CDC Quarantines Man For TB (Tuberculosis XDR-TB)

For the first time in four decades, the CDC has quarantined a man as a public health risk, the government announced today.The Georgia man is infected with extensively drug resistant tuberculosis (XDR-TB). He was ordered into isolation in Atlanta.

The agency took the unusual step under the federal Public Health Act after the man, who had been asked not to travel, flew from Atlanta to Prague, via Paris May 12, and then back to Montreal May 24. He re-entered the U.S. by car the same day, according to CDC director Julie Gerberding, M.D.

It’s the first time since 1963 that the agency has used its statutory power to isolate a citizen. In that case, Dr. Gerberding told a press conference today, the patient had smallpox.

“Because (XDR-TB) is so potentially serious and could cause such serious harm to people,” she said, “we felt it was our responsibility to err on the side of abundant caution and issue an isolation order.”

The order came as the CDC, co-operating with public health agencies in several other countries as well as the airlines involved, was trying to track down other passengers on the two flights, she said.

The man, whose name and age were not given, flew on Air France flight 385 from Atlanta and Czech Air flight 0104 to Montreal, she said.

While XDR-TB is no more or less infectious than regular TB, it is much more difficult to treat, she said. A TB strain is defined as XDR if it is resistant to at least rifampicin and isoniazid from among the first line anti-TB drugs, as well as to any fluoroquinolone, and to at least one of three injectable second-line drugs (capreomycin, kanamycin, and amikacin).

Dr. Gerberding said the man’s international trip was not illegal. “No laws were broken here,” she said.

Instead, a “covenant of trust” between the man and local Georgia health officials was broken. She said the man had been told he had TB — but not XDR-TB — and was counseled not to travel.

The CDC was not aware of the case — and the fact the man had XDR-TB — until after he had left the country for what Dr. Gerberding said he felt were “compelling personal reasons.”

She refused to elaborate on those reasons.

The man was reached in New York after he returned to the U.S., according to Martin Cetron, M.D., director of the CDC’s division of global migration and quarantine.

Dr. Cetron said the man was told he had XDR-TB, and co-operated in getting himself to a New York hospital’s isolation facility without exposing other people.

He was then flown to hospital in Atlanta using a CDC aircraft, Dr. Gerberding said.

It’s not yet known how many passengers on the two international flights might have come in contact with the man, Dr. Gerberding said. “We don’t get this information at the touch of a button,” she said.

She said the agency is particularly interested in ensuring that people within two rows of the man’s seat be followed for tuberculosis.

“We have no suspicion that this patient was highly infectious,” he said. “In fact the medical evidence would suggest that his potential for transmission would be on the low side.”

“But we know it isn’t zero.”

Dr. Gerberding said the main issue is the health of passengers who were exposed, rather than a threat to the general public. Since TB is a slow-developing disease, she said, the passengers aren’t an immediate danger to other people.

XDR-TB remains rare in the U.S., according to Kenneth Castro, M.D., director of the CDC’s TB elimination section. Between 1993 and 2006, he said, the CDC has confirmed only 49 cases in the country.

But the incidence of the disease continues to rise in other parts of the world, posing a risk to Americans who travel abroad.

Dr. Gerberding said it is not clear where the man acquired his infection, adding the investigation is still in an early stage.