RSS feedAn American lawyer made medical history in United States this week when he was placed on health quarantine for being infected with extensively drug resistant (XDR) tuberculosis (TB). The last time the US government quarantined someone was in 1963! What emerged was that this person had been diagnosed with TB in January 2007. In May 2007, he flew to Europe for his wedding and honeymoon and while in Europe he was apparently told by the Centers for Disease Control and Prevention (CDC) not to fly back to USA. Against advice he flew to Canada and drove into USA. While crossing into the US, the immigration officer allowed the person to drive into USA despite the fact that the immigration computer system carried a warning about admitting him into USA. Now, the person is saying that he was told that he was not contagious while CDC insist that he was told not to travel.
XDR tuberculosis was first isolated in 2005. In early 2005, doctors in a rural hospital in KwaZulu-Natal, a province of South Africa, were alarmed by the high rate of rapid death among AIDS patients who were also infected with TB. A study showed the presence of multidrug-resistant (MDR) TB and also what came to be called XDR tuberculosis. XDR tuberculosis is caused by a strain of Mycobacterium tuberculosis resistant to isoniazid and rifampicin (which defines MDR tuberculosis) in addition to any fluoroquinolone and at least one of the 3 following injectable drugs: capreomycin, kanamycin and amikacin. Of the 53 patients with XDR tuberculosis, only one survived. In these patients the median time from collecting the first sputum specimen to death was only 16 days! In fact some of the MDR tuberculosis isolates found in different parts of the world were actually XDR tuberculosis. For example 4%, 15% and 19% of the MDR tuberculosis isolates found in United States, the Republic of Korea and Latvia, respectively, were XDR strains.
In a recent article published in the prestigious New England Journal of Medicine titled “XDR Tuberculosis – Implications for Global Public Health”, the authors wrote “Ideally, if tuberculosis is suspected, it should be diagnosed at the point of care, and information about drug susceptibility should be obtained rapidly to guide treatment decisions. In most countries, this ideal is not achieved because of insufficient primary care services and the lack of adequate laboratories and of tools permitting easy, prompt detection of drug resistance. To correct these deficiencies, governments and international aid partners must invest in building a proper care and laboratory infrastructure, and research on better diagnostics must be intensified without delay.”
The United States of America spends more than 9% of the GDP on health care (this level of spending is more than any European country). It has the most advanced technology being used in the health care system. Yet this recent TB case showed that perhaps in USA, to quote from the NEJM article, there are insufficient primary care services and a lack of adequate laboratories and of tools permitting easy, prompt detection of drug resistance. If this can occur in USA, what chance would the poor African nations have in their combat against XDR tuberculosis?
This incident also raises the issue of individual social responsibility. In USA, if an AIDS patient knowingly infects another person, he or she can be prosecuted. Should someone with XDR tuberculosis, who knowingly exposed others to the risk of being infected with tuberculosis, be subject to prosecution?
