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Quarantine: U.S. isolates traveler with super TB

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    Posted: May 29 2007 at 2:56pm

U.S. isolates traveler infected with super-TB

Tue May 29, 2007 4:34PM EDT

By Will Dunham

WASHINGTON (Reuters) - The United States has isolated a man who may have exposed fellow passengers on two transatlantic flights to a strain of tuberculosis that is extremely hard to treat, officials said on Tuesday.

It was the first time the federal government has issued such an isolation order since 1963, according to the U.S. Centers for Disease Control and Prevention.

CDC Director Dr. Julie Gerberding said authorities were trying to notify passengers who traveled aboard Air France flight 385 from Atlanta which arrived in Paris on May 13 and on Czech Air flight 0104 from Prague to Montreal on May 24.

The man, from the U.S. state of Georgia, returned to the United States by car and has been in the hospital "in respiratory isolation" since then, the CDC said. He is suffering from extensive drug-resistant TB, known as XDR TB, that resists virtually all antibiotics.

"This is an unusual TB organism, one that's very, very difficult to treat. And we want to make sure that we have done everything we possibly can to identify people who could be at risk," Gerberding said at a news conference.

Authorities did not identify the man, but said he had voluntarily entered a medical isolation facility in New York City.

Tuberculosis is a bacterial infection that usually attacks the lungs. It kills about 1.6 million people annually, with the highest number in Africa. It is spread through the air when infectious people cough, sneeze, talk or spit.

PASSENGERS AT RISK

Gerberding said the plane passengers most likely to be at risk were those seated close to the patient.

"Consistent with the World Health Organization guidelines, CDC is recommending that those passengers be notified by their health officials in their responsible country or state, and that such persons then have a test for tuberculosis to determine whether or not they were in fact exposed," she said.

Others aboard the planes also should be notified so they can be tested for TB, although their risk was not thought to be high, she said.

Gerberding said the patient had "compelling personal reasons" to travel and did so despite the illness. She stressed that he had not broken any laws.

"In this case, the infected patient traveled on two trans-Atlantic air flights and in doing so, may have exposed passengers and crew to XDR TB," the CDC said in a statement.

It was working with U.S. state and local health departments, ministries of health in other countries, the airline industry, and the World Health Organization.

Dr. Kenneth Castro of the CDC's Division of Tuberculosis Elimination said that from 1993 to 2006 CDC knew of just 49 people in the United States with XDR tuberculosis.

XDR TB requires 18 months to two years of treatment with a mixture of four to six drugs. The treatment can often require surgery as well as the newest drugs and can cost $500,000 per patient.

Multidrug-resistant TB is resistant to at least two first-line antibiotics. XDR TB is resistant to first-line antibiotics, and to an entire class of antibiotics called fluoroquinolones, as well as to at least one of three injectable drugs.

Isolation refers to the separation of persons who have a specific infectious illness from those who are healthy. Quarantine refers to the separation and restriction of movement of persons who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious.

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Media Advisory

FOR IMMEDIATE RELEASE
Thursday, May 29, 2007

Contact: CDC Media Relations
(404) 639-3286

Public Health investigation seeks people who may have been exposed to extensively drug resistant tuberculosis (XDR TB) infected person.

WHO:

Dr. Julie Gerberding, Director, CDC
Dr. Martin Cetron, Director, CDC Division of Global Migration and Quarantine
Dr. Kenneth Castro, Director, CDC Division of Tuberculosis Elimination

WHAT:

Release of information about the action and steps that CDC is taking in response to a case of extensively drug-resistant tuberculosis (XDR TB) in a U.S. citizen who undertook international travel.  XDR TB is a recently defined subtype of multi-drug resistant TB and can cause severe illness and death. 

WHY:

Like all forms of TB, XDR TB is a disease caused by germs that are spread person-to-person through the air. In this case, the infected patient traveled on two trans-Atlantic air flights and in doing so, may have exposed passengers and crew to XDR TB.  A federal quarantine order has been issued and CDC is currently collaborating with U.S. state and local health departments, international Ministries of Health, the airline industry, and WHO.

WHEN:

Tuesday, May 29, 2007, 2 p.m. ET
Brief remarks followed by Q&A
Dial-in:

  • US Media: 1-888-795-0855
  • International:   210-234-0025
  • Passcode:     CDC Media

Listen to the Briefing by visiting the webcast link at: www.videonewswire.com/event.asp?id=40136

Transcript

A full transcript of this teleconference will be available following the briefing on the CDC web site at www.cdc.*******od/oc/media/transcripts/t070529.htm .

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Post Options Post Options   Thanks (0) Thanks(0)   Quote 4=laro Quote  Post ReplyReply Direct Link To This Post Posted: May 29 2007 at 8:52pm
I really find it hard to believe that he had to travel (what could be so compelling that he would feel it necessary to risk infecting hundreds of people to an uncurable disease.)  If he is cured, he should be tried and locked up forever.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: May 29 2007 at 9:05pm

He originally flew on May 12th so it's already been a couple of weeks.  Plus the CDC probably had to wait another few days to announce it because of the holiday, so it would have a fairly good head start on everybody.   Incubation is 2 - 10 wks.

 

 

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2 Flights Carried Man With Deadly TB

WASHINGTON, May 29 — Public health officials today urged the passengers and crew of two recent trans-Atlantic flights to get checked for tuberculosis, after learning that a man with an exceptionally deadly and drug-resistant form of the disease had flown on the planes.

The man, an American who was not identified, flew on May 12 from Atlanta to Paris aboard Air France Flight 385, then traveled on May 24 from Prague to Montreal aboard Czech Air Flight 410 before driving back to the United States, the Centers for Disease Control announced. He is currently hospitalized in an isolation ward.

Dr. Julie Gerberding, director of the Centers for Disease Control, announced the matter personally.

While tuberculosis is not highly transmissible, the deadliness of this strain — and the ease of modern transportation — underscored the need for rapid response, as with the SARS virus epidemic of a few years ago.

A federal quarantine order has been issued — the first in decades — and the C.D.C. is working with state and local health departments, airline officials, international health ministries and the World Health Organization, Mr. Gerberding said, according to Bloomberg News. “We felt it was our responsibility to err on the side of abundant caution and issue the isolation order,” she said.

Tuberculosis had been a leading cause of death even in the developed world until the development of streptomycin in the 1940s. Today, treatment by anti-tuberculosis drugs like isoniazid and rifampicin can cure up to 95 percent of patients.

But those and other so-called first-line drugs do little against a type of tuberculosis known as multidrug-resistant TB, or MDR TB. More worryingly, the type of tuberculosis found in the infected American — known as extensively drug-resistant tuberculosis, or XDR TB — resists treatment even by three of the six second-line drugs used when first-line drugs fail. Only two cases of the strain were found last year in the United States.

Tuberculosis is typically spread by sneezing or coughing, and the C.D.C. said the man potentially was infectious during the two flights.

Health officials recommended medical exams for cabin crew members on the flights, as well as passengers sitting within a few rows of the man. Dr. Gerberding would not say the row in which he sat, but the doctor said the nearby passengers would be contacted. More information can be obtained at the Web site of the Centers for Disease Control, www.cdc.gov.

Antibiotics have helped lower tuberculosis rates for years, also though the CDC found some resurgence starting in 1985, particularly among recent immigrants and people infected with HIV, the virus that causes AIDS. Still, TB cases hit an all-time low last year in the United States of 13,767, according to The Associated Press.

But tuberculosis is still deadly, particularly in countries where medical care is lacking, killing about 1.6 million people each year worldwide. It is particularly deadly among those infected with HIV.

At any given time, one person in three worldwide is infected with dormant tuberculosis germs, according to the World Health Organization. People become ill when the bacteria become active, usually when a person’s immunity declines, whether because of advancing age, HIV infection or some other medical problem.

While first-line drugs usually are effective, multidrug-resistant tuberculosis can develop if those medications are misused or improperly administered. That requires treatment with more expensive — and less well-tolerated — second-line drugs, which require treatment courses of 18 to 24 months, compared with six to nine months for first-line drugs.

Misuse or mismanagement of those drugs, in turn, can render them ineffective, leading to the extensively drug resistant TB, or XDR TB. Options for treating it are extremely limited, according to the W.H.O. Only about 30 percent of patients can be cured.

A 2005 survey by the C.D.C. and the W.H.O. found that 10 percent of multidrug-resistant tuberculosis strains met the definition for XDR TB, Dr. Gerberding testified before Congress in March. Cases of the latter were found in 17 countries, most often in the former Soviet Union and Asia. While in the United States just 2 percent of multidrug-resistant TB cases were XDR TB, the figure was 15 percent in South Korea and 19 percent in Latvia.

In one outbreak in South Africa, Dr. Gerberding testified, 41 percent of the 544 patients infected with tuberculosis were found to have multidrug-resistant strains; of those, 53 met the definition of XDR TB.

Of the latter group, all but one person died, on average just 16 days after health workers had tested them

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Post Options Post Options   Thanks (0) Thanks(0)   Quote coyote Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 3:26am
This is exactly how a pand.flu will happen! By ignorant and naive people. He should be tried and locked up. I find it hard to believe that someone could not have stopped him from boarding those planes!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 3:54am
And some are telling me,Dont worry AI well be stoped before it gets here!!!lol
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Post Options Post Options   Thanks (0) Thanks(0)   Quote coyote Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 4:00am
Ya right. OH IT CANT HAPPEN HERE.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 5:57am
I think this is exactly how it will spread...air travel.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 6:00am
This was a link from Matt Drudges site.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 6:27am
WASHINGTON, May 29 Public health officials today urged the passengers and crew of two recent trans-Atlantic flights to get checked for tuberculosis, after learning that a man with an exceptionally deadly and drug-resistant form of the disease had flown on the planes.

I've had the news on last night and this morning, have NOT seen any warnings. Therese said on another AFT post how this is really being played down, I fully agree. I believe this is how the pandemic will start and those who have NOT prepared won't have a chance to prepare. By the time the public is notified we are entering a pandemic situation, everyone will already know someone who has the flu. It will be too late to prep without the dangers of exposure. JMHO
    
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Post Options Post Options   Thanks (0) Thanks(0)   Quote roni3470 Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 6:49am
One question on this specific issue...if you have been vaccinated for TB, can you still catch this strain?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 7:13am
 Apparently the guy is a lawyer who flew to Paris on his honeymoon.   He had no symptoms and was feeling fine, although he knew he was a carrier.  The last time somebody in a similar situation traveled by plane with regular TB, out of a total 925 passengers who came in contact, 15 became infected.  The numbers could be similar.  
 
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 7:24am
Originally posted by Albert Albert wrote:

Apparently the guy is a lawyer who flew to Paris on his honeymoon.   He had no symptoms and was feeling fine, although he knew he was a carrier.  The last time somebody in a similar situation traveled by plane with regular TB, out of a total 925 passengers who came in contact, 15 became infected.  The numbers could be similar.     
I wonder where the 15 newly possibly infected victims were seated on the plane in relation to the TB infected individual. Earlier we read they were only testing the rows around the TB infected man. I wonder if others in the plane have become symptomatic? This self-centered TB infected man should be held liable for all the expense resulting from his self-centered blatant act.      
    
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 8:34am
The last time somebody with regular TB got on a plane, out of 925 passengers, 15 became infected.  The numbers could be similar.  
 
 
Wow...more information coming out. Geez I think he needed to postpone his honeymoon. His new wife is probably not too happy either ~~
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 8:47am

13 people may have contracted whooping cough from Seton employee

Another 159 people flock to ER for examination, worried they may have been exposed

By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Wednesday, May 30, 2007

Thirteen people, including three infants, might have contracted whooping cough from a Seton Medical Center employee working in the maternity area, and another 159 people showed up in the emergency room fearing that they had been exposed, a Seton official said Tuesday.

The 13 who appeared to have been infected were given antibiotics as a preventive measure, as were all 159 people who came to the ER, said Greg Hartman, a senior vice president for the Seton Family of Hospitals. Two of the 159 had symptoms that might have been whooping cough, he said.

Seton announced Saturday that a worker in the labor and delivery area might have infected some patients and family members with whooping cough, also known as pertussis. Seton said it would offer free examinations and antibiotics for anyone who might have been exposed.

Pertussis, which can appear to be the flu, pneumonia or allergies, can be difficult to diagnose and is highly contagious. Pertussis bacteria are spread by droplets during sneezing or coughing.

Symptoms include a runny nose, a slight fever, watery eyes and severe coughing, which can produce produce a "whooping" sound when a person takes a breath.

Babies younger than a year are at the greatest risk of severe illness, even death, especially those younger than 2 months: too young to be vaccinated against the disease.

No one has died or required hospitalization in the Seton outbreak, Hartman said.

ER visits by those responding to Seton's announcement were steady over the Memorial Day weekend but "trailed off significantly" Tuesday, Hartman said. He didn't know how many people might have been seen by their own doctors instead of coming to the Seton ER.

Seton learned Friday that an employee whom it declined to identify by name, gender or job title probably was infected with pertussis and could have exposed patients and visitors in the labor and delivery areas.

The employee was diagnosed by a doctor with whooping cough, but a definitive diagnosis probably won't be possible because antibiotics had been started, Hartman said.

Seton made private calls Friday to patients who might have been exposed since May 5 because of the potential incubation period, Hartman said.

It consulted with the Austin/Travis County Health and Human Services Department and made a public announcement Saturday in an effort to be as open as possible, Hartman said.

Whooping cough was uncommon for years in Texas and nationally, but the illness has made a comeback in recent years, especially in 2005. That year, Travis County had 525 reports of whooping cough, a fourth of the state's 2,224 cases — more than any other county, according to data provided by the Department of State Health Services. Williamson County was second highest.

Last year, Travis County reported 139 cases, or 15 percent of the state's 954 cases, again the highest of any county, and Williamson County again was second with 109 cases, according to Doug McBride, a spokesman with the state health department.

So far this year, Travis County has had 20 of the state's 227 cases, not counting the recent Seton cases, McBride said. Williamson County has the most cases so far this year with 35, based on preliminary numbers, McBride said.

Health experts don't know why whooping cough cases are more prevalent in the two counties.

Seton Medical Center will continue to examine and offer prescriptions to people who fear that they were exposed between May 5 and Friday, Hartman said.

maroser@statesman.com; 445-3619

 
 
 
Find this article at:
http://www.statesman.com/news/content/news/stories/local/05/30/30whooping.html
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 9:20am
XDR TB is quite deadly.   
 
 

There is currently an epidemic of XDR-TB South Africa. The outbreak was first reported as a cluster of 53 patients in a rural hospital in KwaZulu-Natal of whom 52 died.[3] What was particularly worrying was that the mean survival from sputum specimen collection to death was only 16 days and that the majority of patients had never previously received treatment for tuberculosis. This is the epidemic for which the acronym XDR-TB was first used, and although TB strains that fulfill the current definition have been identified retrospectively,[6][7] this was the largest group of linked cases ever found. Since the initial report in September 2006,[8] cases have now been reported in most provinces in South Africa. As of 16 March 2007, there were 314 cases reported, with 215 deaths.[9] It is clear that the spread of this strain of TB is closely associated with a high prevalence of HIV and poor infection control; in other countries where XDR-TB strains have arisen, drug-resistance has arisen from mismanagement of cases or poor patient compliance with drug treatment instead of being transmitted from person to person.[10] This strain of TB does not respond to any of the drugs currently available in South Africa for first- or second-line treatment. It is now clear that the problem has been around for much longer than health department officials have suggested, and is far more extensive.[11] By 23 Nov 2006, 303 cases of XDR-TB had been reported, of which 263 were in KwaZulu-Natal.[12] Serious thought has been put to isolation procedures that may deny some patients their human rights, but which may be necessary to prevent further spread of this strain of TB.[13]

http://en.wikipedia.org/wiki/XDR_TB

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 12:27pm
This is very serious. There are 3 Pandemics currently - Malaria, TB, and Dengue Fever. TB is likely to be the dark horse. In one cluster 98% CFR in 16 or so days. This makes Avian look like the common cold in terms of contagion, fact it is in the U.S., and also we have nothing to treat it with.
This may well beat AF to the punch, and ironically it is a far tougher foe than Avian in many ways. Those stating the man in travel was not contagious do have have sufficient experience in terms of this particular strain to determine the risk factor.
 
16 days is a fairly quick time to become fatal. Most masks are much more effective against TB than a virus sized particle. Prep up and give coughing people a wide berth.
 
IMHO of course - Medclinician
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Post Options Post Options   Thanks (0) Thanks(0)   Quote roni3470 Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 12:36pm
I was in the gym at lunch adn this was all over CNN..including the CDC press conference on it.
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Groom With TB Under Federal Quarantine
 Email this Story

May 30, 1:15 PM (ET)

By MIKE STOBBE

(AP) Grady Memorial Hospital in Atlanta, Ga., is shown Wednesday May 30, 2007. An unidentified man with...
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ATLANTA (AP) - A man with a form of tuberculosis so dangerous he is under the first U.S. government-ordered quarantine since 1963 had health officials around the world scrambling Wednesday to find passengers who sat near him on two trans-Atlantic flights.

The man told a newspaper he took the first flight from Atlanta to Europe for his wedding, then the second flight home because he feared he might die without treatment in the U.S.

Centers for Disease Control and Prevention Director Julie Gerberding said Wednesday that the CDC is working closely with airlines to find passengers who may have been exposed to the rare, dangerous strain. Health officials in France said they have asked Air France-KLM (AKH) for passenger lists, and the Italian Health Ministry said it is tracing the man's movements.

"Is the patient himself highly infectious? Fortunately, in this case, he's probably not," Gerberding said. "But the other piece is this bacteria is a very deadly bacteria. We just have to err on the side of caution."

Health officials said the man had been advised not to fly and knew he could expose others when he boarded the jets from Atlanta to Paris, and later from Prague to Montreal.

The man, however, told the Atlanta Journal-Constitution that doctors didn't order him not to fly and only suggested he put off his long-planned wedding in Greece. He knew he had a form of tuberculosis and that it was resistant to first-line drugs, but he didn't realize it could be so dangerous, he said.

"We headed off to Greece thinking everything's fine," said the man, who declined to be identified because of the stigma attached to his diagnosis.

He flew to Paris on May 12 aboard Air France Flight 385. While in Europe, health authorities reached him with the news that further tests had revealed his TB was a rare, "extensively drug-resistant" form, far more dangerous than he knew. They ordered him into isolation, saying he should turn himself over to Italian officials.

Instead, the man flew from Prague to Montreal on May 24 aboard Czech Air Flight 0104, then drove into the United States at Champlain, N.Y. He told the newspaper he was afraid that if he didn't get back to the U.S., he wouldn't get the treatment he needed to survive.

He is now at Atlanta's Grady Memorial Hospital in respiratory isolation.

A spokesman for Denver's National Jewish Hospital, which specializes in respiratory disorders, said Wednesday that the man would be treated there. It was not clear when he would arrive, spokesman William Allstetter said.

CDC officials have recommended immediate medical exams for cabin crew members and passengers who sat within two rows of the man on the flights.

The other passengers are not considered at high risk of infection because tests indicated the amount of TB bacteria in the man was low, said Dr. Martin Cetron, director of the CDC's division of global migration and quarantine.

But Gerberding noted that U.S. health officials have had little experience with this type of TB. It's possible it may have different transmission patterns, she said.

"We're thankful the patient was not in a highly infectious state, but we know the risk of transmission isn't zero, even with the fact that he didn't have symptoms and didn't appear to be coughing," Gerberding said on ABC's "Good Morning America."

"We've got to really look at the people closest to him, get them skin tested."

Dr. Howard Njoo of the Public Health Agency of Canada said it appeared unlikely that the man spread the disease on the flight into Canada. Still the agency was working with U.S. officials to contact passengers who sat near him.

Daniela Hupakova, a spokeswoman for the Czech airline CSA, said the flight crew underwent medical checks and are fine. The airline was contacting passengers and cooperating with Czech and foreign authorities, she said. Health officials in France have asked Air France-KLM to provide lists of passengers seated within two rows of the man, an airline spokeswoman said on condition of anonymity according to company policy.

The man told the Journal-Constitution he was in Rome during his honeymoon when the CDC notified him of the new tests and told him to turn himself in to Italian authorities to be isolated and be treated. The CDC told him he couldn't fly aboard commercial airliners.

"I thought to myself: You're nuts. I wasn't going to do that. They told me I had been put on the no-fly list and my passport was flagged," the man said.

He told the newspaper he and his wife decided to sneak back into the U.S. through Canada. He said he voluntarily went to a New York hospital, then was flown by the CDC to Atlanta.

He is not facing prosecution, health officials said.

"I'm a very well-educated, successful, intelligent person," he told the paper. "This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary-confinement-in-Italy thing."

CDC officials told The Associated Press they could not immediately comment on the interview.

Health officials said the man's wife tested negative for TB before the trip and is not considered a public health risk. They said they don't know how the Georgia man was infected.

The quarantine order was the first since the government quarantined a patient with smallpox in 1963, according to the CDC.

Tuberculosis is caused by germs that are spread from person to person through the air. It usually affects the lungs and can lead to symptoms such as chest pain and coughing up blood. It kills nearly 2 million people each year worldwide.

Because of antibiotics and other measures, the TB rate in the United States has been falling for years. Last year, it hit an all-time low of 13,767 cases, or about 4.6 cases per 100,000 Americans.

Health officials worry about "multidrug-resistant" TB, which can withstand the mainline antibiotics isoniazid and rifampin. The man was infected with something even worse - "extensively drug-resistant" TB, also called XDR-TB, which resists many drugs used to treat the infection.

There have been 17 U.S. XDR-TB cases since 2000, according to CDC statistics.

---

Associated Press writers Malcolm Ritter in New York and Rob Gillies in Toronto contributed to this report.

---

On the Net:

Centers for Disease Control and Prevention: http://www.cdc.*******

Public Health Agency of Canada: http://www.phac-aspc.gc.ca/

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May 30, 2007

TB Patient Says He Was Advised Not to Fly

A man who may have exposed passengers and crew members on two trans-Atlantic flights earlier this month to a highly drug-resistant form of tuberculosis knew he was infected, and had been advised by health officials not to travel overseas.

The man flew to Paris from his home in Atlanta on May 12 for his wedding and honeymoon, even though health officials told him they “preferred” that he not get on the flight, he said in an interview published today in The Atlanta Journal-Constitution.

Days later, while he was in Italy, he was contacted by officials of the Centers for Disease Control and Prevention, and was told that he had a rare and potentially virulent form of the disease and should turn himself over to Italian health authorities immediately.

Officials of the centers said at a news conference today that they had begun to make arrangements with the Italian authorities to isolate and treat the man in Rome. But instead of cooperating with the plans, the man traveled to the Czech Republic and took a flight from Prague to Montreal.

He said in the published interview that he did that in the belief that he had been put on a no-fly list and would not be allowed to board a flight bound for the United States.

From Canada, he drove to the United States, and then turned himself in at a tuberculosis isolation hospital in New York City.

The director of the C.D.C., Julie Gerberding, said today that the man, whose name has not been released, was not highly infectious, but that there was nonetheless a possibility that others could catch the disease from him.

Dr. Martin Cetron, director of the CDC’s division of global migration and quarantine, said at a news conference today that federal and international officials were still trying to track down passengers and crew members who were on the two trans-Atlantic flights the man took: Air France 385 on the night of May 12-13, and Czech Air 104 from Prague to Montreal on May 24.

Dr. Cetron said the agency was looking in particular for the passengers who sat in the two rows behind the man and the two rows in front of him, which together could add up to more than 80 people.

According to investigators, the man apparently sat in row 51 on the Air France flight, and near row 12 on the return flight to North America.

“Our focus has been on these two international flights, but we are piecing together the patient’s full itinerary,” Dr. Cetron said. “At this time, the patient continues to feel well and to be asymptomatic.”

He told reporters at the news conference that the patient was never formally ordered not to travel, that he apparently had not broken any laws, and that he was cooperating with federal health authorities now.

Dr. Cetron said that the man flew on five other flights as well during his honeymoon, but those flights, all within Europe, were too short to pose a significant risk of transmitting the disease.

Kristen Loughman, a spokeswoman for Air France, said today that the airline provided investigators with the names of passengers who were on the flight. A spokesman for Czech Air said that his airline, too, was cooperating with the authorities.The infected man is now at Grady Memorial Hospital in Atlanta under federally enforced isolation; he was flown there from New York City on Monday on a plane owned by the C.D.C.

He told The Atlanta Journal-Constitution that he was planning to undergo an intensive 18-month treatment at a hospital in Denver, and that he did not understand why he was not ordered into isolation before he left for his wedding in Europe. “I’m a very well-educated, successful, intelligent person,” the man, who declined to give his name, was quoted in the newspaper interview as saying. “This is insane to me, that I have an armed guard outside my door, when I’ve cooperated with everything other than the whole solitary-confinement-in-Italy thing.”

Dr. Cetron said the man’s wife had been tested for tuberculosis and the results were negative, and that the authorities were getting touch with his coworkers and others with whom he came in regular contact.

The Centers for Disease Control and Prevention said that because this was the first airline-contact investigation for extremely drug resistant tuberculosis, it was not sure that current recommendations were adequate to determine the possible range and risk of transmission on infection.

The agency said it was advising all passengers and crew members who were on the two commercial flights to be tested for tuberculosis, even though they are believed to be at low risk of having been infected.

That appraisal was based on test results showing that the number of tuberculosis bacteria in the man’s sputum was too low to detect, though it would still be enough to infect others under the right conditions.

Dr. Gerberding said at a news conference on Tuesday that her agency was erring on the side of caution because the form of tuberculosis, known as XDR TB, was often fatal and had become a growing public health threat in many countries.

Drug-susceptible, or regular, TB and XDR TB are thought to be spread the same way. Fluids containing the TB bacteria become aerosols when a person coughs, sneezes, speaks or sings. The bacteria can float in the air for several hours, depending on the environment. People who breathe air containing these bacteria can become infected.

The risk of acquiring any type of tuberculosis appears to depend on several factors, including the extent of disease in the person who is the source of the bacteria, the duration of exposure and how well the area is ventilated.

It usually takes several hours or days of exposure in poorly ventilated or crowded environments for a person to become infected. An important way to prevent the spread and transmission of the disease is by limiting an infectious person’s contact with other people.

People who have a confirmed diagnosis of TB or XDR TB are generally treated in isolation and kept there until they are no longer infectious

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Emergence of XDR-TB

WHO concern over extensive drug resistant TB strains that are virtually untreatable

5 SEPTEMBER 2006 | GENEVA -- The World Health Organization (WHO) has expressed concern over the emergence of virulent drug-resistant strains of tuberculosis (TB) and is calling for measures to be strengthened and implemented to prevent the global spread of the deadly TB strains. This follows research showing the extent of XDR-TB, a newly identified TB threat which leaves patients (including many people living with HIV) virtually untreatable using currently available anti-TB drugs.

Related links

:: Drug- and multidrug-resistant tuberculosis (MDR-TB)


Later this week, WHO will join other TB experts at a two-day meeting in South Africa (7-8 September) to assess the response required to critically address TB drug resistance, particularly in Africa, and will take part in a news conference scheduled for Thursday, 7 September in Johannesburg.

What is XDR-TB?

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.

What is the current evidence of XDR-TB?

Recent findings from a survey conducted by WHO and CDC on data from 2000-2004 found that XDR-TB has been identified in all regions of the world but is most frequent in the countries of the former Soviet Union and in Asia.

In the United States, 4% of MDR-TB cases met the criteria for XDR-TB.

In Latvia, a country with one of the highest rates of MDR-TB, 19% of MDR-TB cases met the XDR-TB criteria.

Separate data on a recent outbreak of XDR-TB in an HIV-positive population in Kwazulu-Natal in South Africa was characterized by alarmingly high mortality rates.

Of the 544 patients studied, 221 had MDR-TB. Of the 221 MDR-TB cases, 53 were defined as XDR-TB. Of the 53 patients, 44 had been tested for HIV and all were HIV-positive.

52 of 53 patients died, on average, within 25 days including those benefiting from antiretroviral drugs.

Scarce drug resistance data available from Africa indicate that while population prevalence of drug resistant TB appears to be low compared to Eastern Europe and Asia, drug resistance in the region is on the rise.

Given the underlying HIV epidemic, drug-resistant TB could have a severe impact on mortality in Africa and requires urgent preventative action.

What action is required to prevent XDR-TB?

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.

The Expert Consultation on Drug Resistant TB, hosted by the South African Medical Research Council with support from WHO and CDC, takes place in Johannesburg, 7-8 September.

A news conference will be held at 12.30pm, Thursday, 7 September, at the conference venue: Sunnyside Park Hotel, Parktown, Johannesburg.

For more information contact:

Glenn Thomas
Stop TB Department
WHO
Mobile: +41 79 5 09 06 77
E-mail: thomasg@who.int

Dr Karin Weyer
Director, South African Medical Research Council
Unit for TB Operational and Policy Research
Tel: +27 12 3 39 85 50
Mobile: +27 82 4 60 88 36
E-mail: kweyer@mrc.ac.za

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Post Options Post Options   Thanks (0) Thanks(0)   Quote pcusick Quote  Post ReplyReply Direct Link To This Post Posted: May 31 2007 at 12:07pm
Funny, a 31 year old personal injury lawyer was given advice by his father-in-law that works at the CDC as a microbiologist in the TB and communicable disease lab regarding his TB issues denies knowing he should not have traveled. I think multiple personal lawsuits and disbarment proceedings might be a good response...!
Accept responsibility for your choices and actions. Failure to choose is in itself a choice for non-action.
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"...There are 3 Pandemics currently - Malaria, TB, and Dengue Fever...."
..............................................................................................................


Unfortunately there are 4 Pandemics currently...  Please add HIV-Aids to the list.

..........

 GOOGLE....

Addressing the HIV/AIDS Pandemic

At the dawn of the new millennium, there are few threats more dangerous to mankind than the global HIV/AIDS pandemic. Infecting 40 million people and ...
www.milbank.org/reports/HIVAIDS0405/HIVAIDS0405.html - 107k - Cached - Similar pages

World Bank HIV/AIDS - Global HIV/AIDS Program

The Global HIV/AIDS Program was created in 2002 to support the World Bank's efforts to address the HIV/AIDS pandemic from a cross-sectoral perspective. ...
www1.worldbank.org/hiv_aids/globalprogram.asp - 23k - Cached - Similar pages

Global Health Council - HIV/AIDS

By the end of 2005, 40.3 million people were living with HIV/AIDS, including 17.5 ... Global trends of infection emerging from the HIV/AIDS pandemic: ...
www.globalhealth.org/view_top.php3?id=227 - 44k - Cached - Similar pages

NEJM -- The HIV-AIDS Pandemic at 25 -- The Global Response

Perspective from The New England Journal of Medicine -- The HIV-AIDS Pandemic at 25 -- The Global Response.
content.nejm.org/cgi/content/full/354/23/2414 - Similar pages

News results for who hiv aids pandemic



Voice of America
Africa: Bush Seeks $30b for HIV/Aids in Africa - 1 hour ago
... contribution to fighting the pandemic to $48.3 billion across 10 years, ... The additional aid will help provide treatment for HIV/Aids patients under ...
AllAfrica.com - 349 related articles »
Zimbabwe: 'Govt Committed to Fighting HIV/Aids' - AllAfrica.com - 2 related articles »

.........................................................................


Posted: March 10 2007 at 6:16pm..  Annharra


 
 
 
 
TB is a worldwide pandemic
.........................................................
 
 
 
 
 
HIV/AIDS .....................................................              And TB...
....................................
 

Male      46,606     Female    9,174
............................................................

Drivers of the epidemic

.................................................

Injecting drug use.
 
A major cause for concern are the drug trafficking routes that pass through Central Asia, which have led to a surge in drug use since 2001. Experts estimate that there may be more than 500,000 drug users in Central Asia, many of whom share needles, placing them at high risk of contracting HIV/AIDS.

Tuberculosis.

 TB is the main opportunistic disease for HIV/AIDS and is a major of people with HIV/AIDS. The TB situation is considered critical in Kazakhstan, Tajikistan, Turkmenistan, and Uzbekistan. TB-HIV co-infection, when it occurs, undermines treatment and care, reduces survival substantially, and increases healthcare costs. HIV also drives the TB epidemic, particularly in areas where the prevalence of both diseases is high.

Fast growth among young people.
 
Some 40 percent of the region’s population is young and HIV/AIDS is spreading most rapidly among them. Adolescents and young adults account for most reported cases among injecting drug users and the age at which young people start injecting drugs is falling. Moreover, they face high levels of unemployment and, with jobs in short supply, many are at special risk of joining groups of highly vulnerable people by resorting to injecting drug use and regular or occasional unprotected sex.

Increased trafficking of women, commercial sex work, and STIs.
 
The proportion of HIV/AIDS cases attributed to heterosexual transmission is growing, with UNAIDS reporting a narrowing of the male-female ratio of newly detected  HIV/AIDS cases from 4:1 to 2:1, indicating that women are increasingly at risk.

Migration increases the risk of spread.

Porous borders and easing of travel restrictions, combined grinding poverty, have increased mobility from rural to urban areas, both within countries and within the region. Central Asia ’s large migrant population increases the risk of the spread of HIV to the general population. Truck drivers, mariners, the homeless, refugees, migrant workers, and trafficked women are among those who are highly vulnerable.

Lack of capacity in public health system.

The ability of the public health system to trace, diagnose, and treat patients with infections has significantly deteriorated since the collapse of the Soviet Union. Furthermore, HIV/AIDS STI and TB services are generally provided through vertical program structures with little or no coordination.
 
 
 
 
..................................................................................................

Positive HIV tests and AIDS diagnoses by year

Year AIDS diagnoses Positive HIV test reports
Adult male Adult female Total, all ages Adult male Adult female Total, all ages
Until end 1996† 14,843 1,118 16,148 30,154 3,855 38,768
1997 606 105 726 1,861 483 2,512
1998 541 100 645 1,697 470 2,343
1999 459 87 555 1,596 515 2,230
2000 436 57 498 1,538 486 2,113
2001 343 70 416 1,580 526 2,178
2002 341 60 404 1,809 620 2,495
2003 302 78 383 1,822 627 2,496
2004 256 59 318 1,825 655 2,538
2005 244 69 318 1,830 628 2,518
Until June 2006 63 18 82 894 309 1,232
Total 18,434 1,821 20,493 46,606 9,174 61,423

† AIDS reporting began in 1979; HIV reporting began in 1985; annual data are not available for positive HIV test reports prior to 1995 for all jurisdictions.

 
 
.............................................................................................................

In recent years the most notable trend has been the increase in diagnoses among young women. Prior to 1996, females comprised 14% of HIV diagnoses in the age group 15-29, whereas in 2005 this proportion was 36%.

Notes

AVERT.org also has a Canada statistics summary, plus statistics for other countries, and a guide to understanding the statistics.

Sources:

  • Public Health Agency of Canada. HIV and AIDS in Canada. Surveillance report to June 30, 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Health Canada, November 2006
  • Health Canada. HIV/AIDS EPI Updates, August 2006, Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Health Canada, 2006

http://www.avert.org/canstatr.htm


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Post Options Post Options   Thanks (0) Thanks(0)   Quote roni3470 Quote  Post ReplyReply Direct Link To This Post Posted: May 31 2007 at 12:53pm
Yes, I agree, how could this guy be a specialist at the CDC and not know his son should not travel...this is a huge crock of something ;)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote PrepGirl Quote  Post ReplyReply Direct Link To This Post Posted: May 31 2007 at 2:28pm
    Well I find it hard to believe that with any suspected cases of TB that they would let you fly.
Not to mention if it was this one everyone is talking about that has no cure. When someone is suspected of having tb there are lots of test and things they make you do and take for medications. And one of the things is not go to Work.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote littlemama Quote  Post ReplyReply Direct Link To This Post Posted: May 31 2007 at 3:20pm
A chilling thought crossed my mind. With alot of inconsistencies with respect to not wearing of masks when transporting, crossing the border, asymtomatic, TB specialist in the family... I know, I know probably paranoira is setting in, Kits in Indonesia, Wales, China. But globally.......... could they be getting ready for patient zero. Are they testing the systems????Just my paranoid thought.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MelodyAtHome Quote  Post ReplyReply Direct Link To This Post Posted: May 31 2007 at 3:49pm
Annharra, I agree with you. My brother died of AIDS and about a dozen of my friends over the last 20 years. It is really awful. People are still having casual unprotected sex...think twice before you do this and I still worry about the blood supply out there. I donated blood years ago and I don't recall them testing for AIDS or anything else. Do they test all the blood that is given? Or just some here and there? How does that work? Anyone know?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 31 2007 at 6:25pm
 
 
 
ROME: The U.S. health authorities failed to notify their Italian counterparts that an American tourist with an extremely dangerous form of tuberculosis was staying in a Rome hotel this month until he was leaving the country, Italian officials said Thursday. That time lapse allowed him to leave Rome and fly to Prague and Montreal, potentially exposing dozens of people to an often lethal germ.

On May 23, a doctor from the Centers for Disease Control and Prevention in Atlanta, the CDC, reached the man, who was honeymooning in Rome from May 21 to May 24, by cellphone to inform him that tests performed before his departure from the United States had revealed that he had a form of tuberculosis that is resistant to almost all drugs, said Dr. Martin Cetron, a CDC official, at a press conference in Atlanta on Wednesday night. The test results had come back on May 22, he said.

They told the patient not to get on a commercial plane and were trying to organize either treatment in Italy or safe transport back to the United States - "begging and asking him to stay put, and not travel while we worked on some options," Cetron said. The man ignored that advice, flying to the Czech Republic and Canada before sneaking over the border into the United States, where he is currently in treatment.

But the U.S. officials did not reveal the man's presence to the Italian authorities - or to the World Health Organization in Geneva - until May 24, about the time he left Italy, both groups said Thursday. That made it impossible for local or international health and law enforcement officials to intervene in the case. Had they been informed, they could have visited the man's hotel to coax him into treatment, prevented him from boarding a plane, or even taken him into custody for forced quarantine.

Cesare Fassari, the spokesman for the Italian Health Ministry, said that had the Italian health authorities been notified in time, they would have "intercepted the man and invited him to be treated in the hospital" although he added that the man's "consent would have been necessary."

The European and North American health authorities are now testing dozens of people who may have been exposed, although doctors say it is unlikely that the man infected anyone because he was not coughing. Tuberculosis does not spread easily; it requires prolonged and intensive exposure to the germs, which are coughed into the air.

The episode revealed holes in international cooperation systems for detecting and isolating people with infectious diseases, experts said. Such deficiencies could be disastrous if the victim were more contagious, as would be likely in an influenza pandemic.

"Despite technology and communication technology - e-mails and cellphones - we're not there yet, and there is the possibility for infectious people to cross borders without the knowledge of authorities," said Mario Raviglione, director of the World Health Organization's Stop TB department. "In this era of globalization you have to move really rapidly."

"We're all learning lessons from this case, particularly the U.S. Centers for Disease Control, I think," he said. "We need to think of this as a precedent so if you have avian flu, people will not escape control."

International health officials planning for an eventual flu pandemic have long worried about infectious patients eluding detection and isolation in the developing world, where disease surveillance is rudimentary.

The Italian Ministry of Health provided some more details on the man's stay in Italy, and sought to allay fears: The 32-year-old man was in Rome for 3 nights and 2 days as part of his honeymoon, the ministry said. He had no symptoms of his lung tuberculosis, and was diagnosed in January only by accident, when he had some X-ray tests after unrelated chest trauma. Tuberculosis can produces serious symptoms or none at all.

On his trip, the man flew from Atlanta to Paris and on to Athens, ending up on Thira Island, Greece. On May 21, he flew from Nikonos back to Athens and on to Rome. Because he was not coughing, only flights of over eight hours put fellow passengers at risk, and then only those passengers in the rows immediately around him, doctors said.

When CDC officials contacted the patient on May 23, they were facing an unprecedented situation and were "exploring all sorts of options" for handling it, Cetron said. The learning curve was steep.

Officials looked into how to alert international airports and started procedures to put the man on a no-fly list, though it was too late. They suggested he call the American Embassy, although it is not clear if any contact was made. The Embassy did not return calls for comment.

In addition, officials from the CDC found a former colleague who "worked with" the Italian Ministry of Health, who they hoped could offer advice on where the patient could be evaluated in Rome. This American doctor eventually went to the hotel to discuss the patient's options, but he had already fled.

"Remember, this is an American citizen in another country and U.S. jurisdiction is not at play here," Cetron said at the news conference. "We were working. Those are complex international and interjurisdictional issues that need to be worked with."

He added that the CDC was "in conversations with the Ministry of Health in Rome." The ministry spokesman said the notification "coincided with" the patient's departure.

Raviglione, of the World Health Organization, said that the risk to others on the flight was "small and low-level," but added, "Yes, he is potentially infectious." Moreover, the strain of tuberculosis the man has is extraordinarily difficult to treat, sensitive to only two intravenous drugs that will probably have to be continued for months, if not years, and are toxic in their own right. "We are extremely unlucky if even one person gets this," he said.

According to World Health Organization guidelines, the man should not have gotten on a plane. "Trusting people to do the right thing doesn't always work," he said, adding that in rare cases "compulsory isolation" of patients is needed. The patient is now in forced quarantine in the United States and on Thursday was transferred from Atlanta to a facility in Denver that specializes in respiratory disorders.

Elisabetta Povoledo contributed reporting from Rome.

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