TB

Image of seals fromwww.fanpop.com/clubs/the-animal-kingdom/images/14060694/title/seal-wall… Paleogeneticist Dr. Johannes Krause (University of Tübingen, Germany) and colleagues were interested in the origin of tuberculosis (TB) in the Americas. Since strains of TB found in the Americas are related to strains found in Europe, prior theories held that Spaniards may have introduced it to the Americas while colonizing South America.  The problem with those theories is that pre-Columbian skeletal remains showed signs of TB much earlier. Dr. Krause was quoted in Scientific American, “Pathogens…

Second of five student guest posts by Nai-Chung N. Chang Tuberculosis (TB) is a major disease burden in many areas of the world. As such, it was declared a global public health emergency in 1993 by the World Health Organization (WHO). It is a bacterial disease that is transmitted through the air when an infected individual coughs, sneezes, speaks, or sings. However, not all individuals who contract the disease will display symptoms. This separates the infected into two categories, latent and active. Latent individuals are non-infectious and will not transmit the disease, whereas active…

Like a detective on the hunt, researcher and Nifty Fifty Speaker Sarah Fortune is trying to figure out how Mycobacterium tuberculosis - the bacterium that causes tuberculosis (TB) - is able to defend itself so well against drug treatment and the body's immune system. The challenge is a daunting one. As much as one-third of the world's population is infected with Mycobacterium tuberculosis, yet relatively little is known about how the organism manages to persist for so long, sometimes for decades, in so many people. Though tuberculosis can be fatal, in most cases the immune system controls…

Mark Pendergrast writes: To kick off this book club discussion of Inside the Outbreaks, I thought I would explain briefly how I came to write the book and then suggest some possible topics for discussion. The origin of the book goes back to an email I got in 2004 from my old high school and college friend, Andy Vernon, who wrote that I should consider writing the history of the EIS. I emailed back to say that I was honored, but what was the EIS? I had never heard of it. I knew Andy worked on tuberculosis at the CDC, but I didn't know that he had been a state-based EIS officer from 1978…

Generals are often said to be fighting the last war and public health officials likewise are managing the last crisis. At the end of May 2007 we had the notorious flying lawyer with TB flap (see our multiple posts here), so in June 2007 CDC quietly instituted their public health version of the "No Fly" list. I guess because the Department of Homeland Security (DHS) No Fly list has been so incompetently and dangerously implemented CDC didn't want to taint their version with the same name, so they are calling it the Do Not Board (ENB) list. The DHS list is pushing a million entries. Pretty soon…

A lot of things that seem on first glance to be "news" are really just reprints or slight edits of press releases written to tout a commercial product. This is also true of "Newsletters" that charge money for inside news. Datamonitor is a company that claims to be "the world's leading provider of online data, analytic and forecasting platforms for key vertical sectors. We help 5,000 of the world's largest companies profit from better, more timely decisions" (Datamonitor website). Some of the stuff they give away, since I see it and I don't subscribe to anything they sell. But based on its…

The American Journal Constitution has a story today wondering if the notorious TB lawyer (see our posts here) that caused an international ruckus because he flew against medical advice (the evidence is a bit obscure on this point) may have been part of a CDC ploy to get increased funding for its TB program. I don't know the answer to that, but the fact it should even be raised and taken seriously in some serious quarters speaks volumes about CDC, its management and an air of desperation there: Months before the Centers for Disease Control and Prevention made Atlanta lawyer Andrew Speaker the…

It is not news that the Atlanta lawyer who had/didn't have Extremely Drug Resistant TB early in the year didn't infect anyone when he flew -- against advice or was it against orders? -- from Europe back to the US via Canada and through New York despite a no fly (or not?) order from CDC (or DHS?). Everything about this case was cocked up -- the diagnosis, the communication with the patient, the communication with the public, the communication between federal agencies, state agencies and local health agencies (see our posts here). The fact that no one who sat close to him or further from him or…

Immigrants traditionally get blamed for a country's ills and historically they have been feared for their ability to bring disease as well. The recent cases of the traveling lawyer (and here, passim)and the Mexican businessman with TB raised concerns that tuberculosis would be brought to the US or other low TB incidence countries by immigrants or travelers from countries where TB was prevalent. Now a new study from Norway suggests this doesn't happen: Immigrants from countries with high rates of tuberculosis who move to countries of low TB incidence do not pose a public health threat to…

For whatever reason, TB control is back on the front burner. TB remains a worldwide scourge and has always had a dedicated cadre of public health professionals battling it. Now they are getting some new ammunition and reinforcements. The Bill and Melinda Gates Foundation is weighing in with a substantial $280 million five year program, most of which goes to vaccine development. An effective TB vaccine is the Holy Grail of TB control. We know much more about the immune system than in the past, so maybe soon we'll see the breakthrough everyone in the field has been hoping for. Until preventive…

The walking TB problem is in the news again. This time it's not a well to do lawyer from Atlanta but a Mexican born resident of Norcross, Georgia, a healthy appearing teen ager told last Friday he had tuberculosis and would have to undergo treatment. We don't know exactly what he was said to him about the nature of the treatment or his disease, but whatever it was, he wasn't having any of it. He refused treatment and wanted to go home to Mexico. The lawyer was told not to travel while in Europe and he headed home to the US. In both cases a bewildered and scared patient wanted to go home. Only…

It now turns out that the XDR-TB case which caused such an uproar last month (see our posts here) wasn't XDR-TB at all but MDR-TB, a treatable form of the disease: Andrew Speaker was diagnosed in May with extensively drug resistant TB, based on an analysis of a sample taken in March by the U.S. Centers for Disease Control and Prevention. The XDR-TB, as it is called, is considered dangerously difficult to treat. But three later tests have all shown Speaker's TB to be a milder form of the disease, multidrug-resistant TB, a federal health official said on condition of anonymity before a news…

This was the kind of fallout from the TB case I was most concerned about: States should have the power to restrict the movement of patients with contagious diseases even before they have the chance to disobey doctors' orders, federal health officials say. The need for such authority to order someone quarantined emerged as lesson No. 1 from the case of the Atlanta lawyer who went to Europe despite having a dangerous form of tuberculosis. [snip] "First of all, up front, before the patient left the United States, we believe that we could strengthen our states' ability to restrict the movement of…

My defense of the TB guy has drawn a lot of traffic and some of the comments imply my view is colored by a case of misplaced compassion. Since I'm a physician I won't shy away from being called compassionate. Whether true or not in my case, it is a desirable trait for a doctor and nothing to be ashamed of. However I don't think my opinions about this case are due to sentiment. I would defend them on the grounds they are sound judgments of a public health professional. Since I am unlikely to convince the doubters by repeating my arguments (you can find them at these links), I will do something…

I'm just about done with the TB incident. I've said what I had to say (here, here, here and here) about the incident itself and TB on a plane in general. The one thing left is the significance for pandemic flu prevention. I don't think there is any significance for pandemic prevention because at the moment we have no way to prevent a pandemic. We don't know what will make a pandemic happen or not happen, but if the biology will let it happen and a strain arises with easy transmissibility between people, then that's the ball game. Even if it burns out in one place it will happen again. And…

What do we know about transmission of tuberculosis on an airplane? Not much, apparently. There is very little literature on it and not a single case of active TB has ever been traced to an airplane contact. On the other hand, it isn't very easy to estimate the risks. The only way you can do it is in cases such as the current one where you know someone with TB got on an airplane and potentially exposed others. Then you would do intensive follow-up of fellow passengers and crew to see if you could find others who might have gotten infected. Now the problems really start. First, there's the task…

I'm going to defend the poor guy who flew on a commercial airliner against CDC advice. The one now in the National Jewish Hospital in Denver being treated for XDR-TB. Someone has to, so it might as well be me. He made a big mistake and the consequences are catastrophic for him and his family. Unlike lots of catastrophic mistakes, however, probably few others will be hurt by it. That's for another post. If it was a big mistake, why defend him? I'll blame it on my mother. Like all mothers, she tried to teach me a lot of stuff, some of which was pretty useless or wrong, some of which was nice…

I'm not a lawyer and I don't play one on TV. But I think I know the difference between quarantine and isolation, and the widespread media reports that the Georgia resident with XDR-TB was the first person "quarantined" by the US government since 1963 didn't make sense. Quarantine means to segregate and possibly confine people who have been exposed to a contagious disease and therefore may become infectious themselves and spread it to others. But they are not sick. People who are segregated from the public and whose movement is restricted are under isolation, not quarantine. The Georgia…

It was only last week we posted about XDR-TB. Yesterday CDC warned passengers on two international flights -- Air France 385, Atlanta to Paris on May 12 and Czech Air 104, Prague to Canada on May 24 -- they may have been infected by another passenger who had Extensively Drug Resistant TB (XDR-TB). Reportedly authorities could not reveal which row the male passenger sat in as this would violate medical confidentiality laws (HIPAA). So anyone on the plane could think themselves at risk, although it was probably only those in the same row and several rows front and aft of the passenger who were…