Will TB Become the Next Bird Flu?

The Washington Post is reporting today about a man being detained in Atlanta after travelling in Europe, Canada and the US even though he knew he was infected with an antibiotic resistant strain of tuberculosis – XDR-TB.

Although the CDC and the two airlines are attempting to contact the passengers who might have sat near the man on 2 separate commercial flights, health officials are playing down the possibility of transmission. While TB was present, officials are saying the man was not highly contagious.

Nevertheless, he was detained in New York City and then flown in a government plane to be quarantined in Atlanta. He hasn’t broken any laws, he is being forcibly detained and required to undergo treatment.

This isn’t the first time someone has been detained this year for the ‘crime’ of TB. Tara Smith, my go to – um – Assistant Professor of Epidemiology at ScienceBlogs, highlighted the case of Robert Daniels, being held against his will in Arizona because he refused to submit to treatment. From the AP story published in April,

Behind the county hospital’s tall cinderblock walls, a 27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation system that keeps germs from escaping. Robert Daniels has been locked up indefinitely, perhaps for the rest of his life, since last July. But he has not been charged with a crime. Instead, he suffers from an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.

County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors’ instructions to wear a mask in public.

“I’m being treated worse than an inmate,” Daniels said in a telephone interview with The Associated Press last month. “I’m all alone. Four walls. Even the door to my room has been locked. I haven’t seen my reflection in months.”

The article goes on to mention that Texas has detained 17 persons for TB while California hasn’t detained anyone this year but four persons last year.

While the rate of antibiotic resistant infections in America is still relatively low, about 2 percent of total TB cases, in some countries, such as Latvia, South Korea and South Africa, it is becoming a serious health threat. According to the March 2007 Fact Sheet from the Stop TB web site (WHO) all G8 countries have now had confirmed cases of XDR-TB.

To give you an idea of how serious this threat is, in its coverage of this story, the New York Times echoes Dr. Julie Gerberding, director of the Centers for Disease Control, during her Congressional testimony in March,

In one outbreak in South Africa, Dr. Gerberding testified, 41 percent of the 544 patients infected with tuberculosis were found to have multidrug-resistant strains; of those, 53 met the definition of XDR TB.

Of the latter group, all but one person died, on average just 16 days after health workers had tested them.

Finally, for all those wondering whether the federal government is getting the black helicopters out of mothballs to use this to create the New World Order, might I direct them to the oh-so-official booklet The Role of Law Enforcement in Public Health Emergencies ? This outlines just how local police departments should be prepared for these kinds of things.

(If you really want to start a fuss, just call up your local sheriffs department, ask for the PR spokesperson and say, as a concerned citizen, you would like to know what plans your local police have made to combat a local contagious disease outbreak. Then just sit back and wait for the FBI to come knock on your door asking you about your religious affiliation. Want to make a bet?)

Remember, while the bird flu is still spreading around the world on the wings of birds, XDR-TB using jets. Expect to hear far more in the next weeks and years of the comeback of TB. Instead of simply being a possible danger like bird flu requiring a mutation to create a highly contagious human variant, XDR-TB is here. Now.

The lessons the public learns with XDR-TB will help cope with more serious outbreaks of other epidemics and pandemics in the near future.

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