XDR-TB Patient, 'Feeling Well' in Isolation, Called Low Infection Risk

May 30, 2007

ATLANTA -- The Georgia man with extensively drug-resistant tuberculosis (XDR-TB) who sparked an international hunt for contacts is asymptomatic and feeling well, officials said today.

ATLANTA, May 30 -- The Georgia man with extensively drug-resistant tuberculosis (XDR-TB) who sparked an international hunt for contacts is asymptomatic and feeling well, officials said today.

Testing continues to determine what drugs can be used to treat the man, now under a federal isolation order in Grady Memorial Hospital here, according to officials of the CDC.

The man, not identified because of privacy concerns, was confined in isolation because he violated a "covenant of trust" by flying to Europe after being advised not to travel, said the CDC. Then he flew back from Prague on a commercial jet after being begged to stay put while safe travel was being arranged.

Contact tracing in several countries was under way to find and test more than 100 passengers and crew members from two aircraft. They were deemed at highest risk of infection from the Georgia man. Although he flew on several aircraft, the investigators homed in on two flights of eight hours or more, and on passengers in nearly rows on those flights. All crew members were also considered at risk.

The CDC said the risk of infection was low, and no worse than any form of TB, but it was not zero.

The man broke no laws, said the CDC, but has lost his freedom for the time being. Arrangements were underway to transport him safely to National Jewish Hospital in Denver, which has an expertise in XDR-TB.

Martin Cetron, M.D., director of the CDC's division of global migration and quarantine, said the man's wife tested negative for TB on an initial test, which still must be confirmed in several weeks to allow the slow-growing TB bacteria to manifest themselves if she has been infected.

Nevertheless, he said, health officials are "greatly reassured by her initial test."

There were about 80 passengers seated within two rows of the man during long-haul flights from Atlanta to Paris and from Prague to Montreal.

Those passengers, as well as the 27 crew members on the two flights, are considered to be at greatest risk of infection, Dr. Cetron said, although he reiterated that the man's disease is not currently considered highly infectious.

Passengers and crew members of several short-haul flights the man took in Europe will also be contacted, although Dr. Cetron said the risk of infection for those people is much smaller, because the time they were exposed is much shorter.

He said the man's TB was first diagnosed in January after a chest x-ray was taken for another reason, The TB was confirmed by an exploratory procedure to obtain samples of his respiratory secretions.

The man was then and remains sputum-negative, Dr. Cetron said.

The TB bacterium was cultured and found to be multi-drug resistant only shortly before he began his international trip. The man was informed he had multi-drug resistant TB and was "clearly advised" not to travel, according to Kenneth Castro, M.D., director of the CDC's TB elimination section.

But the man departed for Europe before he received a formal letter advising against travel, Dr. Castro said. The man told an Atlanta newspaper he was on his honeymoon.

Once the CDC learned the man's TB was extensively drug resistant, Dr. Cetron said, officials reached him by cell phone in Rome, "begging him and asking him to stay put and not to travel" while the agency tried to find a way to get him back to the U.S. safely.

But before those arrangements could be completed, the man had flown from Rome to Prague and on to Montreal on May 24, where he and his wife crossed into the U.S. by car.

The man told the Atlanta Journal-Constitution that the CDC had asked him to turn himself in to Italian authorities for isolation and treatment and had told him he was not to fly commercially.

"I thought to myself: You're nuts. I wasn't going to do that. They told me I had been put on the no-fly list and my passport was flagged," the man said.

He and his wife decided to sneak back into the U.S., because he feared he wouldn't get proper treatment outside the U.S.

Dr. Cetron said the man was reached May 25 by cell phone "between Albany and New York City" and agreed to go to a hospital in New York that had a respiratory isolation facility.

"Since we issued the federal isolation order, he has been fully compliant," he said.

The man told the newspaper he found the situation absurd. "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," he 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).

The two long-haul flights involved in the case are Air France 385, which left Atlanta for Paris May 12, and Czech Air 0104 which traveled from Prague to Montreal May 24. The Air France flight is also a Delta codeshare, flight 8517.