TB on a plane

Recent news stories of extremely drug-resistant tuberculosis highlight why there is no room for complacency when it comes to infectious diseases.

Editorial. June 25, 2007.

In May, a series of developments gave meaning to dire public health predictions that emerging and re-emerging infectious diseases -- often considered the plight of lesser-developed nations and poorer populations -- are not so far removed from more mainstream American lives.

The events surround a case of extremely drug-resistant tuberculosis. The patient, a 31-year-old Atlanta lawyer, left the U.S. on a commercial flight May 12 for his European wedding and honeymoon.

Reports indicate he knew he had TB but was not aware of his resistance profile. Ultimately, his illness triggered a Centers for Disease Control and Prevention isolation order, the first since 1963, as well as a full investigation of the patient's level of contagiousness -- he maintains he was told there was no threat -- and the possible exposure of other travelers. At press time, the source of his XDR TB was still unknown and public health officials were urging testing of passengers in nearby rows on his longer flights. This XDR TB situation grabbed the headlines for days. But it also highlights a bigger issue: TB continues to pose a health threat in the U.S.

TB is a global epidemic. Annually, it kills nearly 2 million people worldwide and infects about 14,000 in this country. The challenge of controlling it is amplified by its treatment regimen -- which requires multiple medications over a long period. Failure to adhere leads to drug resistance.

According to the Stop TB Partnership, which includes the CDC and the World Health Organization, multidrug-resistant TB develops when effective drugs are misused or mismanaged. It is a classic example of why antibiotic resistance is a man-made problem. The resilient strain that results takes longer to treat with second-line therapies, which are more expensive and have more side effects. XDR TB, which still is relatively rare, ups the ante even further. It emerges as the bug gains strength over the second-line meds and severely limits treatment options, if any exist at all.