10 Questions with the Centers for Disease Control and Prevention
Release Date: July 18, 2007
Release Number: Con-02-01
1. Why is TB - specifically XDR TB - such a public health threat?
MDR and XDR TB are extremely difficult to treat, and therefore a person with active MDR or XDR TB disease may easily transmit it to others. Standard therapy is ineffective for these types of TB. Second-line treatments may also be ineffective and if they are effective tend to work more slowly; as a result, the patient is likely to be infectious for a longer period of time. In addition, the consequences of transmission are much greater for the contacts of an infected person and for public health.
There are effective preventive treatments for persons infected with regular TB. There are no documented effective preventive treatments for patients infected with MDR or XDR TB. If infected contacts to regular TB and develop active TB, the treatment for regular TB is very effective. The treatment for MDR and XDR TB is much less effective, much longer, much more toxic, and much more expensive.
2. Were public health officials aware that Speaker was leaving the country?
It is CDC's understanding that a conference was held on May 10, 2007, at Fulton County Health Department, between clinicians, the patient, and his family. We understand that the patient was told he had multidrug-resistant tuberculosis disease with an indication of pulmonary tuberculosis, and that he was advised against travel.
According to local health authorities, they were in the process of delivering written notice (an administrative letter) to advise the patient not to travel. From May 11 through 14, Fulton County health officials attempted to hand-deliver the written notice to the patient at his home of record and business address, but the patient was not there. It was later determined by county health officials that the patient had indeed traveled on May 12, despite advice from his personal physician and public health authorities and before written advice could be served, the patient appeared to have changed travel plans and left the country.
3. If a passenger is on a plane with someone who has TB, should they be tested?
The risk of acquiring any type of TB can depend on several factors, including the extent of disease in the patient with TB, the duration of exposure, and ventilation. Transmission of TB has been documented only in flights lasting longer than eight hours. In accordance with WHO guidelines, people known to have infectious TB must not travel by public air transportation if they are not receiving adequate treatment, or until treatment has been completed. Patients with MDR-TB should not travel until they have been proved to be non-infectious (i.e., culture negative).
4. A federal order of isolation was issued for Speaker; has it been issued before?
Taking a measure such as issuing an order of isolation is unusual. The last contested order we are aware of was issued in 1963. It is very rare for CDC to use federal authority to issue an isolation or quarantine order under the Public Health Service Act statute. In the majority of instances, the state and local health departments have the authority and their own laws to take care of these situations.
The reason for use of a federal quarantine order for isolation in the patient's case is because of the nature of international travel and potential for interstate spread. In addition, the patient was not compliant with several recommendations made to him regarding his travel plan. Under the Public Health Service Act, CDC has the authority to isolate or quarantine persons to prevent the importation and interstate spread of communicable infectious diseases. CDC doesn't take this authority lightly. In this case, the patient is an isolation order in part because of the international arrival and because of the need to transfer him across state lines.
5. What advice would you have for the private sector and corporate America on how they should begin to look at their own vulnerabilities to infectious disease?
During an infectious disease outbreak, US businesses will play a key role in employees' health and safety, as well as limiting the negative impact to the economy and society. Current federal guidance for this type of event has been targeted to a potential pandemic flu, but the checklists that have been developed are good starting points for developing a comprehensive plan for any type of public health emergency. Business continuity is a key element of these planning checklists with special focus for firms with international employees.
You will find the current guidance at: http://www.pandemicflu.gov/plan/workplaceplanning/businessoversea.html
6. What should an employer do if one of his or her employees is exposed to a threatening illness in another country?
Companies that have completed a comprehensive plan for pandemic flu, will have reviewed several elements related to this question:
- Encourage and track influenza vaccinations for employees.
- Evaluate employees access to and availability of healthcare services, and improve services as needed.
- Implement guidelines to modify frequency and type of face to face contact among employees and customers.
- Forecast and allow for employee absences.
These are only a few examples of consideration that focus on the well-being of your staff. Several additional elements are covered at the DHHS website: www.pandemicflu.gov
7. Are the airlines, cruise ships, and other companies who own public travel organizations responsible for training their own staff during a public health crisis?
Private industry has the responsibility for educating their employees about public health threats and the necessary response actions. The CDC Quarantine stations offer supplemental training to travel industry partners for disease specific events, such as providing information on the signs of illness related to SARS. CDC Quarantine officials are also empowered to provide travelers with written information related to an event, and do so in conjunction with travel industry partners.
8. Do sick passengers run the risk of re-introducing diseases we thought were eradicated in the U-S, like TB, or whopping cough by traveling to exotic places?
In the 1970s, infectious disease was thought to be a thing of the past. At that time, CDC reduced the number of quarantine stations from 55 to 8. However, two major events - the September 11 attack on the World Trade Center in 2001 and the SARS outbreak in 2003 - caused concerns about bioterrorism and the worldwide spread of disease. As a result, during 2004-2007, CDC increased the number of US Quarantine stations from 8-20. CDC relies on quarantine stations to protect US borders in matters of public health. They are staffed with quarantine medical and public health officers from the CDC. These health officers decide whether ill persons can enter the US and what measures should be taken to prevent the spread of infectious disease.
Disease recurrence is a constant threat, as well as the introduction of novel viruses (SARS). The Quarantine stations perform a number of daily activities to lessen the threat and contain any potential outbreak:
- Respond to reports of illnesses on airplanes, maritime vessels, and at land-border crossings.
- Inspect animals, animal products, and human remains that pose a potential threat to human health.
- Screen cargo and hand-carried items for potential vectors of human infectious disease.
- Distribute immunobiologics and investigational drugs.
- Provide travelers with essential health information.
9. What are simple things people can do to prevent the spread of illness while traveling?
"Simple" is a correct way to describe what you can do to prevent illness and these are proven methods for limiting the spread of germs.
- Get a flu shot to help protect yourself from seasonal flu.
- Make sure your family's immunizations are up-to-date.
- Wash hands frequently with soap and water.
- Cover your mouth and nose with a tissue when you cough or sneeze.
- Cough or sneeze into your upper sleeve if you don't have a tissue.
- Clean your hands after coughing or sneezing. Use soap and water or an alcohol-based hand sanitizer.
- Stay at home if you are sick.
10. What do you see as the most vulnerable disease that could be exposed to the American public in the future?
The Avian influenza (H5N1) that has currently affected 317 people worldwide and resulted in the death of 191, is the focus of preparation within the world public health community. The widespread persistence of H5N1 in poultry populations poses two main risks for human health.
- The first is the risk of direct infection when the virus passes from poultry to humans, resulting in very severe disease. Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 has caused the largest number of cases of severe disease and death in humans. Unlike normal seasonal influenza, where infection causes only mild respiratory symptoms in most people, the disease caused by H5N1 follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Primary viral pneumonia and multi-organ failure are common. In the present outbreak, more than half of those infected with the virus have died. Most cases have occurred in previously healthy children and young adults.
- A second risk, of even greater concern, is that the virus - if given enough opportunities - will change into a form that is highly infectious for humans and spreads easily from person to person. Such a change could mark the start of a global outbreak (a pandemic).
The World Health Organization is leading an international response to this threat and has developed a strategic action plan for pandemic influenza.
- Reduce human exposure to the H5N1 virus - Reduce opportunities for human infection and, in so doing, reduce opportunities for pandemic virus to emerge.
- Strengthen the early warning system - Ensure that affected countries, WHO, and the international community have all data and clinical specimens for an accurate risk assessment.
- Intensify rapid containment operations - Prevent the H5N1 virus from further increasing its transmissibility among humans or delay its international spread.
- Build capacity to cope with a pandemic - Ensure that all countries have formulated and tested pandemic response plans and that WHO is fully able to perform its leadership role during a pandemic.
- Coordinate global scientific research and development - Ensure that pandemic vaccines and antiviral drugs are rapidly and widely available shortly after the start of a pandemic and that scientific understanding of the virus evolves quickly.
* Courtesy of the CDC Joint Information Center with excerpts from the World Health Organization and the CDC Division of Global Migration and Quarantine.
Last Modified: Thursday, 19-Jul-2007 11:11:21