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TB case brings warning to air passengers

Posted Oct 23 2008 2:23pm
A man with a rare and dangerous form of tuberculosis ignored doctors' advice and took two trans-Atlantic flights, leading to the first U.S. government-ordered quarantine since 1963, health officials said Tuesday. The man, whom officials did not identify, is at Atlanta's Grady Memorial Hospital in respiratory isolation.

He was potentially infectious at the time of the flights, so officials at the Centers for Disease Control and Prevention recommended medical exams for cabin crew members on those flights, as well as passengers sitting in the same rows or within two rows.

CDC officials did not release row numbers but said the airlines were working with health officials to contact those passengers. Passengers who should be tested will be contacted by health officials from their home countries.

The infected man flew from Atlanta to Paris on May 12 aboard Air France Flight 385. He returned to North America on May 24 aboard Czech Air Flight 0104 from Prague to Montreal. The man then drove into the United States at the Champlain, N.Y., border crossing.

The man told health officials he was not coughing during the flights. Tests indicated the amount of TB bacteria in him was low, so passengers are not considered to be at high risk of infection, said Dr. Martin Cetron, director of the CDC's division of global migration and quarantine.

The man had been told by health officials in early May that he had a form of TB that was resistant to first-line antibiotics and was advised not to travel to Europe. "He was told traveling is against medical advice," said Dr. Steven Katkowsky, director of the Fulton County Department of Health & Wellness.

Health officials said they don't know how the Georgia man was infected.

A CDC official reached the man by phone in Rome and told him not to take commercial flights, but he flew back to North America anyway. "He was told in no uncertain terms not to take a flight back," Cetron said.

Cetron reached the man once he was back in the United States. At that point, he voluntarily went to a New York hospital, then was flown by the CDC to Atlanta, where he was issued the federal quarantine order. He is not facing prosecution, health officials said.

The quarantine order was the first since 1963, when the government quarantined a patient with smallpox, according to the CDC.

The man, who went on the trip with his wife, also traveled within Europe, but CDC officials said they did not have information to release about whether the trips were by plane, train or other public transportation.

His wife tested negative for TB before the trip and is not considered a public health risk, health officials said.

CDC officials said they are concentrating on investigating the trans-Atlantic flights, when possibility of spread of the disease was greatest because he was in a confined space with other people for many hours.

Tuberculosis is a disease 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.

Three-quarters were people from foreign countries. One case was a Russian man who arrived in Phoenix last year. He was jailed after he stopped taking medications and went unmasked to a restaurant and other businesses, threatening the health of others.

The CDC's statement that the patient is at the low end of communicability "provides some reassurance," said Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University.

The highly dangerous form is "expanding around the world," particularly in South Africa, eastern Europe and the former states of the Soviet Union, he said.
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