New Global Health Scare: Man with XDR-TB goes on Trans-Atlantic Flights.

Global health authorities are now on high alert due to the travel of a US man with highly drug resistant strain of tuberculosis (XDR TB), who went to attend his wedding in Greece from Atlanta (please see his itinerary below). Only when the man was in Italy did he realize the danger that he posed to other travellers (especially on long-haul flights). According to the man, he wasn't advised by his doctors not to travel. (Excuse my French, but the guy must be incredibly stupid - TB is a highly contagious disease especially in confined areas like airplanes - he was a danger to himself and others). Health experts are worried about how XDR TB could further endanger those who are already HIV infected. The results could be disastrous.

Flight Itinerary of U.S. Traveler with Extensively Drug–Resistant Tuberculosis (XDR TB) (May 30, 2007)

Provided below is the complete flight itinerary of the U.S. traveler with extensively drug-resistant tuberculosis (XDR TB) who traveled between North America and Europe from May 12-24.

CDC recommends that all U.S. residents and citizens onboard Air France #385/Delta #8517 departing Atlanta on May 12 and arriving in Paris on May 13, and on Czech Air #0104 departing from Prague and arriving in Montreal on May 24 seek TB testing and evaluation. Passengers traveling on these flights please call 1-800 CDC INFO for further information.

Both CDC and the WHO consider the risk of infection to travelers on flights under eight hours to be very low. However, if you were a passenger on one of the flights that were shorter than 8 hours and are concerned, check with your local public health department or your primary care physician about being tested for TB.

For more information please see http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00262.

Airlines	Flight#	Date	Departing	Scheduled Departure	Calculated Scheduled Duration	Arriving	Total Number of Passengers	Patient Seat Row Number
Air France/Delta	385/8517	5/12/2007	Atlanta, Georgia	8:45 PM Local	8 Hr 27 Min	Paris, France	433	30
Air France	1232	5/14/2007	Paris, France	07:35 AM Local	3 Hr 11 Min	Athens, Greece	unknown	unknown
Olympic Air	560	5/16/2007	Athens, Greece	7:25 PM Local	0 Hr 40 Min	Thira Island, Greece	unknown	unknown
Olympic Air	655	5/21/2007	Mykonos Island, Greece	1:45 PM Local	0 Hr 40 Min	Athens, Greece	unknown	unknown
Olympic Air	239	5/21/2007	Athens, Greece	5:30 PM Local	2 Hr 05 Min	Rome, Italy	unknown	unknown
Czech Airlines	727	5/24/2007	Rome, Italy	8:50 AM Local	1 Hr 55 Min	Prague, Czech Republic	unknown	unknown
Czech Airlines	0104	5/24/2007	Prague, Czech Republic	12:25 PM Local	8 Hr 25 Min	Montreal, Canada	191	12

Extensively Drug-Resistant Tuberculosis (XDR TB)
Posted: April 2007

What is XDR TB?

Extensively drug-resistant tuberculosis (XDR TB) is a relatively rare type of multidrug-resistant tuberculosis (MDR TB). It is resistant to almost all drugs used to treat TB, including the two best first-line drugs: isoniazid and rifampin. XDR TB is also resistant to the best second-line medications: fluoroquinolones and at least one of three injectable drugs (i.e., amikacin, kanamycin, or capreomycin).

How is XDR TB spread?

Drug-susceptible (regular) TB and XDR TB are spread the same way. TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs can float in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB germs can become infected.

TB is not spread by

• shaking someone’s hand
• sharing food or drink
• touching bed linens or toilet seats
• sharing toothbrushes
• kissing
• smoking or sharing cigarettes

Why is XDR TB so serious?

Because XDR TB is resistant to the most powerful first-line and second-line drugs, patients are left with treatment options that are much less effective and often have worse treatment outcomes. XDR TB is of special concern for persons with HIV infection or other conditions that can weaken the immune system. These persons are more likely to develop TB disease once they are infected, and also have a higher risk of death once they develop TB disease.

Who is at risk for getting XDR TB?

Drug-resistant TB (MDR or XDR) is more common in people who:

• Do not take their TB medicine regularly
• Do not take all of their TB medicines as told by their doctor or nurse
• Develop active TB disease again, after having taken TB medicine in the past
• Come from areas of the world where drug-resistant TB is common
• Have spent time with someone known to have drug-resistant TB disease

How can I prevent myself from getting TB?

Avoid close contact or prolonged time with known TB patients in crowded, enclosed environments like clinics, hospitals, prisons, or homeless shelters.

Can the TB vaccine (BCG) help prevent XDR TB?

There is a vaccine for TB disease called Bacille Calmette-Guérin (BCG). It is used in some countries to prevent severe forms of TB in children. However, BCG is not generally recommended in the United States because it has limited effectiveness for preventing TB in adults. The effect of BCG against XDR TB would likely be similar to the effect on drug-susceptible TB.

If I have regular (drug-susceptible) TB, how can I prevent getting drug-resistant TB?

The most important thing is for you to continue taking all your TB medicines exactly as prescribed. No doses should be missed and treatment should not be stopped early. You should tell your health care provider if you are having trouble taking the medications. If you plan to travel, make sure you have enough medicine to last while away.

Can XDR TB be treated and cured?

Yes, in some cases. Some TB control programs have shown that cure is possible for an estimated 30% of affected people. Successful outcomes depend greatly on the extent of the drug resistance, the severity of the disease, and whether the patient’s immune system is weakened.

What are the symptoms of XDR TB?

The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs may also include coughing, chest pain, and coughing up blood. Symptoms of TB disease in other parts of the body depend on the area affected. If you have these symptoms, you should contact your doctor or local health department.

What should I do if I have been around someone who has XDR TB?

If you think you have been exposed to someone with TB disease, you should contact your doctor or local health department about getting a TB skin test or the QuantiFERON®-TB Gold test (QFT-G), a blood test. And tell the doctor or nurse when you spent time with this person.

How long does it take to find out if you have XDR TB?

If TB bacteria are found in the sputum (phlegm), the diagnosis of TB can be made in a day or two, but this finding will not be able to distinguish between drug-susceptible (regular) TB and drug-resistant TB. To determine drug susceptibility, the bacteria need to be grown and tested in a laboratory. Final diagnosis for TB, and especially for XDR TB, may take from 6 to 16 weeks.

Is XDR TB a problem in the United States?

The risk of acquiring XDR TB in the United States appears to be relatively low. However, it is important to acknowledge the ease at which TB can spread. As long as XDR TB exists, the United States is at risk and must address the threat.

How many cases of XDR TB have been reported in the United States?

In the United States, 49 cases of XDR TB have been reported between 1993 and 2006.

Is it safe to travel where cases of XDR TB have been reported?

Although MDR and XDR TB are occurring globally, they are still rare. HIV-infected travelers are at greatest risk if they come in contact with a person with MDR or XDR TB.

All travelers should avoid high risk settings where there are no infection control measures in place. Documented places where transmission has occurred include crowded hospitals, prisons, homeless shelters, and other settings where susceptible persons come in contact with persons with TB disease.

Air travel itself carries a relatively low risk of infection with TB of any kind.

What can health care providers do to prevent XDR TB?

Health care providers can help prevent MDR and XDR TB by quickly diagnosing cases, following recommended treatment guidelines, monitoring patients’ response to treatment, and making sure therapy is completed.

Providers should also ensure proper implementation of infection control procedures to prevent exposure to TB in hospitals or health-care settings where TB patients are likely to be seen.

Are immigrants putting the U.S. at increased risk for TB?

Persons applying to enter the U.S. with immigrant or refugee visas must complete a questionnaire about any symptoms of TB they may have and obtain a chest radiograph. If positive, the person submits sputum specimens for examination for TB bacteria. Persons identified as having infectious TB are not granted entry to the United States, until they have been treated.

Why haven’t we heard about XDR TB before now?

For some years we have seen isolated cases of very highly resistant TB around the world that we would today call XDR TB. The drugs used to treat TB have been around a long time and drug resistance has taken many years to develop. Over time, countries have improved their laboratory capacity to test for drug resistance and their ability to track the number of cases. All of these factors have contributed to an increase in reporting of cases of drug-resistant TB. With more cases being identified, the problem was more closely examined, defined, and given a name.

A Georgia man infected with XDR TB was checked into the National Jewish Hospital at Denver, CO (Associated Press Photo). The man told a newspaper he flew from Atlanta to Greece for a wedding and then traveled to Italy for a honeymoon.

31 year old Lawyer (yes he is a lawyer who probably like any other screws everyone) Andrew Speaker (whose father in law works for the Center for Disease Control- geeze!!!) has the potentially lethal strain.