured party. Any conclusions as to the identity of the villain rest upon very shaky terrain. Some persons bitten by bed bugs may suffer no obvious signs of such encounters. Less fortunate folks may exhibit profound dermal lesions and systemic symptoms (unusual, but possible). More often, the bites might resemble those caused by mosquitoes, fleas, or a myriad of other creatures. With few exceptions, there’s really no good way to proclaim the cause of a bite without observing the culprit in the act or at least nearby.

If this traveler suspected she had been bitten by bed bugs or other pests while overseas (or elsewhere), she could have submitted digital images of them to IdentifyUS LLC for a rapid and expert evaluation. She’d have received a reply with our insight and guidance within the day, and likely in just hours. This information could have resolved the mystery, unburdened her from these concerns and averted the inconvenience to her and her fellow passengers. Even if bed bugs were the culprits, they’d not be traveling on her person. She would not pose risk (of bed bugs) to anyone else - but her checked and carry on baggage might if bugs were hiding within. Let’s hope that there were no stowaway bugs within her possessions. She likely would have benefited by reading our guidance on safe traveling.

With all this said, the bed bug conclusion is merely a presumption. Assuming that her injuries were caused by contact with an arthropod, the list of potential villains could also include: lice, fleas, mosquitoes and a myriad of other biting flies, a panoply of biting and/or infesting mites, stings from ants and their relatives, or contact with irritating hairs and exudates from a even larger array of insects. Then again, red pus-filled lesions might result from diverse infections or exposure to plant-derived irritants.

At the end of the day, this event caused a small amount of anxiety for the traveler and a few others. A little inconvenience and due diligence can make life far safer for everyone concerned. What we described here is not an isolated incident by any means. We’ve been consulted multiple times by officials of major airlines and transportation agencies because of a real or presumed insect stowaway within the cabin, the cargo hold, or even on or in a passenger. The distress caused to passengers, flight crews, maintenance workers and fiscal bean counters for the airlines (and other transportation providers) have been profound. For the passengers and flight crews, any such incidents could be markedly reduced by seeking insight from good travel medicine clinicians long before departing on travel to exotic locations, and by exploiting eHealth / mHealth resources such as those provided by IdentifyUS. We’re just a mouse click away from your computer or just ask Siri to ‘Search the web for IdentifyUS’.

Furthermore, we are prepared to offer helpful insight and valuable guidance to those in the transportation arena, whether they pertain to travel by airplanes, ships, trains or other vehicles. Our proactive and reactive strategies will help reduce risk and protect the physical as well as fiscal health of your companies, employees, passengers and clients.

We’ll describe yet other such incidents and missteps in forthcoming installments of this blog. Stay tuned.

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