Transatlantic Passengers May Have Been Exposed To Drug Resistant TB

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Main Category: Tuberculosis
Also Included In: Respiratory / Asthma;  Public Health
Article Date: 30 May 2007 - 9:00 PDT

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The US Centers for Disease Control and Prevention (CDC) have alerted the media they are keen to locate transatlantic airline passengers who may have sat close to a man who is known to have travelled twice across the Atlantic while infected with the extensively drug resistant strain of tuberculosis known as XDR TB.

CDC Director Dr Julie Gerberding told the media in a telebriefing yesterday that the man left Atlanta in the US on 12th May on an Air France flight number 385 and landed in Paris on the 13th. He then left Prague in the Czech Republic on Czech Air Flight 0104 and arrived in Montreal, Canada on Thursday 24th May. He returned to the US from Canada by car.

Passengers who sat near the man during these two long haul flights may be at risk of infection. The CDC, in line with World Health Organization guidelines, urged health officials in the states and countries where those passengers now are to contact them and make sure they get tested for TB.

Passengers who were on the flight but did not sit near the man are not thought to be at risk but the CDC urges health authorities to contact them as well to ask them to be tested and put their mind at rest.

It was not until the man had left the US that it was discovered that he had the drug resistant version of tuberculosis, XDR TB, which does not respond to antibiotics.

Gerberding said that in situations where a person is known to have TB, they are placed in a "covenant of trust" where a request is made that they do not put themselves in a situation where they could infect others. She said officials knew the man had compelling reasons to travel when he did, which was before it was known that the form of TB he had was the drug resistant version.

Gerberding said the man is now in isolation while he undergoes a medical evaluation, following which they expect to be "able to provide the best technical expertise in designing a treatment regimen that would be best suited for his organism".

According to media reports, the man is in respiratory isolation at Atlanta's Grady Memorial Hospital and is reported to have told the Atlanta Journal-Constitution newspaper that he flew to Canada to avoid American authorities. Apparently they contacted him on his honeymoon in Italy to tell him about the seriousness of his condition and that he should turn himself over to the Italian authorities. He said he went back to the US because it was where he was most likely to get the treatment he needed to survive.

The CDC feel that the man was not highly infectious during his travels, and medical evidence suggests his "potential for transmission would be on the low side".

However, because he sat for so long near to other people, there is a chance that one or more of the other passengers, due to their own medical history, could have been more vulnerable than an average traveller. So on balance, in view of the fact this is a serious form of TB, despite the fact the man may not have been very infectious, the CDC decided to alert the authorities and the media to ensure all exposed passengers get tested.

The CDC emphasized that people should not be concerned about the passengers who were exposed now being a risk to others because TB takes a long time to evolve which leaves plenty of time for those passengers to be located and get tested.

According to the WHO, one in three people in the world in infected with dormant TB bacteria. People get ill when the bacteria become active, which can happen when the infected person's immune system gets weak, for example by catching HIV, getting old, or some other reason. It spreads from person to person when an infected person coughs, sneezes or spits close enough for the other person to breathe in some of the active bacteria. TB mostly affects the lungs.

TB is usually treated with first-line drugs, but if these drugs are misused or mismanaged, for instance if the course is interrupted or stopped before it should, then the disease develops to a multidrug-resistant TB (MDR-TB). MDR-TB is treated with second-line drugs, which take longer and are more expensive. XDR TB is resistant to both first and second-line drugs, making its control a high priority for public health throughout the world.

The WHO does not know how many people in the world are infected with XDR TB, but they suggest it is very rare. They estimate about half a million people worldwide have MDR TB, and this usually has to occur before a person contracts XDR TB.

The CDC did not say how the man in Atlanta contracted XDR TB.

Click here for the full transcript of the CDC media briefing.

Click here for Frequently Asked Questions about XDR TB (from the WHO).

Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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