Posted on 05/30/2007 3:49:49 PM PDT by TornadoAlley3
ATLANTA -- A man with a form of tuberculosis so dangerous he is under the first U.S. government-ordered quarantine since 1963 had health officials around the world scrambling Wednesday to find about 80 passengers who sat within five rows of him on two trans-Atlantic flights.
The man told a newspaper he took the first flight from Atlanta to Europe for his wedding, then the second flight home because he feared he might die without treatment in the U.S.
Centers for Disease Control and Prevention Director Julie Gerberding said Wednesday that the CDC is working closely with airlines to find passengers who may have been exposed to the rare, dangerous strain. Health officials in France said they have asked Air France-KLM for passenger lists, and the Italian Health Ministry said it is tracing the man's movements.
"Is the patient himself highly infectious? Fortunately, in this case, he's probably not," Gerberding said. "But the other piece is this bacteria is a very deadly bacteria. We just have to err on the side of caution."
Dr. Martin Cetron, director of the CDC's division of global migration and quarantine, said Wednesday that the agency was trying to contact 27 crew members from the two flights for testing and about 80 passengers who sat in the five rows surrounding the man. About 40 or 50 of those people sat in or near Row 51 on the Air France flight from Atlanta to Paris, and about 30 passengers were in or near seat 12C on the second flight, from Prague to Montreal.
Health officials said the man had been advised not to fly and knew he could expose others when he boarded the jets.
The man, however, told The Atlanta Journal-Constitution that doctors didn't order him not to fly and only suggested he put off his long-planned wedding in Greece. He knew he had a form of tuberculosis and that it was resistant to first-line drugs, but he didn't realize until he was already in Europe that it could be so dangerous, he said.
"We headed off to Greece thinking everything's fine," said the man, who declined to be identified because of the stigma attached to his diagnosis.
He flew to Paris on May 12 aboard Air France Flight 385, also listed as Delta Air Lines codeshare Flight 8517. While he was in Europe, health authorities reached him with the news that further tests had revealed his TB was a rare, "extensively drug-resistant" form, far more dangerous than he knew. They ordered him into isolation, saying he should turn himself over to Italian officials.
Instead, the man flew from Prague to Montreal on May 24 aboard Czech Air Flight 0104, then drove into the United States at Champlain, N.Y. He told the newspaper he was afraid that if he didn't get back to the U.S., he wouldn't get the treatment he needed to survive.
He is now at Atlanta's Grady Memorial Hospital in respiratory isolation.
A spokesman for Denver's National Jewish Hospital, which specializes in respiratory disorders, said Wednesday that the man would be treated there. It was not clear when he would arrive, spokesman William Allstetter said.
"The patient continues to feel well and be asymptomatic. He's currently still in isolation," Cetron said Wednesday. Citing privacy concerns, he said the CDC "cannot and won't talk further about this patient."
The other passengers on the flights are not considered at high risk of infection because tests indicated the amount of TB bacteria in the man was low, Cetron said.
But Gerberding noted that U.S. health officials have had little experience with this type of TB. It's possible it may have different transmission patterns, she said.
"We're thankful the patient was not in a highly infectious state, but we know the risk of transmission isn't zero, even with the fact that he didn't have symptoms and didn't appear to be coughing," Gerberding said on ABC's "Good Morning America."
"We've got to really look at the people closest to him, get them skin tested."
Dr. Howard Njoo of the Public Health Agency of Canada said it appeared unlikely that the man spread the disease on the flight into Canada. Still the agency was working with U.S. officials to contact passengers who sat near him.
Daniela Hupakova, a spokeswoman for the Czech airline CSA, said the flight crew underwent medical checks and are fine. The airline was contacting passengers and cooperating with Czech and foreign authorities, she said. Health officials in France have asked Air France-KLM to provide lists of passengers seated within two rows of the man, an airline spokeswoman said on condition of anonymity according to company policy.
The man told the Journal-Constitution he was in Rome during his honeymoon when the CDC notified him of the new tests and told him to turn himself in to Italian authorities to be isolated and be treated. The CDC told him he couldn't fly aboard commercial airliners.
"I thought to myself: You're nuts. I wasn't going to do that. They told me I had been put on the no-fly list and my passport was flagged," the man said.
He told the newspaper he and his wife decided to sneak back into the U.S. through Canada. He said he voluntarily went to a New York hospital, then was flown by the CDC to Atlanta.
He is not facing prosecution, health officials said.
"I'm a very well-educated, successful, intelligent person," he told the paper. "This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary-confinement-in-Italy thing."
CDC officials told The Associated Press they could not immediately comment on the interview.
Health officials said the man's wife tested negative for TB before the trip and is not considered a public health risk. They said they don't know how the Georgia man was infected.
The quarantine order was the first since the government quarantined a patient with smallpox in 1963, according to the CDC.
Tuberculosis is caused by germs that are spread from person to person through the air. It usually affects the lungs and can lead to symptoms such as chest pain and coughing up blood. It kills nearly 2 million people each year worldwide.
Because of antibiotics and other measures, the TB rate in the United States has been falling for years. Last year, it hit an all-time low of 13,767 cases, or about 4.6 cases per 100,000 Americans.
Health officials worry about "multidrug-resistant" TB, which can withstand the mainline antibiotics isoniazid and rifampin. The man was infected with something even worse -- "extensively drug-resistant" TB, also called XDR-TB, which resists many drugs used to treat the infection.
There have been 17 U.S. XDR-TB cases since 2000, according to CDC statistics.
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Associated Press writers Malcolm Ritter in New York and Rob Gillies in Toronto contributed to this report.
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On the Net:
CDC: http://www.cdc.gov/
Public Health Agency of Canada: http://www.phac-aspc.gc.ca/
His wife will have to be retested in a few weeks...the jury is still out.
I think she'll need another test in a couple of months or so to confirm that, though. Ditto for the passengers and crew.
if you wish to believe that one must “inhale” it, go right ahead. There are many ways for any organism to reach your respiratory tract/lungs.....they are discussed widely every fall as the “cold season” approaches.
You CAN inhale it and come down with an active case of TB.....that much is true......but it’s not much of the whole truth.
What are the odds that this jerk is a registered DemocRAT?
Not really. In the early 20th century (and probably before that), New Orleans was a TB nightmare. You could actually get it by walking barefooted through a place where someone with TB had spit—yeah, I know, who walks in New Orleans barefooted, but some did—and this was one of the reasons (or so I was told) that laws were passed about spitting on the street.
I’m not in the medical profession, so perhaps someone can correct me if I’m wrong, but I don’t think these are technically bacteria—I think they called them “spores” and all they needed to grow was (like mold) warmth and moisture.
Personally, if I had been on one of those planes with all the recycled air and all, I’d get a test no matter what row I was in.
Huh. I thought our health system stunk and Europe'socialist health system was the pinnacle of perfection.
Our health system is the best in the world — particularly for exotic things — but only if you can afford it.
Don't shoot the messenger, pard. That's what all the docs are saying. They've got MDs and I don't :)
More on the patient, who's a lawyer, from this link
Last I knew over 90% of my county's budget was going to Medicaid. Trust me, lots of folks can afford it.
Extensively Drug-Resistant Tuberculosis (XDR TB) Posted: April 2007
From the link:
TB is not spread by shaking someone’s hand sharing food or drink touching bed linens or toilet seats sharing toothbrushes kissing smoking or sharing cigarettes
The best healthcare services aren’t paid by insurance, they’re paid “out of pocket.” More and more people (who can afford it) are either giving up on insurance or taking as little as possible.
For the typical doctor, hospital etc. it’s about the same in Europe as most parts of the U.S.
Not to mention the fact that you get sometimes get a discount if you pay in cash. I think that's a great idea for run of the mill complaints. Save insurance for the big stuff.
No, I’m talking about boutique or concierge medicine, which is one of the fastest growing fields. The doctors in this field don’t accept insurance, limit the number of patients in their practice and make house/office calls.
you can get it by “inhaling” it, for sure....I haven’t said that’s not true, in case you didn’t notice.
But that ain’t the half of it!
Any (repeat any) way this organism can reach a respiratory tract is transmission.
If one were to step into TB-laden spit and unknowingly transfer it to the mouth and respiratory tract....BINGO....transmission!
Many asian countries have laws about spitting....TB is the reason.
The organism does not care one whit how it gets from one respiratory tract/set of lungs to the next.
Cold and honest fact is that this organism does it the same ways that others do......
The germ is very small and can float distances thru the air. That’s why active cases are isolated in negative pressure rooms. A surgical mask won’t protect you. I’m not an expert but I would think everyone on the plane was exposed.
scenario at hand
Pt with extreme-drug-resistant TB - in his lungs, trachea, mouth, nose, on his fingers, etc etc....long airline trip - talking, breathing, clearing throat, coughing (hopefully covering his mouth with hands - up to restroom, with organism on hands/fingers, uses latch on door - whoops! tourist B comes along, maybe chit-chats with him at close quarters near door to restroom.....then uses both inner and outer doorlatches after the patient.....returns to his seat (maybe 15 rows from the patients seat), deposits it onto the armrest he/she shares with person in next seat.....
CDC and politicals are downplaying this.....they will tell you that it is “inhaled”....true enough....but far from the whole truth.....this guy should have been quarantined when they found him in Italy.....his trail of possible and even likely exposure will ultimately be of interest to people in 4 countries besides the US and those on the same airliners. Granted, the contagion of this case is no greater or less than any other TB or respiratory disease.....but they call this strain “Extremely Drug Resistant TB” for a very good reason.....its resistance to TB drugs.....dramatically increases its morbidity and mortality.
Most people get TB by respiratory transmission though.
I neither agree or disagree.....and it is probably impossible to prove, because any experiments to prove or disprove modes of transmission would be unethical.
I DO surely believe that it is transmitted by small droplets of spittle containing the organism.....common sense wrt all respiratory diseases is self-explanatory. (despite claims to the contrary).
I would LOVE to see the folks at CDC who claim mosquitos don’t vector AIDS spend a few nights in a mosquito rich environment with a bunch of known HIV + people.......think they would? Not a chance! So much for their integrity.
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