镂空的草帽 - 2007-5-31 1:06:00
ATLANTA, Georgia (CNN) -- A man infected with the extensively drug-resistant form of TB known as XDR TB knew he was not supposed to travel overseas but did so anyway, director of the Centers for Disease Control and Prevention Dr. Julie Gerberding told CNN's "American Morning" on Wednesday.
However, that is not what the Atlanta man -- whose name has not been released -- told the Atlanta Journal-Constitution. The man, who is quarantined at an Atlanta, Georgia, hospital, said Fulton County health officials told him they "preferred" he not travel, but knew about his plans for an overseas wedding and honeymoon, the newspaper reported.
CNN is trying to contact the man and his family.
He said he has a form of drug-resistant TB and has no symptoms, but the man and Gerberding both said it wasn't until he was in Europe that his diagnosis of XDR TB was confirmed by lab tests. ( TB patient quarantined after traveling
)
He was then contacted while on his honeymoon in Italy last week by CDC officials and asked to turn himself over to Italian health authorities, he told the newspaper.
Gerberding said health officials "usually rely on a covenant of trust to assume that a person with tuberculosis just isn't going to go into a situation where they would transmit disease to someone else."
"The patient really was told that he shouldn't fly," she added.
"The patient himself was not highly infectious" but there still was a small risk he could transmit the disease to someone else, Gerberding told CNN.
It is the first time in 40 years the federal government has issued a quarantine order for an individual. Gerberding acknowledged that "we kind of had to make up a plan as we went along."
The CDC director announced Tuesday that federal health are looking for people who may have been seated near the man during the two trans-Atlantic flights. (XDR TB leaves doctors with few treatment options)
He departed Atlanta on May 12 aboard Air France Flight 385 and arrived in Paris the next day, she said at the news conference. He returned last Thursday to North America aboard Czech Air Flight 0104 from Prague, Czech Republic, to Montreal, Canada, then drove into the United States.
Those most at risk would have been seated within two rows of the man, Gerberding said.
Newer-model planes use HEPA filters that are able to trap the long, rod-shaped tuberculosis bacilli, according to the CDC.
He told the newspaper he was aware he was placed on a no-fly list in the United States after his recent diagnosis with XDR TB, which is why he decided to fly into Canada.
He told the newspaper that he asked the CDC whether they would provide a jet for him to return home, and was told there was no money for it.
But Gerberding told CNN, "I don't think that that's an accurate description of what actually happened involving the CDC."
"We were doing everything we could to try to find a way to get him home," she said. "In fact, the irony is that when we were no longer able to reach him, we were even preparing to send the CDC plane to Europe to bring him home at government expense."
She noted that it was Memorial Day weekend and because of the holiday, "it took some time to get all the pieces together."
The man told the newspaper that a CDC staff member told him to turn himself into Italian health authorities where he would be put in isolation and given medical treatment. He said he sneaked back into the country because he feared "an unsuccessful treatment in Italy would have doomed him," the newspaper reported.
The man is in isolation at Atlanta's Grady Memorial Hospital and "is required to stay in isolation until the responsible public health officials deem that he is no longer infectious to others," according to Gerberding.
An armed guard stands outside his room.
XDR TBXDR TB was recently defined as a subtype of multiple-drug resistant tuberculosis.
People with XDR TB are resistant to first- and second-line drugs; their treatment options are limited and the disease often proves fatal.
It can take between six and 16 weeks for a final diagnosis of XDR TB.
The man told the Atlanta Journal Constitution that he planned to undergo an 18-month "cutting-edge treatment" at a Denver, Colorado, hospital after his honeymoon, something he said his private doctor and government health officials were aware of.
The man returned via Canada and entered the United States by driving through the border crossing at Champlain, New York.
Customs and Border Protection spokesman Kevin Corsaro said the man did not appear sick to border agents.
CBP said it has not changed its screening or security precautions as a result of the case.
Once he returned to the United States, the man was contacted by health officials, who required that he go to an isolation hospital in New York City for evaluation, said Dr. Martin Cetron, the CDC's chief of quarantine.
"He drove himself there, voluntarily."
The man was admitted and served a provisional quarantine order that lasted 72 hours while he was being assessed, Cetron said.
Asked if he preferred to stay in New York or return to his family in Atlanta for treatment, the man chose the latter option, said Cetron. At that point, the CDC used one of its planes to fly the patient to Atlanta on Monday, an unusual use of agency resources, Gerberding acknowledged.
She said the move was "one that we felt was fair and appropriate, given that he is a citizen of Georgia, his family members are here and his disease does require prolonged treatment."
Upon his arrival in Atlanta, he was issued a federal isolation order to cover the time while the case was handed over to the jurisdiction of state and local officials in Fulton County, Cetron said.
Between 1993 and 2006, 49 people were diagnosed with XDR TB in the United States, said Dr. Ken Castro, director of the division of TB Elimination at CDC.
But the disease is more common elsewhere, he said. "When they looked, they found it in every single continent of the world," he said.
One in three people in the world is infected with dormant TB bacteria, according to the World Health Organization. Age, immune suppression and other medical conditions can activate the bacteria, which can usually be treated with a course of four standard, or first-line, anti-TB drugs.
WHO estimates that there were almost half a million cases of multiple-drug-resistant tuberculosis worldwide in 2004.
People with TB of the lungs, the site most commonly affected, can spread the disease by coughing, sneezing or even talking.
"A person needs only to breathe in a small number of these germs to become infected (although only a small proportion of people will become infected with TB disease)," the WHO said on its Web site.
"The risk of becoming infected increases the longer the time that a previously uninfected person spends in the same room as the infectious case," it added.
Crowded, poorly ventilated, closed environments are most conducive to the spread of infection, it said. Cure is possible for up to 30 percent of cases, it added.
People with HIV infection and other diseases that suppress the immune system are most at risk of catching TB and becoming sick.
No one at the disease agency recalls the agency issuing a quarantine order since 1963, when a possible case of exposure to smallpox emerged, she said.
"From our perspective, no laws were broken here," Gerberding said. "Our system works very well."
However, that is not what the Atlanta man -- whose name has not been released -- told the Atlanta Journal-Constitution. The man, who is quarantined at an Atlanta, Georgia, hospital, said Fulton County health officials told him they "preferred" he not travel, but knew about his plans for an overseas wedding and honeymoon, the newspaper reported.
CNN is trying to contact the man and his family.
He said he has a form of drug-resistant TB and has no symptoms, but the man and Gerberding both said it wasn't until he was in Europe that his diagnosis of XDR TB was confirmed by lab tests. ( TB patient quarantined after traveling
)He was then contacted while on his honeymoon in Italy last week by CDC officials and asked to turn himself over to Italian health authorities, he told the newspaper.
Gerberding said health officials "usually rely on a covenant of trust to assume that a person with tuberculosis just isn't going to go into a situation where they would transmit disease to someone else."
"The patient really was told that he shouldn't fly," she added.
"The patient himself was not highly infectious" but there still was a small risk he could transmit the disease to someone else, Gerberding told CNN.
It is the first time in 40 years the federal government has issued a quarantine order for an individual. Gerberding acknowledged that "we kind of had to make up a plan as we went along."
The CDC director announced Tuesday that federal health are looking for people who may have been seated near the man during the two trans-Atlantic flights. (XDR TB leaves doctors with few treatment options)
He departed Atlanta on May 12 aboard Air France Flight 385 and arrived in Paris the next day, she said at the news conference. He returned last Thursday to North America aboard Czech Air Flight 0104 from Prague, Czech Republic, to Montreal, Canada, then drove into the United States.
Those most at risk would have been seated within two rows of the man, Gerberding said.
Newer-model planes use HEPA filters that are able to trap the long, rod-shaped tuberculosis bacilli, according to the CDC.
He told the newspaper he was aware he was placed on a no-fly list in the United States after his recent diagnosis with XDR TB, which is why he decided to fly into Canada.
He told the newspaper that he asked the CDC whether they would provide a jet for him to return home, and was told there was no money for it.
But Gerberding told CNN, "I don't think that that's an accurate description of what actually happened involving the CDC."
"We were doing everything we could to try to find a way to get him home," she said. "In fact, the irony is that when we were no longer able to reach him, we were even preparing to send the CDC plane to Europe to bring him home at government expense."
She noted that it was Memorial Day weekend and because of the holiday, "it took some time to get all the pieces together."
The man told the newspaper that a CDC staff member told him to turn himself into Italian health authorities where he would be put in isolation and given medical treatment. He said he sneaked back into the country because he feared "an unsuccessful treatment in Italy would have doomed him," the newspaper reported.
The man is in isolation at Atlanta's Grady Memorial Hospital and "is required to stay in isolation until the responsible public health officials deem that he is no longer infectious to others," according to Gerberding.
An armed guard stands outside his room.
XDR TBXDR TB was recently defined as a subtype of multiple-drug resistant tuberculosis.
People with XDR TB are resistant to first- and second-line drugs; their treatment options are limited and the disease often proves fatal.
It can take between six and 16 weeks for a final diagnosis of XDR TB.
The man told the Atlanta Journal Constitution that he planned to undergo an 18-month "cutting-edge treatment" at a Denver, Colorado, hospital after his honeymoon, something he said his private doctor and government health officials were aware of.
The man returned via Canada and entered the United States by driving through the border crossing at Champlain, New York.
Customs and Border Protection spokesman Kevin Corsaro said the man did not appear sick to border agents.
CBP said it has not changed its screening or security precautions as a result of the case.
Once he returned to the United States, the man was contacted by health officials, who required that he go to an isolation hospital in New York City for evaluation, said Dr. Martin Cetron, the CDC's chief of quarantine.
"He drove himself there, voluntarily."
The man was admitted and served a provisional quarantine order that lasted 72 hours while he was being assessed, Cetron said.
Asked if he preferred to stay in New York or return to his family in Atlanta for treatment, the man chose the latter option, said Cetron. At that point, the CDC used one of its planes to fly the patient to Atlanta on Monday, an unusual use of agency resources, Gerberding acknowledged.
She said the move was "one that we felt was fair and appropriate, given that he is a citizen of Georgia, his family members are here and his disease does require prolonged treatment."
Upon his arrival in Atlanta, he was issued a federal isolation order to cover the time while the case was handed over to the jurisdiction of state and local officials in Fulton County, Cetron said.
Between 1993 and 2006, 49 people were diagnosed with XDR TB in the United States, said Dr. Ken Castro, director of the division of TB Elimination at CDC.
But the disease is more common elsewhere, he said. "When they looked, they found it in every single continent of the world," he said.
One in three people in the world is infected with dormant TB bacteria, according to the World Health Organization. Age, immune suppression and other medical conditions can activate the bacteria, which can usually be treated with a course of four standard, or first-line, anti-TB drugs.
WHO estimates that there were almost half a million cases of multiple-drug-resistant tuberculosis worldwide in 2004.
People with TB of the lungs, the site most commonly affected, can spread the disease by coughing, sneezing or even talking.
"A person needs only to breathe in a small number of these germs to become infected (although only a small proportion of people will become infected with TB disease)," the WHO said on its Web site.
"The risk of becoming infected increases the longer the time that a previously uninfected person spends in the same room as the infectious case," it added.
Crowded, poorly ventilated, closed environments are most conducive to the spread of infection, it said. Cure is possible for up to 30 percent of cases, it added.
People with HIV infection and other diseases that suppress the immune system are most at risk of catching TB and becoming sick.
No one at the disease agency recalls the agency issuing a quarantine order since 1963, when a possible case of exposure to smallpox emerged, she said.
"From our perspective, no laws were broken here," Gerberding said. "Our system works very well."