Published Date: 2007-05-29 00:00:00
Subject: PRO/EDR> Tuberculosis, XDR, airplane exposure - multicountry (USA, France, Canada, Czech Rep.)
Archive Number: 20070529.1738

TUBERCULOSIS, XDR, AIRPLANE EXPOSURE - MULTICOUNTRY (USA, FRANCE,
CANADA, CZECH REPUBLIC)
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Date: Sun 27 May 2007
Source: Bloomberg.com [edited]
<http://www.bloomberg.com/apps/news?pid=20601101&sid=aqThLT2y.lEc&refer=japan>


Airline Passengers Possibly Exposed to TB Are Sought
----------------------------------------------------
A man infected with drug-resistant tuberculosis may have exposed
fellow air passengers on 2 trans-Atlantic flights this month [May
2007] to the potentially lethal disease, U.S. health officials said.

The authorities are looking for travelers who were aboard Air France
flight 385, which left Atlanta for Paris on May 12 [2007], and Czech
Air flight 104, which arrived in Montreal from Prague on May 24.
Passengers may need to be tested for the infection, the officials said today.

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, U.S. Centers for Disease
Control and Prevention (CDC) director Julie Gerberding said in a
press conference. The man, a U.S. citizen, was ordered into
isolation, she said.

"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. Daniela Hupakova, a
Czech Air spokeswoman, didn't return a call seeking comment. Air
France officials couldn't be reached.

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 USD 500 000.00
to treat, the CDC said in March [2007].

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 [2007], the Geneva-based
agency asked donor countries and organizations to give USD 650
million to improve diagnosis and treatment of the disease.

While the infected man may not have been particularly contagious
while on the flights, people who were sitting closest to him were at
highest risk of exposure, Gerberding said. The CDC officials declined
to say which row the man was sitting in, saying they will inform
travelers if they were seated near him.

"Anybody who comes into contact with XDR-TB could become infected,"
Gerberding said.

Health officials are still trying to determine how the patient became
infected with XDR-TB, Gerberding said. After flying into Montreal, he
re-entered the U.S. by car. He was contacted by CDC officials in New
York, and voluntarily reported to a testing center, where he was
found to have XDR-TB and ordered into isolation, said Marty Cetron,
director of the CDC's division of global migration.

The agency flew the man to Atlanta where he had said he preferred to
undergo treatment, Gerberding said. "We didn't feel it was safe for
him to fly on a commercial aircraft," she said. "We took the step of
using government aircraft to fly him back to Georgia."

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 3 infected people.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[XDR TB is defined as a multidrug-resistant strain (MDR TB) with
resistance to the 2 most important 1st-line drugs isoniazid and
rifampin and in addition to the 2 most important second-line
antibiotics a fluoroquinolone and an injectable agent (amikacin,
kanamycin, or capreomycin). This patient is reported to have
radiographic evidence of pulmonary TB and to have positive cultures
for XDR TB bacilli and is relatively asymptomatic. On the basis of
the patient's clinical and laboratory results, this patient was
considered potentially infectious at the time of his airline travel,
and meets the criteria in the WHO guidelines for initiating an
airline contact investigation:
<http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.363_eng.pdf>

In accordance with the WHO TB and Airline Travel Guidelines, to
ensure appropriate follow-up and care for persons who may have been
exposed to XDR TB, the CDC is recommending the following for
passengers and crew onboard Air France flight 385 departing Atlanta
on May 12 and arriving in Paris on May 13 [2007], and on Czech Air
flight 104 departing from Prague and arriving in Montreal on May 24
[2007]: passengers seated in the same row as the index patient and
those seated in the 2 rows ahead and the 2 rows behind, as well as
the cabin crew members working in the same cabin should be evaluated
for TB infection. This includes initial evaluation and testing with
follow up 8-10 weeks later for re-evaluation. - Mod.DK]

See Also

Tuberculosis, XDR - South Africa (08): Western Cape 20070425.1349
Tuberculosis, XDR, 2003-2006 - Europe (Germany, Italy) 20070403.1132
Tuberculosis, XDR - South Africa (07): Eastern Cape 20070326.1044
Tuberculosis, XDR, 1993-2006 - USA 20070322.1005
Tuberculosis, XDR - South Africa (06) 20070319.0959
Tuberculosis, XDR, 1991-2003 - Spain 20070302.0738
Tuberculosis, XDR - South Africa (05) 20070228.0717
Tuberculosis, XDR - South Africa (04) 20070220.0638
Tuberculosis, XDR - South Africa (03) 20070209.0504
Tuberculosis, XDR - worldwide 20070205.0456
Tuberculosis, XDR - South Africa (02) 20070128.0375
Tuberculosis, XDR - South Africa: interventions
............dk/ejp/dk

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