CDC Issues Quarantine Over Tuberculosis Case

The CDC has placed a Georgia man with a rare and exceptionally dangerous form of tuberculosis under quarantine, the first time a quarantine order has been issued in the United States since 1963. Authorities say the man may have exposed passengers and crew aboard two trans-Atlantic flights earlier this month. Robert Siegel talks with CDC Director Julie Gerberding.

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ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MICHELE NORRIS, host:

And I'm Michele Norris.

A man with a rare drug-resistant form of tuberculosis is under a federal quarantine order after returning from Europe on a commercial flight. The man flew from Prague to Montreal last week despite the fact that the U.S. had placed his name on a no-fly list, and had alerted the World Health Organization.

The Centers for Disease Control and Prevention is working to identify flight crews and travelers who may have sat near the man. The CDC is also urging people on the same flight to get tested for TB.

SIEGEL: Dr. Julie Gerberding is director of the Centers for Disease Control and joins us now. Dr. Gerberding, first, can you give us some measure of how dangerous this particular strain of tuberculosis is and how contagious the gentleman who had is?

Dr. JULIE LOUISE GERBERDING (Director, Centers for Disease Control and Prevention): Well, let me first start with the bacteria. It's in a family of tuberculosis organisms that we refer to as extensively drug-resistant. And that means that not only is it resistant to the normal drugs we would use, but it's also resistant to most of the back up drugs that we would use for treatment. So it looks right now like there's just a very small number of effective drugs left on the shelf for this bacteria and that's why it's so worrisome.

And patient himself is not showing any signs of being highly infectious. His respiratory secretions are such that you can grow the bacteria from them but you can't see it under the microscope. And what that generally means is while it's there, it's there in fairly low quantities, and we hope it stays that way. But we also know that people who have even low numbers of bacteria can still be infectious to others, and so we are airing on the side of precaution in identifying people most likely to be exposed so that they can be evaluated and tested.

SIEGEL: You described the initial relationship with this man as being typical of the CDC that you established a covenant of trust by which, I gather you mean, there was no coercion involved. And yet the man in question decided to fly to Europe not knowing exactly, I gather, what strain of tuberculosis he was suffering from.

Dr. GERBERDING: At a normal circumstance is where a person with a communicable disease is advised that they pose a risk to other people and given specific advice about what steps they should take to protect others until they're no longer a potential source.

SIEGEL: Did he decide not to follow your advice?

Dr. GERBERDING: Well, in this case, it was the county health officials who were engaged with the patient in helping him negotiate decisions about his infectivity. And our understanding is that they did advise him not to travel but he had very important personal reasons for wanting to be in Europe at this particular point in time. And I think he made his own decision that the benefit to him of traveling outweighed what he perceived to be the risk. At the time, those conversations occurred, as far as we know, no one was aware that he had the XDR form of the tuberculosis.

SIEGEL: The patient, as I understand it, flew back through Montreal on Czech Air in part because he was, by that time, on a no-fly list, and he would have been prevented from flying into a U.S. city. Is that the case and if it is the case, wouldn't we have informed other countries that this gentleman was a risk?

Dr. GERBERDING: The patient was on a no-fly order. What that means is that he should not board a commercial aircraft. And we certainly had notified the World Health Organization as well as the health ministries of countries where his family thought he might be traveling to put them on notice that it would be inadvisable for him to travel on commercial air.

The opportunity for him at that time, which he was unaware of because we were not able to communicate with him directly, was that we were actually spending a great deal of energy trying to find alternative ways to bring him home. I think if he had been aware how far we were willing to go to help him get home by a noncommercial aircraft, we might have been able to send a plane to Europe to pick him up and bring him home directly.

SIEGEL: At that point, was Czech Air, which did fly him back to Montreal, were they unaware of the no-fly order or were they operating in violation of it?

Dr. GERBERDING: You know that's one of the things that we'll have to find out. I suspect they were unaware of the no-fly order, but as we look back at how we can take steps to strengthen our ability to make sure that we don't have infected people on commercial airlines, we'll be looking into exactly what did happen at the various involved airports.

SIEGEL: Dr. Gerberding, thank you very much for talking with us.

Dr. GERBERDING: Thank you for your interest.

SIEGEL: That's Dr. Julie Gerberding, the director of the Centers for Disease Control speaking to us from Atlanta.

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