In The Days

• Source: Reuters
• Author: Will Dunham
• News Date: 5/29/07

WASHINGTON (Reuters) – The United States has isolated a man who may have exposed fellow passengers on two transatlantic flights to a strain of tuberculosis that is extremely hard to treat, officials said on Tuesday.

“For nation shall rise against nation, and kingdom against kingdom: and there shall be famines, and pestilences, and earthquakes, in divers places.”
—Matthew 24:7

It was the first time the federal government has issued such an isolation order since 1963, according to the U.S. Centers for Disease Control and Prevention.

CDC Director Dr. Julie Gerberding said authorities were trying to notify passengers who traveled aboard Air France flight 385 from Atlanta which arrived in Paris on May 13 and on Czech Air flight 0104 from Prague to Montreal on May 24.

The man, from the U.S. state of Georgia, returned to the United States by car and has been in the hospital “in respiratory isolation” since then, the CDC said. He is suffering from extensive drug-resistant TB, known as XDR TB, that resists virtually all antibiotics.

“This is an unusual TB organism, one that’s very, very difficult to treat. And we want to make sure that we have done everything we possibly can to identify people who could be at risk,” Gerberding said at a news conference.

Authorities did not identify the man, but said he had voluntarily entered a medical isolation facility in New York City.

Tuberculosis is a bacterial infection that usually attacks the lungs. It kills about 1.6 million people annually, with the highest number in Africa. It is spread through the air when infectious people cough, sneeze, talk or spit.

Gerberding said the plane passengers most likely to be at risk were those seated close to the patient.

“Consistent with the World Health Organization guidelines, CDC is recommending that those passengers be notified by their health officials in their responsible country or state, and that such persons then have a test for tuberculosis to determine whether or not they were in fact exposed,” she said.

Others aboard the planes also should be notified so they can be tested for TB, although their risk was not thought to be high, she said.

Gerberding said the patient had “compelling personal reasons” to travel and did so despite the illness. She stressed that he had not broken any laws.

“In this case, the infected patient traveled on two trans-Atlantic air flights and in doing so, may have exposed passengers and crew to XDR TB,” the CDC said in a statement.

It was working with U.S. state and local health departments, ministries of health in other countries, the airline industry, and the World Health Organization.

Dr. Kenneth Castro of the CDC’s Division of Tuberculosis Elimination said that from 1993 to 2006 CDC knew of just 49 people in the United States with XDR tuberculosis.

XDR TB requires 18 months to two years of treatment with a mixture of four to six drugs. The treatment can often require surgery as well as the newest drugs and can cost $500,000 per patient.

Multidrug-resistant TB is resistant to at least two first-line antibiotics. XDR TB is resistant to first-line antibiotics, and to an entire class of antibiotics called fluoroquinolones, as well as to at least one of three injectable drugs.

Isolation refers to the separation of persons who have a specific infectious illness from those who are healthy. Quarantine refers to the separation and restriction of movement of persons who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious.