Air Traveler With Drug-Resistant TB Quarantined

The Centers for Disease Control and Prevention has quarantined an air passenger with a severe form of tuberculosis and is notifying people who sat near him on two international flights to get tested for the disease.

It is the first time since 1963, that the CDC has issued an order for a patient to be quarantined. Usually, such decisions are left to the states, but this case involved international and interstate travel, so the federal government stepped in.

The CDC is concerned about passengers seated in rows near the infected man on a May 13, Atlanta to Paris, Air France 385 flight and another Czech Air 0104 from Prague to Canada on May 23.

"We are focusing in on these two air lines because they are long trips, because our science indicates these are the kinds of trips that could pose a risk of transmission," said CDC Director Dr. Julie Gerberding.

The type of tuberculosis, known a XDR TB, is rare, and because it is drug resistant it is very difficult to treat. Gerberding said the agency decided to err on the side of caution to avoid any potential exposure.

"The medical evidence would suggest the potential for transmission would be on the low side. But we know it isn't zero," she said.

"We are considering not only his own ability to transmit but also the seriousness of this organism and the chance some passenger could be at a special risk on the basis of their own personal medical history," Gerberding said.

XDR TB does not respond to treatment with the usual first- or second-line tuberculosis drugs, so treatments take longer and are more costly. One case last year cost as much as a half million dollars to treat.

There have only been a few cases of people acquiring highly infectious diseases on long flights. Dr. Henry Masur, president of the Infectious Disease Society says exposure – even at close proximity — doesn't usually result in infection.

"You may breathe in the organism, but most people will not get that organism into their body to cause infection," he said.

A skin test shows whether a person is harboring the disease, which can remain latent for years. When a regular case of TB is diagnosed, it only takes one drug to treat it. If there's a reason to suspect the person has XDR TB, the treatment is not as simple.

"Generally you would pick several drugs that were active against the organism, but there's very little experience to know how many drugs or for how long you would have to treat the patient," Masur said.

And if the strain is not known, Masur said it becomes a kind of trial and error to find the right drugs.

Part of what makes XDR difficult to treat is the time it takes to identify the strain. The patient in this case knew he had TB and had been advised not to travel. But he had already left the U.S. before it was discovered that he had the XDR TB strain.

Dr. Martin Cetron of the CDC's Global migration and Quarantine Division said the man ignored CDC orders against traveling and got on a flight to Canada, and then drove into the United States.

"I spoke to him personally and requested his compliance to go to the isolation facility in New York City to be evaluated," Cetron said. "He voluntarily drove himself there, he was given instructions on how to do that safely and without putting the public health at risk."

He was then taken by CDC plane to Atlanta, where he was transferred and placed in quarantine.

Air Passenger Might Have Exposed Travelers to TB

The federal government has quarantined someone for the first time in nearly 50 years after a man with a drug-resistant form of tuberculosis — called XDR TB — traveled by airplane.

The man, who has not been identified, took two commercial flights to Europe and back to Canada, possibly exposing other passengers. Federal officials are now searching for those passengers and crew members so they can be tested. The man is being held in a Centers for Disease Control and Prevention facility in Atlanta.

Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, talks with Day To Day's Madeleine Brand.

This man was advised not to travel and did. Why?

You're dealing with human behavior. We know that, dating back to the earliest of times, there are people who, for selfish reasons, for unclear purposes, will in fact do whatever they please. In this case, this is where public health has to battle the issue of individual rights and privacy with that of the greater health good. This was a collision that was bound to happen sometime and will happen more often in the future.

Shouldn't there be more stringent rules preventing them from doing whatever they please?

This individual had been compliant with public health action. It was only with the advent of his wedding in Europe that he decided that he wasn't going to be. There was actually an order issued before he left the United States, but [public health officials] were unable to serve it on him. This just points out that you have to have extreme measures for the very, very small number of people who just won't be compliant.

Extreme measures being what?

Putting someone in a legal hold. Actually, today the terminology is a bit confusing. While what we're really talking about is holding this individual under what is called quarantine laws, it is really "isolation," where you're holding someone against their will so that they don't transmit the disease to others.

"Quarantine" is the process where we find people who may have been exposed to someone and put them under some kind of watchful eye, or in some cases actually hold them until the time period has passed in which they would have become infected.

So, technically speaking, this is really isolation. But either way you look at it, it is holding people against their will so that they will not continue to transmit to others.

Should this guy be sanctioned in some way?

What we need to do is really understand it better. What could we have done to have supported this individual in not continuing to travel?

So maybe the CDC should have sent a plane?

In the future, we're going to have more of these situations, and one of the ways we're going to help people be compliant — and this is in the public's best interest to do this — is ask ourselves what can we do to assure someone that if they are in a far distant land and have an urgent need to get home for health care, that we in fact support them in doing the right thing. That may sound like we're really taking care of them. In a sense, we're protecting the public.

This story contains only a portion of the conversation, and excerpts have been edited for clarity.

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