Drug-resistant tuberculosis may be the disease generally identified with the third world and the poor. But it is spreading its tentacles everywhere. US authorities fear that an American might have exposed fellow air passengers on two transatlantic flights this month to the potentially lethal disease. The man has since been quarantined.
Now they authorities are looking for travelers who were aboard Air France flight 385, which left Atlanta for Paris on May 12, and Czech Air flight 0104, which arrived in Montreal from Prague on May 24. Passengers may need to be tested for the infection, the officials said.
The infected man may have exposed other travelers to a strain of extensively drug-resistant tuberculosis, a lung disease that doesn't respond to most available treatments, Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, said in a press conference in Atlanta.
"We felt it was our responsibility to err on the side of abundant caution and issue the isolation order," to minimize the chances the disease will spread, she said. The CDC is working with state and local health departments, the airline industry, international health ministries and the World Health Organization to track down patients, Gerberding said.
The authorities seek to determine where all the passengers on the flight originated, so they can be notified. How many countries are involved still isn't known, Gerberding said. The man is infected with extensively drug-resistant tuberculosis, or XDR-TB, which renders patients virtually untreatable, the officials said. About 49 cases of XDR-TB were reported to federal health officials from 1993 through 2006, and each cost about $500,000 to treat, the CDC said in March.
The disease is particularly threatening to people with damaged immune systems, such as AIDS patients, Gerberding said. While many people are infected with tuberculosis have no symptoms, AIDS allows the bacteria to overcome the patient's immune defenses more quickly.
About two-thirds of those infected with XDR-TB die, the World Health Organization said in March. In February, the Geneva- based agency asked donor countries and organizations to give $650 million to improve diagnosis and treatment of the disease.
``They'll probably need a lot more than that,'' said Tawanda Gumbo, a TB specialist at the University of Texas Southwestern Medical Center in Dallas who has treated patients with resistant strains in the U.S. and Zimbabwe. ``This is a major problem and we've been losing drugs to treat it one by one.''
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 risk of transmission may be on the low side, but we know it isn't zero,'' Gerberding said. "Anybody who comes into contact with XDR-TB could become infected." 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.
The last time a federal order was used to isolate a patient was in 1963, Gerberding said. That patient had smallpox, a highly contagious virus -- since eradicated -- that killed about one of every three infected people.