WEDNESDAY, May 30, 2007 (HealthDay News) -- A leading tuberculosis expert believes U.S. health officials were right to quarantine a Georgia man with a dangerous form of the respiratory disease who took two trans-Atlantic flights, possibly infecting fellow passengers in the process.
But a second TB expert said the U.S. Centers for Disease Control and Prevention's decision to isolate the man in an Atlanta hospital was unwarranted, contending that the man is "minimally infectious."
Meanwhile, the man at the center of the controversy, who asked that his name be withheld due to the stigma associated with the disease, disputed federal and local health officials' claims that he traveled abroad in violation of their wishes. He said that while officials told him they preferred that he postpone his long-planned wedding in Greece and honeymoon, they did not prohibit him from flying. And the man knew he had tuberculosis but did not think he posed a health risk, according to published reports.
On Tuesday, CDC officials issued the first federal isolation order since 1963 to quarantine the man, who had been diagnosed with "extensively drug-resistant" TB, also called XDR-TB. This form of the disease resists many drugs used to treat the infection.
On May 12, the man flew from Atlanta to Paris, continued on to Prague, then took a return flight to Montreal, Canada, on May 24, before driving back into the United States.
The CDC has advised passengers who were on the two flights to get tested for tuberculosis, although they are thought to be at low risk of infection from the disease, agency officials said Wednesday.
"We believe that the patient's degree of infectiveness is limited," Dr. Martin Cetron, the CDC's director of the Division of Global Migration and Quarantine, said during an afternoon teleconference. Tests show the man was carrying a relatively low level of the tuberculosis bacteria, he said.
Cetron noted that on the flight from Atlanta to Paris, some 40 to 50 passengers who sat near the man were those most likely at risk. The man probably sat in row 51. The same is true for the 30 passengers who sat near the man on the flight from Prague to Montreal. On that flight the man sat in seat 12C.
However, Cetron said that the CDC and other health agencies in the United States and abroad would notify all passengers on both planes as well as passengers who flew with the patient on several shorter flights to and from Greece and Italy.
Dr. Tawanda Gumbo, an assistant professor of internal medicine at the University of Texas Southwestern Medical Center at Dallas and an infectious disease expert who specializes in TB and XDR-TB, believes that isolating the patient was the right thing to do.
"The best we can do right now is to make sure it doesn't spread. We don't want it to spread," Gumbo said, noting that tuberculosis can be very contagious. "You don't have to do anything, just breathe," he added.
It's very possible that passengers on both of the trans-Atlantic flights the patient took were infected, Gumbo said. "We know from the past that a single patient on an airplane can infect other people on the airplane," he said.
But Philip Alcabes, an epidemiologist and professor at New York City's Hunter College School of Health Sciences, said the man posed no public safety threat, and quarantine was "a maximum penalty for a minor medical problem."
"Pulling the trigger on a quarantine should be reserved for serious medical emergencies that pose a genuine health hazard to the general population," Alcabes said. "Doing so for this event only serves to trivialize the real quarantine call-to-action when it is finally needed. The man in question is obviously minimally infectious, as his wife has not been infected."
"Transmission in an airplane is very unlikely, owing to the intrinsic difficulty of transmitting TB and to the relatively high rate of filtration of airplane cabin air," Alcabes said.
"The CDC is making much of the fact that the man's TB strain is drug resistant," Alcabes added. "That is of some clinical relevance but of no public health importance. Drug-resistant strains are no more infectious than other strains. This TB is no more likely to be transmitted in this way than garden-variety TB would. Transmission is not impossible, but highly unlikely."
Dr. Howard Njoo, of the Public Health Agency of Canada, agreed with Alcabes' view that the man posed little risk to his fellow passengers, adding that modern jetliners are equipped with air filters designed to screen out infectious germs like the ones that cause tuberculosis.
"The risk of transmission is considered to be very low; however, we cannot say definitively that the risk is zero and therefore we are undertaking certain public health measures," Njoo told told CTV's Canada AM on Wednesday morning.
Meanwhile, Dr. Julie Gerberding, director of the CDC, said Wednesday that her agency was working closely with airlines to locate passengers who may have been exposed to the rare, dangerous strain of tuberculosis.
The infected man flew to Paris on May 12 aboard Air France Flight 385, then returned to Montreal on May 24 aboard Czech Air Flight 0104, before driving into the United States at Champlain, N.Y.
CDC officials said they were focusing on the trans-Atlantic flights because that's where people would have had the most exposure to the patient. But the risk of infection was considered low, the officials said.
As for the patient, the Atlanta-area man said he doesn't think he did anything wrong.
"I didn't want to put anybody at risk," he told The Atlanta Journal-Constitution in a telephone interview from Grady Memorial Hospital, with an armed sheriff's deputy outside his door.
The man, who said he has no symptoms and feels healthy, said he has met regularly for treatment with Fulton County, Ga., health officials since January. He said the local officials and the CDC knew he had drug-resistant TB before he left the United States, but they did not prevent him from leaving when he told them about his planned wedding in Greece, the newspaper said.
He questioned why no health officials told him to cancel his wedding before he left Atlanta -- and why the CDC waited until he was on his honeymoon in Rome to order him into isolation.
"The county health department knew I was going over to have a honeymoon. We had a meeting before I left," he told the newspaper.
"We headed off to Greece thinking everything's fine," he told the paper. He said he contacted the paper because he wanted to make sure his side of the story was heard.
He told the newspaper he did not report to Italian health officials because he was afraid that if he didn't get back to the United States, he wouldn't get the treatment he needed to survive.
"I'm a very well-educated, successful, intelligent person," he said. "This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary confinement in Italy thing."
The man is not facing prosecution, health officials said, according to the Associated Press.
The man has plans to travel to Denver's National Jewish Hospital, which specializes in respiratory disorders, where he is to undergo an operation that would remove part of his infected lung.
Gumbo noted that such surgery is similar to older treatments for TB. "Before we had effective drugs, one on the options was surgery," he said. "When we run out of therapies there is really nothing else that could be done.
Extensively drug-resistant tuberculosis poses a growing threat because it is becoming more common throughout the world, Gumbo said. "It is being introduced into wider and wider populations," he said.
More information
For more information on extensively drug-resistant tuberculosis, visit the U.S. Centers for Disease Control and Prevention.
