Some International Jet Passengers Exposed to Highly Drug Resistant TB

< May. 30, 2007 > -- US health officials are looking for airline passengers who may have been exposed by a fellow passenger to a highly drug-resistant and dangerous strain of tuberculosis.

The passenger had been diagnosed with tuberculosis and advised not to travel. But on May 13, he flew from Atlanta to Paris, continued on to Prague, then took a return flight to Montreal on May 24, before driving back into the US.

"On May 13th, the patient departed on Air France flight 385 from Atlanta and arrived in Paris," Dr. Julie Gerberding, director of the US Centers for Disease Control and Prevention (CDC), says. "The patient returned in Czech Air flight 0104 to Canada, then entered the United States by car."

After returning to the United States, the man was contacted by the CDC and asked to check himself into the isolation ward of a New York City hospital, which he did. On Monday, he was flown home in a CDC plane to Atlanta, where he remains hospitalized.

Close By Passengers At Greatest Risk

The man was infected with "extensively drug-resistant" TB, also called XDR-TB, which resists many drugs used to treat the infection.

"This patient may have been a source to the passengers," Dr. Gerberding says. "The passengers most likely to be at risk would be the passengers who were seated immediately close to the patient," she adds.

Passengers on both flights came from many countries and states, Dr. Gerberding says.

All Passengers Need to Be Identified for Surveillance

Dr. Gerberding says the CDC is working with local health officials to identify passengers on the two jetliners. She advises these passengers to be tested for tuberculosis.

The CDC is also asking the local health officials to notify the passengers of their potential risk. "While we don't think that their risk is high, we want to offer them the opportunity to be evaluated and tested," Dr. Gerberding says.

Extensively drug-resistant tuberculosis is a subtype of multi-drug resistant tuberculosis that can cause severe illness and death.

Like all forms of tuberculosis, extensively drug-resistant tuberculosis is spread person-to-person through the air, usually through vapor droplets. Last year, there were two cases of extensively drug-resistant tuberculosis in the US, she says.

Dr. Gerberding notes that patients with highly communicable diseases such as tuberculosis usually agree to voluntarily limit their travel. "In this case, the person had compelling personal reasons for traveling and made the decision to go ahead and meet those personal responsibilities."

This is the first time since 1963 that a federal isolation order has been issued, Dr. Gerberding says. Back then, the order was issued to quarantine a patient who had smallpox, she says.

Always consult your physician for more information.

What is XDR-TB?

Tuberculosis (TB) is a chronic bacterial infection that usually infects the lungs, although other organs are sometimes involved. TB is primarily an airborne disease.

There is a difference between being infected with the TB bacterium and having active tuberculosis disease.

According to the World Health Organization (WHO), MDR-TB (Multidrug Resistant TB) describes strains of tuberculosis that are resistant to at least the two main first-line TB drugs - isoniazid and rifampicin. XDR-TB, or Extensive Drug Resistant TB (also referred to as Extreme Drug Resistance) is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.

The description of XDR-TB was first used earlier in 2006, following a joint survey by WHO and the US Centers for Disease Control and Prevention (CDC).

Resistance to anti-TB drugs in populations is a phenomenon that occurs primarily due to poorly managed TB care. Problems include incorrect drug prescribing practices by providers, poor quality drugs or erratic supply of drugs, and also patient non-adherence.

XDR-TB poses a grave public health threat, especially in populations with high rates of HIV and where there are few health care resources.

Recommendations outlined in the WHO Guidelines for the Programmatic Management of Drug Resistant Tuberculosis include:

• strengthen basic TB care to prevent the emergence of drug-resistance

• ensure prompt diagnosis and treatment of drug resistant cases to cure existing cases and prevent further transmission

• increase collaboration between HIV and TB control programmes to provide necessary prevention and care to co-infected patients

• increase investment in laboratory infrastructures to enable better detection and management of resistant cases.

Always consult your physician for more information.