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Thu, May 31, 2007

Airline Passenger With Tuberculosis Under Federal Quarantine

Unidentified Man "Didn't Know It Could Be So Dangerous"

The US government has ordered its first quarantine since a smallpox case in 1963. The patient is a man who has been diagnosed with a rare, severely drug-resistant form of tuberculosis, who boarded a commercial jet out of Atlanta earlier this month for a transatlantic trip to his wedding... another for his honeymoon... and yet another back to the US for treatment.

From the time he left Georgia, the man flew on seven different flights on three different airlines. Now health authorities around the world are scrambling to round up any passengers that may have had contact with the man for testing, said US Centers for Disease Control and Prevention Director Julie Gerberding.

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

The man's itinerary included flights on: Air France flight 385 to Paris on May 12; Air France flight 1232 to Athens, Greece, on May 14; Olympic Air flight 560 to Thira Island, Greece, on May 16; Olympic Air flight 655 to Athens on May 21; Olympic Air flight 239 to Rome on May 21; Czech Airlines flight 727 to Prague, Czech Republic, on May 24; and Czech Airlines flight 0104 to Montreal, Canada on May 24.

He crossed over into the US from Canada at the Champlain, NY border crossing, fearful he wouldn't get necessary treatments if he didn't get back in the states, according to the Associated Press.

The man told the Atlanta Journal-Constitution doctors didn't specifically order him not to fly, as originally reported in some media, but only suggested he postpone his wedding in Greece.

The man was apparently diagnosed in Georgia and went ahead and flew to Paris for his wedding in Greece. He said he was in Rome on his honeymoon when the CDC contacted him with the news his TB was worse than initially thought and far more dangerous. CDC officials then ordered him to turn himself in to Italian health authorities for isolation and treatment.

It was then he was told he could not 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.

Gerberding said US health officials have had little experience with the "extensively drug-resistant" form of TB. They're not even quite sure of this strain's transmission patterns.

"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 told ABC's "Good Morning America."

CDC officials have also recommended medical exams for all pilots and cabin crew members.

Daniela Hupakova, a spokeswoman for the Czech airline CSA, said their flight crew have already been medically evaluated and tested and are "fine." She said the airline was contacting potentially affected passengers and cooperating fully with Czech and foreign authorities.

The other airlines have not reported on the status of their crew members.

Concern primarily surrounds passengers who were sitting within two rows of the man on the flights. Passengers beyond that perimeter are not considered to be at a high risk of infection, according to Dr. Martin Cetron, director of the CDC's division of global migration and quarantine, because tests indicated the amount of TB bacteria in the man was "low."

It is unlikely the disease was transmitted while the man was on the flight into Canada, said Dr. Howard Njoo of the Public Health Agency of Canada. But, the agency would still work with the US in contacting passengers who sat near him.

It is still unknown how the man acquired the infection in the first place; his wife has since tested negative. He said he knew he had a form of TB, but didn't know it could be so dangerous.

Tuberculosis is an airborne pathogen. According to the CDC, this particular strain of TB, extensively drug-resistant tuberculosis (XDR TB) "is a relatively rare type of multi drug-resistant tuberculosis (MDR TB). It is resistant to almost all drugs used to treat TB. Because XDR TB is resistant to the most powerful first-line and second-line drugs, patients are left with treatment options that are much less effective and often have worse treatment outcomes."

There have been 17 XDR-TB cases in the US since 2000, according to CDC statistics.

"We've got to really look at the people closest to him, get them skin tested," Gerberding said. The man is currently at Atlanta's Grady Memorial Hospital in respiratory isolation and is not facing prosecution.

FMI: www.cdc.gov

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