Authorities Look for Travellers Exposed to Man Infected With XDR-TB

May 29, 05:07 PM

Current Headlines: By HELEN BRANSWELL

(CP) - Public health authorities in the United States, Canada and a number of other countries are looking for international travellers who may have been exposed to an individual infected with a dangerous and highly drug resistant form of tuberculosis.

Officials of the U.S. Centers for Disease Control said Tuesday that the man, a U.S. citizen, travelled to Paris on May 12, then returned from Prague to Montreal on May 24 on Czech Airlines flight 0104. From Montreal he drove to New York City.

He is infected with extensively drug resistant tuberculosis, an often fatal form of TB which is resistant to most antibiotics used to target the disease.

"We have no suspicion that this patient was highly infectious (when he was travelling)," CDC Director Dr. Julie Gerberding said during a teleconference from Atlanta.

"In fact, the medical evidence would suggest that his potential for transmission would be on the low side, but we know it isn't zero."

The man is being treated in Atlanta under a federal quarantine order, the first the CDC has issued since 1963.

"We always want to balance personal liberties with the requirement to protect people's health," Gerberding said.

"But in this situation, because this organism is so potentially serious and could cause such serious harm to people, especially those that would have other medical conditions that would reduce their immunity, we felt it was our responsibility to err on the side of abundant caution and issue the isolation order to assure that we were doing everything possible to protect people's health."

Public health authorities around the world are gravely concerned about the rise of extensively drug resistant TB, which has been found in 37 countries to date.

To date, Canada has reported two cases of XDR-TB, as it is often called. Both were in Ontario. One was reported in 2003 and the other in 2006. In the United States, 49 cases occurred between 1993 and 2006.

Gerberding said the CDC is recommending that people who sat near the man on the two transatlantic flights - beside or two rows in front and two rows behind - be tested for tuberculosis.

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

Dr. Michael Gardam, a tuberculosis expert in Toronto, said people who sat near the man on those two flights face months of testing and uncertainty.

"That's the real . . . tough story here, is that most of these people are not going to have been infected by this fellow, but it might be hard to know that," said Gardam, head of infection control at University Health Network, a consortium of three large Toronto teaching hospitals.

"It's going to be very anxiety provoking for the next two years."

The man, a Georgia resident, left Atlanta on May 12 on Air France flight 385, arriving in Paris on May 13.

Gerberding said he had been advised by public health authorities in Georgia he should not travel, though it is unclear whether he knew at the time he left that his strain of tuberculosis was extensively drug resistant.

On his return, he flew to Montreal. He then drove to the United States; it is believed he crossed into the U.S. at the border crossing between Lacolle, Que., and Champlain, N.Y.

When CDC officials learned he had returned to the U.S. they tracked him down in New York City and he agreed to drive himself to a medical facility there. He was later flown back to Atlanta on the CDC's private plane.

"We did not feel it was safe for him to fly on commercial aircraft so we took the unusual step of using government resources to bring him back to Georgia in the safest way that we could as quickly as we possibly could arrange it," Gerberding said.

The man is currently being treated in isolation in Atlanta. Dr. Martin Cetron, the CDC's director of global migration and quarantine, said federal quarantine orders remain in place until the subject is no longer a threat to others or until authorities are persuaded the person will comply with all instructions aimed at eliminating the risk to others.

It is estimated that XDR-TB is fatal in more than 50 per cent of cases. It is particularly dangerous for people infected with HIV. So far roughly 90 per cent of HIV-AIDS patients who have become infected with XDR-TB have died.