Tuberculosis Man

[amalgamate]

TB man 'sorry' over plane trips

A US tuberculosis patient who triggered a health scare by boarding two transatlantic flights has apologised to passengers he may have endangered.
"I'm very sorry for any grief or pain that I have caused," Andrew Speaker, a 31-year-old lawyer, told ABC TV.

Mr Speaker, who flew to Europe for his wedding last month, knew he had TB but said he did not know he posed a risk.

Health officials had told him he was not contagious and had not forbidden him to travel, he said.

Wearing a medical mask, he told ABC's Good Morning America programme he hoped fellow passengers could "forgive me and understand that I really believed that I wasn't putting people at risk".

Mr Speaker added that he had tape recordings to prove his claim that he was only advised against travelling, but not barred by officials.

"At every turn it was conveyed to me that my family, my wife, my daughter, that no-one was at risk," he said.

Quarantine

The ABC interview took place at a specialist clinic in Denver, where Mr Speaker is under quarantine.

US and European authorities have launched a worldwide search for people who may have come into contact with him during two transatlantic flights.

Mr Speaker was found to have a rare strain of tuberculosis, and the European Centre for Disease Control (ECDC) says the risk of contracting the drug-resistant disease is low.

Nevertheless it was recommending that people who sat in the same row or in the two rows in front of or behind him to be checked.

Mr Speaker travelled from Atlanta to Paris on 12 May to get married and spend his honeymoon in Europe.

He returned from Prague to Montreal on 24 May and continued his journey into the US by car.

The personal injury lawyer was initially placed under federal quarantine at an Atlanta hospital - the first such order since 1963.

He is restricted to a special "negative pressure" room that traps and cleanses air particles, and medical staff will wear masks when in contact with him.

TB is rare in the US. Last year there were 13,767 recorded cases or 4.6 cases per 100,000 Americans.

[amalgamate]

Tuberculosis- Health Information

[Al-khiyal]

"The term "quarantine" comes from the Italian phrase "quaranta giorni," or "40 days,"
the amount of time Venetians isolated those coming into port in the plague years of the 14th century"

NEW YORK, June 2, 2007: Accounts of the 12 days of world travel by a patient with a dangerous form of tuberculosis seem to agree only in that many opportunities were missed to head off what has become an international public health scandal.

The finger-pointing extended to Canada, Greece and Italy, where officials said they had received no word of the presence of the patient, Andrew Speaker, in time to take action.

The likelihood that Speaker might have infected other passengers as he flew from North America to Europe and back is low, tuberculosis experts say, because the disease is not as contagious as illnesses like influenza. In any case, Speaker has not been coughing, and may not have enough TB bacteria in his sputum to spread the disease if he did, health officials said.

But the risk was still real, and the case calls into question preparations to deal with medical crises like influenza pandemics and even bioterror attacks.

Officials at the U.S. Centers for Disease Control and Prevention said they had reached 74 passengers out of 310 from the United States, including all 26 people who were in the rows closest to Speaker on his flight to Paris.

The agency is focusing only on U.S. citizens, said Julie Gerberding, the director of the centers; she said other nations should be contacting their own citizens. Passengers on the trans-Atlantic flights are being advised to have tuberculosis tests immediately, and to have follow-up tests in several weeks.

Italian officials said they were first informed unofficially of an American with a dangerous tuberculosis case while Speaker was still in Rome but had to take the initiative in calling the Centers for Disease Control and Prevention in Atlanta to ask for details. That information did not come until after Speaker had left Italy.

In the sharpest contradiction in the accounts, Speaker said Friday on the ABC News program "Good Morning America" that health officials in Fulton County, Georgia, who met with him before his trip all but wished him bon voyage. Although they urged him not to travel to his wedding in Greece because of his tuberculosis, he recalled, they backed off under his father's lawyerly prodding, saying: "Well, we have to say that to cover ourself, but he's not a risk."

But Steven Katkowsky, director of the Fulton County Department of Health and Wellness, said in an interview that the county could not have made the warning more clear. "We told him that if you travel, you're putting people at risk," Katkowsky said.

Instead of canceling his reservations for a wedding and monthlong honeymoon, county officials said, Speaker moved up the departure date from May 14 to May 12 - too soon to get the follow-up letter from the county stating, "it is imperative that you are aware that you are traveling against medical advice."

Though their accounts differ, the local health authorities in Georgia and Speaker agree that the officials did not try to restrict Speaker's movement. Katkowsky said that the law presented "kind of a Catch-22" when it comes to restricting the activities of tuberculosis patients against their will.

"A patient has to be noncompliant before you can intervene," he said. "There's no precedent for a court stepping in before a patient has proven himself to be noncompliant."

It would have been an extraordinary step that, while not unheard of in tuberculosis cases, would evoke a centuries-old struggle to balance public health and individual liberty. The term "quarantine" comes from the Italian phrase "quaranta giorni," or "40 days," the amount of time Venetians isolated those coming into port in the plague years of the 14th century, said Robert Klitzman, a co-founder of the Columbia University Center for Bioethics and an associate professor of clinical psychiatry at the university's College of Physicians and Surgeons.

Klitzman said that these days, quarantine and forced medical isolation "have a uniformly bad name to the more liberally minded people," raising the notion of "the state violating individual autonomy." On Thursday, Speaker became the first person placed under quarantine by the U.S. government since 1963.

Speaker first received a diagnosis of tuberculosis in January after a chest X-ray to see if he had broken a rib in a fall. Yet it would be months before the matter became a priority of county health officials.

The day of the meeting with Speaker, May 10, the county health officials called the Georgia Division of Public Health, said Dena Smith, the state public health press secretary. That office made a call to the U.S. Centers for Disease Control, or CDC.

Smith said the call from the county left officials in her office with the impression that the problem was largely hypothetical. "They had no idea at that time that the patient was thinking about leaving the country," she said. Her office did not receive word that Speaker had flown overseas until May 17, she said.

Speaker left Atlanta on the evening of May 12 on Air France Flight 385. After spending May 13 in Paris, Speaker traveled to Greece, staying a week in Athens and Mykonos before arriving in Rome on the evening of May 21.

The CDC learned on May 22 that Speaker had XDR tuberculosis, a type that is resistant to multiple drugs, but it did not immediately contact the Italian health authorities or the World Health Organization, Italian officials said.

Instead, on May 23, the U.S. health officials contacted a doctor, whom they did not identify, who had worked at the CDC in the past but is now working in Italy. On the same day, Italian officials said, this doctor contacted the Italian Health Ministry to let it know about a tuberculosis case and tell it that the CDC would be in touch.

The CDC also contacted Speaker, who said he was told that he could not fly home unless he chartered a plane - at a cost of $100,000 - and that he should check into a local hospital.

"I felt very abandoned," he said, emphasizing that he firmly believed he could not infect others. He said he feared he might end up "stuck in an Italian hospital indefinitely, where I could die."

But when pressed by the ABC News interviewer, Diane Sawyer, he said: "In hindsight, maybe it wasn't the best decision."

Once again, Speaker changed his travel plans, leaving for Montreal by way of Prague on Czech Airlines Flight 104 on the morning of May 24. He arrived in Canada that afternoon, local time, rented a car and headed for the United States.

By the time Speaker reached the border, an alert had been attached to the U.S. passport database warning customs agents to detain him. But the guard waved him through - a matter that is now under investigation.

U.S. officials did not get word to the Canadian authorities that Speaker was in their country until after he left, Gerberding said. She defended that, saying: "We didn't know where he was. For all we knew, he was anywhere in the world."

Meanwhile, according to Cesare Fassari, spokesman for the Italian Health Ministry, when the ministry still had not received any further information on May 24, Dr. Maria Grazia Pompa, who leads Italy's tuberculosis surveillance program, "contacted the CDC and said: 'Weren't you supposed to contact us?' "

"At that time, the disease centers confirmed that there was a case, but did not provide details," Fassari said.

Those came in an e-mail message to Pompa on the afternoon of May 25.

When asked why the CDC could not have moved more quickly to catch up with Speaker, Gerberding said at a news conference that much of the previous week's activity had been spent debating issues concerning the laws and regulations that govern isolation and quarantine in the United States and internationally.

The World Health Organization put forth guidelines last year, for example, that prohibit people with Speaker's form of tuberculosis from taking commercial flights. Those guidelines, she said, are "wonderful statements of principles" that do not provide "operational details of things like who should pay to move a patient, or who should care for a patient."

"I think a central question that we will be grappling with is, whose patient is it?" she said.

Ultimately, however, the idea of an all-seeing public health and enforcement network that could spot and stop a traveling patient could raise worries of its own, said Michael Osterholm, an epidemiologist who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. "Short of a military state where you have 24/7 surveillance on someone," Osterholm said, "you have to count on the good will of the individual."

He called this a fact of life in an open society, one that could lead to major problems in an outbreak of pandemic influenza, in which many people would probably be boarding planes knowing they were sick to get away from an epidemic. "They would say, 'I want to make sure I get out,' " whatever the risk to others. In that kind of situation, he said, the public health system would inevitably be unable to keep up.

Tom Skinner, a spokesman for the CDC, said: "There are going to be many lessons learned from this whole particular incident."

Tuberculosis case leads to international finger-pointing

[Al-khiyal]

WASHINGTON, June 5, 2007: The unexpected turns in the case of Andrew Speaker, the Atlanta lawyer with extensively drug-resistant tuberculosis, have riveted the country.

Speaker made two trans- Atlantic flights against the counsel of public health officials. A border guard let him into the United States apparently because he appeared healthy. His father-in-law works in the field of tuberculosis research. And yesterday, his doctors in Denver reported that two tests of his sputum show no presence of the TB bacteria.

But TB specialists said yesterday that the real importance of the case is that it is a warning: People everywhere should brace themselves for many more cases of the drug-resistant airborne germ in the months and years ahead.

"This is the tiniest tip of the iceberg," said Dr. Paul Farmer, a Harvard professor who has treated drug-resistant TB in Haiti, Peru, and Siberia. "We need to take excellent care of our own but also acknowledge that we're lucky as a nation: We have little TB, drug resistant or otherwise. We need to think about this much more globally."

Farmer said poor countries need laboratory diagnostic tools, more drugs, better trained doctors who could perform surgery if necessary, and a cadre of community health workers. Those workers visit patients in their homes, ensuring they are taking their drugs properly and protecting them from hospital-acquired infections or illnesses.

Senior officials of the World Health Organization met privately yesterday in Geneva to review the lessons of Speaker's case. Dr. Mario Raviglione , director of WHO's Stop TB Department, said in an interview that the TB specialists "found a number of things that failed in the system" that allowed Speaker to travel from country to country in Europe and eventually to the United States.

Speaker, who is now under a federal quarantine order while being treated at a Denver hospital, flew to Greece last month for his wedding and honeymoon.

While in Europe, he learned he had an extensively drug-resistant strain of TB, known as XDR-TB, and the Centers for Disease Control and Prevention told him not to fly and to turn himself in at a clinic. Instead, Speaker took steps to avoid the no-fly order.

Raviglione said Speaker's evasive actions exploited poor communications among international health authorities, airline carriers, and border posts that allowed him to travel from Rome to Prague, then fly from Prague to Montreal, before crossing into the United States in a private car.

Most critically, he said, the US case revealed the lack of urgency in fighting drug-resistant tuberculosis, including the most dangerous type, XDR-TB. Since XDR-TB was identified more than a year ago in South Africa, authorities have identified cases in 37 countries, including the United States.

"TB is not just a disease of the poorest people," Raviglione said. "This is a disease that can hit everyone, even reach a lawyer in the US. It spreads through the air and respects no border. No one should feel safe in this world."

An estimated 424,000 new cases of multiple-drug resistant TB were contracted in 2004, the latest available statistics, up from roughly 273,000 in 2000. Because many patients survive for years after diagnosis, specialists estimate that as many as 2 million people globally are infected with drug- resistant TB. Of the cases in 2004, an estimated 62 percent were in China, India, and Russia.

While funding for AIDS and malaria have greatly increased in recent years - the Bush administration last week proposed $30 billion in additional money, starting in 2009, to fight AIDS - the amount for fighting tuberculosis has lagged well behind. Raviglione said WHO will publish a report in the coming weeks estimating that the cost of controlling XDR-TB alone will be an extra $1 billion annually. Now, he said, the TB fight needs an additional $1.5 billion to $2 billion a year, including funding for XDR-TB.

Senator Edward M. Kennedy, a Massachusetts Democrat, along with two other US senators - Sherrod Brown, an Ohio Democrat , and Kay Bailey Hutchinson , a Texas Republican - will introduce legislation today calling for US public health officials to be given the "resources needed to eliminate TB in the US."

Mycobacterium tuberculosis, which has been found in 4,000-year-old Egyptian mummies, has been treated with antibiotics since 1944. But the TB bacteria developed mutant strains when patients didn't use the drugs properly. Some strains eventually developed multiple resistances, and much of the medical world, including WHO, believed for years that drug-resistant TB was virtually incurable in poor countries.

But successful treatment of patients by Farmer, Dr. Jim Yong Kim, and others at the Boston-based Partners in Health in the late 1990s in Lima, Peru, showed that belief was false.

"We need to wake up and pay attention to what's happening with TB in other parts of the world," said Dr. Mark L. Rosenberg , Harvard-educated executive director of the Task Force for Child Development and Survival in Atlanta. "We need to start treating XDR-TB where it is, not just respond to one case of one American who will get the finest treatment."

Specialists say drug-resistant TB to occur more

[Al-khiyal]

Specialists say drug-resistant TB to occur more

June 8, 2007 -- A hospital was on tuberculosis alert today after a member of staff contracted a rare form of the disease.

The employee at Causeway Hospital in Coleraine contracted a multi-drug-resistant form of the respiratory disease and is in a stable condition.

Work colleagues and friends have been screened for the disease while the hospital has begun drawing up a list of patients who may also require testing.

The Northern Health and Social Care Trust said the chances of people catching this strain of TB was extremely low.

Dr Peter Flannigan, the trust's medical director, said they were concerned about possible exposures to the infection between September last year and last month.

"But because of the very limited contact, time wise . . . this does not present any degree of significant risk to anybody who attended the accident and emergency department," he said.

Tuberculosis attacks the lung and is a bacterial infection that is spread through the air. Among the symptoms are chest pain and the coughing up of blood.

Northern Ireland hospital on tuberculosis alert

[Al-khiyal]

".....this does not present any degree of significant risk to anybody who attended the accident and emergency department...."

There is a tuberculosis alert at the Causeway Hospital in Coleraine, after a member of staff contracted a rare form of the respiratory disease.

The worker, diagnosed with a multi-drug resistant form of TB, is said to be in a stable condition.

Friends and colleagues of the person are being screened. A list of patients who may need testing is being drawn up.

The Northern Health and Social Care Trust has stressed that the risk of catching the infection is very low.

The trust's medical director, Dr Peter Flannigan, said the time they were concerned about is September last year and May this year.

"Our main concern is with regard to the patients who during this period of time were treated in surgical ward one and the gynaecology ward of Causeway Hospital," he said.

"The healthcare worker also did some work in the accident and emergency department.

"But because of the very limited contact time-wise they would have had with the public, at that stage this does not present any degree of significant risk to anybody who attended the accident and emergency department."

He said they reviewed the records of 1,600 patients and about 160 of those would need further screening. He said between 90 and 100 other members of staff would also be screened.

Tuberculosis is a bacterial infection that usually attacks the lungs.

It is spread through the air and can lead to symptoms such as chest pain and coughing up blood.

There has been an increase in the incidents of TB infection in the UK, with a rise of 2% last year to over 8,000 new cases in England, Wales and Northern Ireland.

Tuberculosis alert at Northern Ireland hospital

[Bent_Bladi]

You know in some countries... they give people TB vaccines (mutated inactive forms of TB) and when they come here and get a TB test they'll get a positive...

that sucks, cuz when u work u have to do a test every year, and each time they get a positive they have to go through these ugly chest x-rays and other things to "prove" that they aren't sick before they get back to work again...

TB ain't the only bacteria that's going super resistant. today i went to a seminar and the doctor was saying that several types of deadly bacterias are going to become resistant to even the more potent antibiotics... ... Sub7anAllah - that just means that our work is never done - you can't stop after finding one cure/vaccine/antibiotic.... you have to keep working cuz they keep changing.

Allah yi7meena