U.S., Cdn Officials Hunt for Travellers Exposed to Dangerous TB Strain on Flights

May 30, 02:06 AM

Current Headlines: By HELEN BRANSWELL

(CP) - Public health officials in a large number of countries - including Canada - are scrambling to find travellers exposed on two international flights to a man with a dangerous form of tuberculosis who travelled to and through Europe against the advice of authorities.

The unidentified man, an American citizen, had been ordered by American authorities not to board a commercial transatlantic flight. But he slipped back into North America by flying through Montreal on May 24.

The passengers who sat around him on Czech Airlines flight 0104 from Prague to Montreal's Pierre Trudeau International Airport are among the people authorities are now trying to track so they can urge them to undergo tuberculosis testing.

The man - who drove from Montreal to New York City via the border crossing at Champlain, N.Y. - is infected with extensively drug resistant tuberculosis, an often fatal form of TB which is resistant to most antibiotics used to target the disease.

"I think that's a question that only he can answer," Dr. Martin Cetron, director of global migration and quarantine for the U.S. Centers of Disease Control in Atlanta said when asked if the man flew to Canada to evade a U.S. no-fly order.

"But we informed him how important it was for him not to take commercial flights, how important it was to stay put, what the options were for getting immediate assistance in Italy," Cetron told The Canadian Press in an interview.

The CDC even dispatched a doctor - a former CDC TB division staffer who now works for Italy's Ministry of Health - to meet with the man to discuss how he could be safely returned to the United States.

"When the ... ex-CDC physician went to meet with him and try to provide some reassurance - because we recognize it's a scary diagnosis - he had already left. Checked out of the hotel," Cetron said.

The man is currently being held under a U.S. federal quarantine order, the first the CDC has issued since 1963.

"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 on Tuesday.

"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."

Dr. Howard Njoo, director-general of the Public Health Agency of Canada's centre for emergency preparedness and response, echoed the view that most passengers on the Montreal-bound plane were probably not at risk.

"Based on past studies and also the way air ventilation works in airplanes, there's been little concern because all these modern jets have what we call HEPA filters," Njoo said in a separate briefing from Ottawa.

"So even though the air is recirculated TB bacteria would be trapped by the filters in the ventilation system."

But 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."

Njoo would not reveal where on the plane the man was seated. The Public Health Agency is urging people who were on the flight to phone a special toll-free number, 1-866-225-0709, as it tries to find the people who sat in the same row as well as the two rows in front and behind the man.

Njoo said the agency is also working with the airline to identify who was on the flight and is putting those people in contact with their local public health authorities for followup.

Gerberding revealed that the man, a resident of Georgia, left Atlanta on May 12 on Air France flight 385, arriving in Paris the next morning.

It appears he had not yet received the diagnosis of XDR-TB, as it is often called. But he did know he was infected with a drug-resistant strain of tuberculosis and he had been told by his local public health department that he should not fly.

"All were aware, as he was, not only that he had tuberculosis but that his strain was not susceptible to first-line agents (antibiotics), at the very least it was multi-drug resistant and that additional susceptibility testing was underway," Cetron said.

"We didn't learn about the XDR (diagnosis) until, I think it was on the 22nd and that's when we actually reached out to find him in Italy."

In an interview with the Atlanta Journal-Constitution, the man said he had travelled to Europe for his wedding and honeymoon and expressed frustration with how he said the CDC handled the situation.

"I didn't want to put anybody at risk," the man, who declined to be identified because of the stigma surrounding his condition, told The Atlanta Journal-Constitution. "We just wanted to come home and get treatment."

The man conceded that the health department advised him not to travel, but he didn't want to call off his wedding, he told the newspaper.

Cetron said authorities are still working to find out how many countries the man visited or travelled through. He said it's thought the man and his wife travelled using a variety of modes of transportation, including short-haul flights. But it is believed long-term exposure - of the sort possible on a long-haul flight - is needed to potentially become infected.

Cetron said he learned "in the wee hours of Friday morning" that the man had slipped back into the United States. So he called him on his cell phone and the man answered.

"I implored upon him the importance of being compliant and going to the hospital in New York City," Cetron said. The man agreed to report to an isolation facility there for assessment.

He was flown back to Atlanta on Monday on the CDC's jet.

"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.

"I want to emphasize that from our perspective no laws were broken here," she added.

The man is currently being treated in isolation in Atlanta. Cetron 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.

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, Canada has reported two cases of XDR-TB. 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.

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.