30 May 2007

U.S. seeks fliers possibly exposed to rare TB

As a follwup to my previous posting entitled:
"Superbug poses dire threat to Africa"

US in TB flight infection warning
US health officials have quarantined a man who may have exposed passengers on board two trans-Atlantic flights to a dangerous form of tuberculosis.
Officials say crew and passengers on the same flights, from Atlanta to Paris and from Prague to Montreal this month, should be checked for the infection.

The Centers for Disease Control and Prevention has identified the illness as "extensively drug-resistant TB". It is the first such federal quarantine order to be issued in over 44 years. The last such order was issued in 1963, to quarantine a patient with smallpox, according to the CDC.

Tuberculosis is a bacterial infection that usually attacks the lungs. It is spread through the air and can lead to symptoms such as chest pain and coughing up blood. There were an estimated 1.6 million deaths from TB in 2005, according to the World Health Organization (WHO).

'At risk'
The infected man travelled from Atlanta to Paris on 12 May on Air France flight 385. He returned to the North America on CSA flight 104 from Prague to Montreal on 24 May. He continued his journey in the US by car and is now under quarantine in hospital, according to the WHO.

CDC officials said the man was potentially infectious during this period and are recommending that crew members and passengers on board the same flights seek medical attention. "We want to make sure that we have done everything we possibly can to identify people who could be at risk," said Dr Julie Gerberding, director of the CDC.

TB is rare in the US. Last year there were 13,767 recorded cases or 4.6 cases per 100,000 Americans. About 1.2% of cases in the US are "multidrug-resistant", and can withstand antibiotics commonly used to treat the illness, according to CDC statistics. The "extensively drug-resistant" TB is more dangerous. Medical treatment can cost $500,000 (£250,000) or more, CDC officials say.

Story from BBC NEWS:
Published: 2007/05/29 20:48:38 GMT

You can also read about the breaking story at CNN but they fail to give the flight information.

AND YA KNOW, I don't often agree with Michelle Malkin but I think she has a point:

"What good is a no-fly list...
By Michelle Malkin · May 30, 2007 12:01 PM
...if a banned passenger can still get on a plane? That's the question the feds need to answer in the case of the Atlanta man infected with a super TB strain:"

and here is the spot from the CDC:

This is an official CDC HEALTH UPDATE
Distributed via Health Alert Network
Tuesday, May 29, 2007, 15:30 EDT (03:30 PM EDT)

Corrected: Investigation of U.S. Traveler with Extensively Drug Resistant Tuberculosis (XDR TB)

This message is being sent to correct the flight number of the Czech Air flight on May 24, 2007 from Prague, Czech Republic to Montreal, Canada. The flight number was 0104 not 410.

Original information from CDC Advisory #00261, transmitted May 29, 2007:

The Centers for Disease Control and Prevention (CDC) is working with a number of international, state, and local partners on an investigation involving a U.S. citizen recently diagnosed with extensively drug-resistant tuberculosis (XDR TB). XDR TB has been recently defined as a subtype of multidrug-resistant tuberculosis (MDR TB) with additional resistance to the two most important second-line antibiotics (i.e., a fluoroquinolone and an injectable agent [amikacin, kanamycin, or capreomycin]) in addition to the two most important first-line drugs (i.e., isoniazid and rifampin).

CDC learned that a patient with XDR TB traveled to Europe via commercial airline (Air France # 385) departing Atlanta on May 12 and arriving in Paris on May 13, 2007, and returned to the United States after taking a commercial flight on May 24 from Prague, Czech Republic to Montreal, Canada (Czech Air # 410). The patient re-entered the U.S. on May 24 via automobile. Since May 25, the patient has been hospitalized in respiratory isolation and is undergoing additional medical evaluation.

CDC is collaborating with U.S. state and local health departments, international Ministries of Health, the airline industry, and the World Health Organization (WHO) regarding appropriate notification and follow up of passengers and crew potentially at risk for exposure to XDR TB. Each country involved in the investigation is determining the most appropriate guidance for its residents. The following recommendations have been developed for U.S. residents who may have been exposed to this patient.

This patient has radiographic evidence of pulmonary TB, is culture-positive for XDR TB, but is sputum smear negative for acid fast bacilli and is relatively asymptomatic. On the basis of the patient’s clinical and laboratory status, and lack of receiving adequate treatment for XDR TB, 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, CDC is recommending the following for passengers and crew onboard Air France # 385 departing Atlanta on May 12 and arriving in Paris on May 13, and on Czech Air # 410 departing from Prague and arriving in Montreal on May 24: passengers seated in the same row as the index patient and those seated in the two rows ahead and the two 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.
As there has never been an airline contact investigation for XDR TB, it is not known if the current recommendations are adequate to determine the possible range and risk of transmission of infection. Because of the serious consequences of XDR TB and anticipated public concern, in addition to the contacts listed above, all U.S. residents and citizens on these flights should be notified and encouraged to seek TB testing and evaluation.
Drug-susceptible (regular) TB and XDR TB are thought to be spread the same way. TB bacilli become aerosolized when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These bacilli can float in the air for several hours, depending on the environment. Persons who breathe air containing these TB bacilli can become infected.

The risk of acquiring any type of TB appears to depend on several factors, such as extent of disease in the source patient, duration of exposure, and ventilation. Transmission has been documented in association with patients who have lung disease, and bacteria seen or cultured in sputum. Persons who become infected usually have been exposed for several hours (or days) in poorly ventilated or crowded environments. An important way to prevent the spread and transmission is by limiting an infectious person’s contact with other people. Thus, people who have a confirmed diagnosis of TB or XDR TB are placed on treatment and kept isolated until they are no longer infectious.

Persons who believe they may have been exposed to TB or XDR TB can call 1-800 CDC INFO for further information.

Where to go for information about:
Tuberculosis: http://www.cdc.gov/tb/default.htm

XDR TB: http://www.cdc.gov/tb/pubs/tbfactsheets/xdrtb.htm http://www.cdc.gov/tb/pubs/tbfactsheets/xdrtb.htm and http://www.cdc.gov/tb/pubs/tbfactsheets/cdcandxdrtb.htm http://www.cdc.gov/tb/pubs/tbfactsheets/cdcandxdrtb.htm

TB Testing: http://www.cdc.gov/tb/pubs/tbfactsheets/skintesting.htm http://www.cdc.gov/tb/pubs/tbfactsheets/skintesting.htm and http://www.cdc.gov/tb/pubs/tbfactsheets/QFT.htm http://www.cdc.gov/tb/pubs/tbfactsheets/QFT.htm

Infection control: http://www.cdc.gov/tb/pubs/tbfactsheets/ichcs.htm http://www.cdc.gov/tb/pubs/tbfactsheets/ichcs.htm and http://www.cdc.gov/tb/pubs/tbfactsheets/rphcs.htm http://www.cdc.gov/tb/pubs/tbfactsheets/rphcs.htm

Tuberculosis and Air Travel:

##This Message was distributed to State and Local Health Officers, Public Information Officers, Epidemiologists, State Laboratory Directors, BT Coordinators and HAN Coordinators, as well as Public Health Associations and Clinician organizations##

Categories of Health Alert Messages:
Health Alert: Conveys the highest level of importance; warrants immediate action or attention.
Health Advisory: Provides important information for a specific incident or situation; may not require immediate action.
Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action.

You have received this message based upon the information contained within our emergency notification database. If you have a different or additional e-mail or fax address that you would like us to use, please contact the Health Alert Network program at your State or local health department.

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