Man with rare tuberculosis may have infected airline passengers

[one...two...tree 2,762]

Associated Press

May. 29, 2007 12:02 PM

ATLANTA - A man with a rare and exceptionally dangerous form of tuberculosis has been placed in quarantine by the U.S. government after possibly exposing passengers and crew on two trans-Atlantic flights earlier this month, federal health officials said Tuesday.

This marks the first time since 1963 that the government issued a quarantine order. The last such order happened in 1963, to quarantine a patient with smallpox, according to the Centers for Disease Control.

The CDC urged people on the same flights to get checked for the infection.

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 104 from Prague to Montreal. The man then drove into the United States.

He cooperated with authorities after learning he had an unusually dangerous form of TB. He voluntarily went to a hospital and is not facing prosecution, officials said.

The man is hospitalized in Atlanta in respiratory isolation, according to the World Health Organization. He was potentially infectious at the time of the flights, so CDC officials recommended medical exams for cabin crew members on those flights, as well as passengers sitting in the same rows or within two rows.

http://www.azcentral.com/news/articles/052...ght0529-ON.html

[Reynaldo 0]

Oh sh!t!!!

We are all going to die!!!

[homesick_american 1]

Oh sh!t!!!

We are all going to die!!!

Nah, just him.

[Kathryn41 3,205]

Here are more details from his story in today's Atlanta-Journal Constitution:

http://www.ajc.com/health/content/health/s...0530meshtb.html

Atlanta man quarantined with deadly strain of TB

CDC issues rare isolation order; air passengers warned

By ALISON YOUNG

The Atlanta Journal-Constitution

Published on: 05/30/07

An Atlanta-area man — infected with a rare and deadly type of tuberculosis — is under federal quarantine at a local hospital with an armed sheriff's deputy outside his door following his odyssey on a series of international flights, including some to smuggle himself back into the country.

The globe-trotting tale of the man, his fiancée, their wedding and honeymoon abroad — and conflicting recollections of what he was told about his disease and whether he could travel — culminated Tuesday with the Centers for Disease Control and Prevention issuing an international health alert.

RELATED LINK:

Q&A on extensively drug-resistant TB

CDC is working with airlines to contact passengers who took two transatlantic flights — a May 13 Air France flight from Atlanta to Paris and a May 24 Czech Air flight from Prague to Montreal — to alert them that they may have been exposed to extensively drug resistant tuberculosis.

The disease, also known as XDR TB, is difficult to treat and can cause severe illness and death. Only 49 such cases have been identified in the United States between 1993 and 2006.

"I didn't want to put anybody at risk," the Fulton County man, who declined to be identified because of the sensitive nature of his diagnosis, said in a telephone interview with The Atlanta Journal-Constitution. "We just wanted to come home and get treatment."

Since January the man, who said he has no symptoms and feels healthy, has met regularly for treatment with Fulton County health officials. He said they and CDC knew he had multidrug-resistant TB before he left the country, but did not prohibit him from going when he told them about his upcoming wedding in Greece.

He questioned why nobody told him to cancel his wedding before he left Atlanta — and why CDC waited until he was on his honeymoon in Rome to order him into isolation.

"I'm a very well-educated, successful, intelligent person," he said. "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."

Accidental detection

At a news conference Tuesday, CDC Director Julie Gerberding announced that the agency had taken the rare action of issuing a federal public health isolation order against the man, which allows the agency to hold someone against their will to protect the public. Gerberding believes the isolation order was last used in 1963 in a case involving a potential smallpox exposure.

"Normally when someone has tuberculosis, we influence them through a covenant of trust," Gerberding said.

While saying tests show the man is at extremely low risk of transmitting the disease, Gerberding said the agency is urging that passengers who sat in nearby seats and rows during the two long trans-Atlantic flights receive TB tests as a precaution, and that others who traveled aboard the flights be offered the opportunity to be tested if they have concerns.

"We're balancing both the needs to protect individual freedoms and the responsibility to protect the public," Gerberding said.

Gerberding and CDC officials gave few details about what prompted the issuance of a federal isolation order, other than saying the "covenent of trust" had been breached. "In this case the patient had a compelling personal reason for traveling," she said.

The man at the center of the international health incident said his TB odyssey began in January. Because he has felt healthy, the disease was detected by accident, during a chest x-ray for something else. It uncovered a small mass in one lobe of his lung. A sputum test came back negative for TB, but a more sensitive culture test confirmed the diagnosis.

"So they started putting me on the standard four-drug treatment," he said. And they tested his fiancée and other close contacts for the disease: None of them had it.

But it turned out his TB was resistant to the "first-line" drugs — and the second-drugs. So county officials stopped treatment. The man said he and his private doctor — with the agreement of county officials — made plans for him to undergo cutting-edge treatment with specialists at National Jewish Medical and Research Center in Denver after his honeymoon.

Circuitous route home

The treatment will involve surgical removal of the mass coupled with drugs to kill the infections. The man said he's been told the course of treatment could take 18 months — and that the only place that can do it is the Denver hospital.

"The county health department knew I was going over to have a honeymoon. We had a meeting before I left," the man said. He acknowledges that the health department preferred that he not travel. But reluctant to cancel his long-planned wedding, the man said he asked what does "prefer" mean? "Does it mean I can't?"

He said that without being told he couldn't — and in light of the department telling him it was fine to be around family and friends and his daughter without putting them at risk — he told them he'd be going ahead with his travel plans.

"We headed off to Greece thinking everything's fine," he said.

Dr. Steven Katkowski, director of public health and wellness for Fulton County, said it's his understanding that the man was "advised not to travel."

"I didn't hear that conversation," Katkowsi said, "certainly the recommendation would be that if you have an active infection with tuberculosis, you ought not to be getting on a commercial airliner."

Katkowski said after that conversation, the department attempted to hand-deliver a medical directive to the man telling him not to travel, but his home address was vacant and he was not at his place of business.

Katkowski and CDC officials say they only knew that the man's TB was resistant to many drugs before he left, but that the tests showing he had the most serious form of TB — XDR TB — only came back after he was in Europe.

The man says he and his bride were in Rome on their honeymoon when they got a message to call the CDC, that they needed to cancel their trip and return home and that CDC would call the next day with travel information.

The patient says he and his wife cancelled plans to move on to Florence the next day as they awaited CDC's instructions.

The next day, instead of giving the couple travel arrangements, the man said a CDC staff member told him he'd need to turn himself in to Italian health authorities the next morning and agree to go into isolation and treatment in that country for an indefinite period of time.

"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.

To evade the no-fly list, which they assumed only involved jets bound for the U.S., the man and wife flew into Canada and drove a car into the U.S.

He said he called the CDC when he was back in the country and agreed to their request to drive first to a TB isolation hospital in New York.

That's where federal officials served him with the federal isolation order, he said. The agency ultimately flew him on the CDC jet to Atlanta, where he's now in an undisclosed hospital.

The man said he wants people to understand he sneaked back into the U.S. because he feared for his life. An unsuccessful treatment in Italy would have doomed him, he said.

CDC officials did not respond to requests for further details about their handling of the case and the man's version of events.

To reach staff writer Alison Young call 404-526-7372.

MORE ON XDR TB

What are the symptoms?

The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever and night sweats. The symptoms of TB disease of the lungs may also include coughing, chest pain and coughing up blood.

Is it safe to travel where cases of XDR TB have been reported?

Although cases are occurring globally, they are still rare. HIV-infected travelers are at greatest risk if they come in contact with an infected person. Transmission has occurred in crowded hospitals, prisons and homeless shelters. Air travel itself carries a relatively low risk of infection with TB of any kind.