2007_05_tb.jpgA man being treated for a drug-resistant strain of tuberculosis and who was advised by the Centers for Disease Control not to travel was briefly quarantined at Bellevue Hospital after he sneaked back into the U.S. in an effort to evade a travel embargo. He is now being detained under armed guard in an Atlanta hospital. The patient, who was in consultation with the CDC prior to traveling to Europe and scheduled to receive advanced life-saving treatment in Denver, had left the U.S. with his wife on their honeymoon to Greece. The CDC had attempted to hand-deliver an official directive barring him from traveling, but were unable to contact him before his departure.

When the patient contacted the CDC after receiving a message from the organization (a CDC official called the patient who was in Rome), he was informed that he needed to turn himself in to Italian health authorities and that it would be necessary for him to be confined for an indefinite term for treatment. Since the treatment he was already scheduled for in Denver was cutting edge and not available in Europe, the man considered the instructions an untenable option and he decided to make a run for it.

2007_05_bellevue.jpgThe Georgia man and his new wife were told that his passport had been flagged and that he was on a no-fly list, so they flew to Canada and crossed into New York state by car. He then voluntarily reported to a New York City hospital and was held at Bellevue for 72 hours. Now he's back in Atlanta and upset with the CDC officials, who have invoked a rare authority to hold people against their will, last used in 1963.

The Atlanta Journal Constitution interviewed the patient, who is claiming the CDC was fully informed of his travel plans and that he was only told health officials "preferred" that he not carry through with his trip. The CDC officials appear to feel that their restraint was taken advantage of and are now pulling out all the stops, with a spokesperson noting that its "covenant of trust" in dealing with potentially deadly disease carriers had been breached. The unnamed patient is very unhappy and contacted the Atlanta Journal Constitution to air his side of the story:

"I'm a very well-educated, successful, intelligent person," he told the paper. "This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary-confinement-in-Italy thing."

The CDC is working with the commercial airlines the man took in an effort to identify anyone who may have been exposed to the drug-resistant strain of TB. It concedes that there is a low risk he transmitted the disease to other travelers, but feels it's necessary to take every precaution.

Tuberculosis is a bacterial infection that was once a leading cause of death in the developed world. It usually attacks the lungs and public health campaigns in the early 20th century concentrated on reducing behavior thought to hasten its spread, like coughing and spitting in public. Successful drug treatments were only discovered in 1946, but resistant strains have developed with very low rates of occurrence in the general population recently. NYC actually has its own Bureau of Tuberculosis Control.

Mary Mallon became infamous in the early 20th century as Typhoid Mary. She was a New York woman who infected scores of people with typhus typhoid fever, a different disease from TB (and apparently also different from thyphus!). After spending three years confined on North Brothers Island, she was released on the condition that she refrain from working as a food handler. Mallon agreed, but later obscured her identity and went back to work, ironically as a cook at Sloan Hospital, sickening more people and effectively killing two. Public health officials had her quarantined for life, and she spent 23 years in captivity before dying of pneumonia in 1938. She is buried in the Bronx.

TB plush from Giantmicrobes