2 Flights Carried Man With Deadly TB

http://www.nytimes.com/2007/05/29/he...gewanted=print
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May 29, 2007
2 Flights Carried Man With Deadly TB

By BRIAN KNOWLTON

WASHINGTON, May 29 — Public health officials today urged the
passengers and crew of two recent trans-Atlantic flights to get
checked for tuberculosis, after learning that a man with an
exceptionally deadly and drug-resistant form of the disease had flown
on the planes.

The man, an American who was not identified, flew on May 12 from
Atlanta to Paris aboard Air France Flight 385, then traveled on May 24
from Prague to Montreal aboard Czech Air Flight 410 before driving
back to the United States, the Centers for Disease Control announced.
He is currently hospitalized in an isolation ward.

Dr. Julie Gerberding, director of the Centers for Disease Control,
announced the matter personally.

While tuberculosis is not highly transmissible, the deadliness of this
strain — and the ease of modern transportation — underscored the need
for rapid response, as with the SARS virus epidemic of a few years
ago.

A federal quarantine order has been issued — the first in decades —
and the C.D.C. is working with state and local health departments,
airline officials, international health ministries and the World
Health Organization, Mr. Gerberding said, according to Bloomberg News.
“We felt it was our responsibility to err on the side of abundant
caution and issue the isolation order,� she said.

Tuberculosis had been a leading cause of death even in the developed
world until the development of streptomycin in the 1940s. Today,
treatment by anti-tuberculosis drugs like isoniazid and rifampicin can
cure up to 95 percent of patients.

But those and other so-called first-line drugs do little against a
type of tuberculosis known as multidrug-resistant TB, or MDR TB. More
worryingly, the type of tuberculosis found in the infected American —
known as extensively drug-resistant tuberculosis, or XDR TB — resists
treatment even by three of the six second-line drugs used when
first-line drugs fail. Only two cases of the strain were found last
year in the United States.

Tuberculosis is typically spread by sneezing or coughing, and the
C.D.C. said the man potentially was infectious during the two flights.

Health officials recommended medical exams for cabin crew members on
the flights, as well as passengers sitting within a few rows of the
man. Dr. Gerberding would not say the row in which he sat, but the
doctor said the nearby passengers would be contacted. More information
can be obtained at the Web site of the Centers for Disease Control,
www.cdc.gov.

Antibiotics have helped lower tuberculosis rates for years, also
though the CDC found some resurgence starting in 1985, particularly
among recent immigrants and people infected with HIV, the virus that
causes AIDS. Still, TB cases hit an all-time low last year in the
United States of 13,767, according to The Associated Press.

But tuberculosis is still deadly, particularly in countries where
medical care is lacking, killing about 1.6 million people each year
worldwide. It is particularly deadly among those infected with HIV.

At any given time, one person in three worldwide is infected with
dormant tuberculosis germs, according to the World Health
Organization. People become ill when the bacteria become active,
usually when a person’s immunity declines, whether because of
advancing age, HIV infection or some other medical problem.

While first-line drugs usually are effective, multidrug-resistant
tuberculosis can develop if those medications are misused or
improperly administered. That requires treatment with more expensive —
and less well-tolerated — second-line drugs, which require treatment
courses of 18 to 24 months, compared with six to nine months for
first-line drugs.

Misuse or mismanagement of those drugs, in turn, can render them
ineffective, leading to the extensively drug resistant TB, or XDR TB.
Options for treating it are extremely limited, according to the W.H.O.
Only about 30 percent of patients can be cured.

A 2005 survey by the C.D.C. and the W.H.O. found that 10 percent of
multidrug-resistant tuberculosis strains met the definition for XDR
TB, Dr. Gerberding testified before Congress in March. Cases of the
latter were found in 17 countries, most often in the former Soviet
Union and Asia. While in the United States just 2 percent of
multidrug-resistant TB cases were XDR TB, the figure was 15 percent in
South Korea and 19 percent in Latvia.

In one outbreak in South Africa, Dr. Gerberding testified, 41 percent
of the 544 patients infected with tuberculosis were found to have
multidrug-resistant strains; of those, 53 met the definition of XDR
TB.

Of the latter group, all but one person died, on average just 16 days
after health workers had tested them.

Copyright 2007 The New York Times Company

Now this guy is defending his decision for his return flight
even after he was expressly told he was contagious and must turn himself
in for quarrantine.
I wonder if the airlines would have a case to sue him for endangering
their pax.

Federal Quarantine for TB Traveler
May 30, 7:48 AM (ET)
By MIKE STOBBE

(AP) A man with a rare and exceptionally dangerous form of tuberculosis
has been placed in quarantine by...

ATLANTA (AP) - A man with a form of tuberculosis so dangerous he is
under the first U.S. government-ordered quarantine since 1963 told a
newspaper he took one trans-Atlantic flight for his wedding and
honeymoon and another because he feared for his life.

Health officials have questioned his decision to fly from Atlanta to
Paris, and later from Prague to Montreal, citing the possibility that he
could expose other passengers. The man told the Atlanta
Journal-Constitution that while doctors told him they preferred that he
put off his long-planned wedding in Greece, they didn't order him not to
fly.

He knew that he had tuberculosis, but didn't think he was a danger, he
said.

"We headed off to Greece thinking everything's fine," said the man, who
declined to be identified in the newspaper because of the stigma
attached to his diagnosis.

Dr. Steven Katkowsky, director of the Fulton County Department of Health
& Wellness, said the man was told traveling was not advised.
The 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, then drove into the United States at the
Champlain, N.Y., border crossing.

The man, whom officials also did not identify, is at Atlanta's Grady
Memorial Hospital in respiratory isolation.

He told the newspaper he flew into Canada to avoid U.S. authorities
after they told him when he was in Italy to turn himself over to
officials there due to the seriousness of the disease. He said he
believed he had to return to the U.S. to get the treatment he needed to
survive.

Officials at the Centers for Disease Control and Prevention have
recommended medical exams for cabin crew members and passengers who sat
within two rows of the man.

"This is a bacteria that is really transmitted through the air, and
generally to people who are in closed spaces for very long periods of
time," Dr. Julie Gerberding, director of CDC, told ABC's "Good Morning
America" on Wednesday.

"So long air flights can pose a risk to some passengers, but short
flights, or people who go onto an aircraft after a patient has left, are
not at risk," she said.

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

CDC officials said the airlines were working with health officials to
contact passengers. Those who should be tested will be contacted by
health officials from their home countries.
Dr. Howard Njoo of the Public Health Agency of Canada said there
appeared to be little chance 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.

Air France-KLM (AKH) has been asked by French health authorities to
provide lists of all passengers seated within two rows of the infected
man, a spokeswoman said Wednesday.

Daniela Hupakova, a spokeswoman for the Czech airline CSA, said the
airline was informed about the man by U.S. officials. The crew of the
flight underwent medical checks and all are fine, she said.

The airline was contacting passengers to recommend they undergo testing,
and was cooperating with Czech and foreign authorities, she said.

The man told the Journal-Constitution the CDC contacted him in Rome
during his honeymoon, telling him that he had 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 paper he and his wife decided to sneak back into the U.S.
via Canada. When he arrived back in the United States, 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.

The man's wife tested negative for TB before the trip and is not
considered a public health risk, health officials said. Health officials
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 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.

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.
---
Associated Press writers Malcolm Ritter in New York and Rob Gillies in
Toronto contributed to this report.
---
On the Net:
Centers for Disease Control and Prevention: http://www.cdc.gov/
Public Health Agency of Canada: http://www.phac-aspc.gc.ca/

On Wed, 30 May 2007 08:37:26 -0700 (auzerais v) wrote:

: Now this guy is defending his decision for his return flight
:even after he was expressly told he was contagious and must turn himself
:in for quarrantine.
:I wonder if the airlines would have a case to sue him for endangering
:their pax.

A pity that the Canadians chose to disregard the US no-fly list.

--
Binyamin Dissen
http://www.dissensoftware.com

Should you use the mailblocks package and expect a response from me,
you should preauthorize the dissensoftware.com domain.

I very rarely bother responding to challenge/response systems,
especially those from irresponsible companies.

Binyamin Dissen wrote:

(auzerais v) wrote:

: Now this guy is defending his decision for his return flight even
: after he was expressly told he was contagious and must turn himself
: in for quarrantine. I wonder if the airlines would have a case to
: sue him for endangering their pax.

A pity that the Canadians chose to disregard the US no-fly list.

They don't have it. The US keeps it secret.

James Robinson wrote:
Binyamin Dissen wrote:


(auzerais v) wrote:

: Now this guy is defending his decision for his return flight even
: after he was expressly told he was contagious and must turn himself
: in for quarrantine. I wonder if the airlines would have a case to
: sue him for endangering their pax.

A pity that the Canadians chose to disregard the US no-fly list.


They don't have it. The US keeps it secret.

I wonder why they only release info on the flights to North America and
not the dates he left. This would be useful for people traveling on
those days between those points.

NotABushSupporter wrote:

I wonder why they only release info on the flights to North America and
not the dates he left. This would be useful for people traveling on
those days between those points.

????

They said what flight he left on in the earliest news releases. Here's an
example of a current article on CNN's web site prominently mentioning Air
France flight 385 on May 12 to Paris:

http://www.cnn.com/2007/HEALTH/condi...ght/index.html

Watching the CDC presser on CNN and the doc said they didn't have his
seat number on the AF flight. That he sat "somewhere between rows 17
and 49".
WTF? Can't AF give the CDC his exact seating assignment or was he
roaming around the 747 like some terrorist lothario?
Also was the Czech flight also a 747?

auzerais v wrote:
Also was the Czech flight also a 747?


The Czech flight to Montreal is an Airbus 310 if I remember correctly.

If the CDC were thouhrough, they would also publish the highway routes
this person took while driving back to Atlanta with some of the stops he
made (restaurants etc).

The USA's "no fly" list is totally useless because it is some random
list that is not shared, mostly because so many people are on it for no
reason.

If there were some internationally agreed upon list that was auditable
and with clear rules on who can and cannot be on it, then perhaps the
CDC could have added that name to it and any/all airlines would have
signaled the CDC when this guy checked in and asked for guidance.

When you consider avian flue, Sars etc, having such a worldwide list
might be of great use.

(auzerais v) wrote:

Watching the CDC presser on CNN and the doc said they didn't have his
seat number on the AF flight. That he sat "somewhere between rows 17
and 49".
WTF? Can't AF give the CDC his exact seating assignment or was he
roaming around the 747 like some terrorist lothario?

They're probably trying to avoid alarming people until they have notified
everyone. Recent news reports say that they have identified everyone who
was seated within two rows of him on all flights, including those he took
around Europe.

Also was the Czech flight also a 747?

A-310

On May 30, 1:35 pm, (auzerais v) wrote:
Watching the CDC presser on CNN and the doc said they didn't have his
seat number on the AF flight. That he sat "somewhere between rows 17
and 49".
WTF? Can't AF give the CDC his exact seating assignment or was he
roaming around the 747 like some terrorist lothario?
Also was the Czech flight also a 747?

It seems like no articles have mentioned where he might have caught
the TB in the first place. That's something that should go on the top
of the list of things that people would like to know.

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DocE


"The future ain't what it used to be." -Yogi Berra
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