May 31, 2007

Extensively Resistant Tuberculosis Incident

In May 2007, a man with tuberculosis that is extensively resistant to normal antibiotics (also called XDR), met with the Center for the Disease Control and Prevention (CDC) and was strictly forbidden to fly.

If know much about TB, here a few basics you need to know (from Wikipedia of course):

(1) Tuberculosis is a common and deadly infectious disease that is caused by mycobacteria, primarily Mycobacterium tuberculosis.

(2) Tuberculosis most commonly affects the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin.

(3) Symptoms include a productive, prolonged cough of more than three weeks duration, chest pain and coughing up blood. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss and paling, and those afflicted are often easily fatigued.

(4) TB is spread by aerosol droplets expelled by people with the active disease of the lungs when they cough, sneeze, speak, kiss, spit or use the unsterilized eating utensils of the infected person.

(5) Treatment for TB uses antibiotics to kill the bacteria. The two antibiotics most commonly used are rifampicin and isoniazid. However, these treatments are more difficult than the short courses of antibiotics used to cure most bacterial infections as long periods of treatment (around 6 to 12 months) are needed to entirely eliminate mycobacteria from the body.

(5) I had to take Isoniazid for a period of 1 year because, when tested, it was found that I had the antibodies for TB (which means that I likely was exposed to the disease). I think it was because I received the BCG vaccine in France, a vaccine that is thought to boost your immune system against TB. It was hard to take a pill everyday for a year, and I gained a lot of weight while taking the drug.

(7) Drug resistant tuberculosis is transmitted in the same way as regular TB. Primary resistance occurs in persons who are infected with a resistant strain of TB. A patient with fully-susceptible TB develops secondary resistance (acquired resistance) during TB therapy because of inadequate treatment, not taking the prescribed regimen appropriately, or using low quality medication.

(8) Drug-resistant TB is a public health issue in many developing countries, as treatment is longer and requires more expensive drugs. Multi-drug resistant TB (MDR-TB) is defined as resistance to the two most effective first line TB drugs: rifampicin and isoniazid. Extensively drug-resistant TB (XDR-TB) is also resistant to three or more of the six classes of second-line drugs.

(9) TB prevention and control takes two parallel approaches. In the first, people with TB and their contacts are identified and then treated. Identification of infections often involves testing high-risk groups for TB. In the second approach, children are vaccinated to protect them from TB. Unfortunately, no vaccine is available that provides reliable protection for adults.

With these facts in mind, consider the following incident: the man decided to go against CDC recommendations and went on a honeymoon with his new wife...From Atlanta, to Paris...From Paris, to Athens, to Rome, to Prague, to Montreal, to New York, back to Altanta! This man epoxed thousands and thousands of people through his travels and international flights.

Source: The Atlanta Journal-Constitution, Published on: 05/31/07

I think this guy should be put in jail--he knowingly put people at risk, exposing them to a disease that is extremely difficult to treat, spreading this extremely drug resistant disease. Shameful!


jau said...

I completely agree with you. What he did was a personal and horrible thing. And thanks for the details about the treatment!

Anonymous said...

Looks like the CDC isn't exactly squeeky clean either.

U.S. waited more than a week to notify European officials about tuberculosis traveler
- Mainichi Daily News, Japan (AP)

007 in Africa said...

Steve in Wisconsin--good point. This incident will hopefully lead to creating a more robust system for containing people (in as humaine way as possible of course) who are contagious to others. Crossing borders and taking planes is about the worst thing one can do to spread an infection.