CDC: 107 people on TB flights need tests

[Annie]

I saw this this morning. I think there should be mandatory testing of any student who comes from a country where TB in endemic.

http://www.foxnews.com/story/0,2933,280852,00.html

 

[angelmom]

I saw this this morning. I think there should be mandatory testing of any student who comes from a country where TB in endemic.

http://www.foxnews.com/story/0,2933,280852,00.html

From the link above:

COLORADO SPRINGS, Colo. — A college student who died of tuberculosis last week probably did not have a drug-resistant strain of the disease, health officials said Monday.

The woman, whose name was not released, died Friday after arriving at the Memorial Hospital emergency room, but officials did not determine that TB was the cause of death until Monday.

An investigation was under way to identify and contact anyone who might be at risk of contracting TB from exposure to the woman, officials said.

<snip>

They said if she had been contagious, any risk of exposure probably occurred in February or later.

<snip>

Dr. Ned Colange, chief medical officer for the state Department of Public Health and Environment, refused to release her name, age or home country, citing privacy laws.

But he said she was from "a country where tuberculosis was endemic" and probably contracted it there before coming to the U.S. He said she had not traveled out of the country since February.

Colange said the only way health officials will know if she had drug-resistant TB is if someone she was in contact with comes down with that strain. He said doctors cannot test for that strain once a patient has died.

"Since most tuberculosis is not drug-resistant, it makes it less likely this one is drug-resistant," he said.

Colange said this case was unrelated to that of Andrew Speaker, an Atlanta lawyer being treated for extensive drug-resistant tuberculosis at National Jewish Medical and Research Center in Denver. Speaker drew national attention because of his travel oversees and his ability to get back into the country despite federal orders that he be stopped at the border.

Colange said Colorado has about 120 cases of TB annually, and about five to 10 die per year, usually from a depressed immune system and not from TB alone.

Anyone else see the irony here?

 

[accordn2me]

I just saw on Fox News that a CDC plane has landed in Miami with a woman throwing up blood. Noone is being allowed off the plane......

Has anyone seen anything else about this CDC plane that landed in Miami yesterday? I know I didn't dream this.....

 

[BarnGoddess]

I just saw on Fox News that a CDC plane has landed in Miami with a woman throwing up blood. Noone is being allowed off the plane......

Googled and found this site:

http://www.freerepublic.com/focus/f-news/1848443/posts

Seems it's a British Airways flight. One poster speculated Hemmoragic fever. Wonder where she's been?

 

[BarnGoddess]

I saw this this morning. I think there should be mandatory testing of any student who comes from a country where TB in endemic.

http://www.foxnews.com/story/0,2933,280852,00.html

When I was in Miami, anyone who had anything to do with food handling or working with children had to have a TB test. The one where they prick your inner arm and wait for results. Then we got politically correct and it was discontinued. Then the Mariel boatlift, Haitians landing, etc. They were taking jobs in restaurants and tropical ailments were beginning to crop up. TB went from being almost non-existent to hearing of it being an increasing disease. My mother and several of her friends came down with Giardia after attending a luncheon. That put her on her back for almost two weeks. She was tested and that's exactly what it was. It's a protozoa that causes it.

I just don't know why we can't test for jobs that can infect large numbers of people. Health industry, schools, food, etc.

 

[MSM]

From the link above:

COLORADO SPRINGS, Colo. &#8212; A college student who died of tuberculosis last week probably did not have a drug-resistant strain of the disease, health officials said Monday.

The woman, whose name was not released, died Friday after arriving at the Memorial Hospital emergency room, but officials did not determine that TB was the cause of death until Monday.

An investigation was under way to identify and contact anyone who might be at risk of contracting TB from exposure to the woman, officials said.

<snip>

They said if she had been contagious, any risk of exposure probably occurred in February or later.

<snip>

Dr. Ned Colange, chief medical officer for the state Department of Public Health and Environment, refused to release her name, age or home country, citing privacy laws.

But he said she was from "a country where tuberculosis was endemic" and probably contracted it there before coming to the U.S. He said she had not traveled out of the country since February.

Colange said the only way health officials will know if she had drug-resistant TB is if someone she was in contact with comes down with that strain. He said doctors cannot test for that strain once a patient has died.

"Since most tuberculosis is not drug-resistant, it makes it less likely this one is drug-resistant," he said.

Colange said this case was unrelated to that of Andrew Speaker, an Atlanta lawyer being treated for extensive drug-resistant tuberculosis at National Jewish Medical and Research Center in Denver. Speaker drew national attention because of his travel oversees and his ability to get back into the country despite federal orders that he be stopped at the border.

Colange said Colorado has about 120 cases of TB annually, and about five to 10 die per year, usually from a depressed immune system and not from TB alone.

Anyone else see the irony here?

Angelmom, I don't think the CDC or government released Speaker's name. He identified himself to the media after the controversy was sparked, so he could tell his side of the story. It would be against the law for the government to identify him, as you pointed out.

ETA: What "irony" are you referring to? We already knew that TB occurs in this country, some of it is drug resistant, and it kills people sometimes.

 

[MSM]

Now some of the background of this case is starting to come out. Emails suggest that the patient's family was "uncooperative" with health officials, with phone conversations described as "clipped and combative."

http://news.yahoo.com/s/ap/20070612/ap_on_he_me/tuberculosis_infection


It is so obvious to me that this guy and his family had ulterior motives and were less than cooperative for their own selfish reasons. I have to ask why we haven't heard this supposed tape that the father made. Could it be because it documents the two of them copping an attitude with the CDC?

 

[MSM]

I saw this this morning. I think there should be mandatory testing of any student who comes from a country where TB in endemic.

http://www.foxnews.com/story/0,2933,280852,00.html

Most schools do require TB testing.

 

[accordn2me]

Googled and found this site:

http://www.freerepublic.com/focus/f-news/1848443/posts

Seems it's a British Airways flight. One poster speculated Hemmoragic fever. Wonder where she's been?

Thanks! I thought it looked BIG to be the CDC's plane.....LOL! I heard that one thing.....then not a word! Started to get scared they are hiding something....else! :bang:

I totally agree with you about testing people that will be working in food service or other jobs where disease transmission is high. I read about a nurse who transmitted a fatal virus...CMV (which my twin cousins died from) to infants in the nursery where she worked. She had long, fake nails. Why are those allowed? We never found out how my baby cousins contracted the CMV.

So many companies test employees for drug abuse issues. Why can't they do it for transmittable diseases? :waitasec:

 

[Laneymae]

It is so obvious to me that this guy and his family had ulterior motives and were less than cooperative for their own selfish reasons. I have to ask why we haven't heard this supposed tape that the father made. Could it be because it documents the two of them copping an attitude with the CDC?

Actually, some of the tape was played on LK when Larry had him on his show. You may be able to check the transcripts. The family only released portions of the tape though, which made Larry question why the whole tape wasn't released. Andrew S. said that the portions they did not release contained personal info, but I don't believe they were honest. I think they only released the portion that they thought would be beneficial to Andrew.

I agree that this family has been uncooperative and has acted selfishly. I wish that border guy had not let him back into our country.

 

[accordn2me]

Actually, some of the tape was played on LK when Larry had him on his show. You may be able to check the transcripts. The family only released portions of the tape though, which made Larry question why the whole tape wasn't released. Andrew S. said that the portions they did not release contained personal info, but I don't believe they were honest. I think they only released the portion that they thought would be beneficial to Andrew.

I agree that this family has been uncooperative and has acted selfishly. I wish that border guy had not let him back into our country.

I don't think they are honest people, either, Laneymae. I'm very suspicious about why Speaker got an X-Ray of his lungs in the first place. They say it's because he fell and thought he "bruised a rib." I don't believe that for a second. Personally, I believe he knew he was high risk for having contracted TB....and he was right!

 

[crypto6]

Thanks! I thought it looked BIG to be the CDC's plane.....LOL! I heard that one thing.....then not a word! Started to get scared they are hiding something....else! :bang:

I totally agree with you about testing people that will be working in food service or other jobs where disease transmission is high. I read about a nurse who transmitted a fatal virus...CMV (which my twin cousins died from) to infants in the nursery where she worked. She had long, fake nails. Why are those allowed? We never found out how my baby cousins contracted the CMV.

So many companies test employees for drug abuse issues. Why can't they do it for transmittable diseases? :waitasec:

Nurses are supposed to keep their nails short and without artificial enhancements. Screening for specific diseases would be hard, since the RNs have many of the viruses in their environment and get them on their hands even though they should wear gloves. The tests are expensive and time consuming and theoretically would have to be done daily. Screening the nose and mouth for methicillin-resistant staph aureus is a good idea, since it could be transmitted via aerosol mechanisms (breathing, cough, sneeze). Most pedes units use less than optimal hand washing techniques and use non-sterile gloves which are cheap and don’t fit well. Using high quality sterile surgical gloves and masks would be an improvement.
There was a recent case of nurses petting their dogs before work and transmitting a weird yeast Chez Med, enter "neonatal infection dog nurse". A lot of times we don't even know the organism is capable of infecting neonates until an epidemic breaks out.

Crypto6

 

[accordn2me]

Nurses are supposed to keep their nails short and without artificial enhancements. Screening for specific diseases would be hard, since the RNs have many of the viruses in their environment and get them on their hands even though they should wear gloves. The tests are expensive and time consuming and theoretically would have to be done daily. Screening the nose and mouth for methicillin-resistant staph aureus is a good idea, since it could be transmitted via aerosol mechanisms (breathing, cough, sneeze). Most pedes units use less than optimal hand washing techniques and use non-sterile gloves which are cheap and don’t fit well. Using high quality sterile surgical gloves and masks would be an improvement.
There was a recent case of nurses petting their dogs before work and transmitting a weird yeast Chez Med, enter "neonatal infection dog nurse". A lot of times we don't even know the organism is capable of infecting neonates until an epidemic breaks out.

Crypto6

Thanks for this informative, reasonable reason why it wouldn't be feasible. With my twin cousins....they said it could have been that their mother had the virus, which is basically "flu-like" for adults, fatal for infants, and given it to them through breast-feeding. so sad.....

 

[crypto6]

Thanks for this informative, reasonable reason why it wouldn't be feasible. With my twin cousins....they said it could have been that their mother had the virus, which is basically "flu-like" for adults, fatal for infants, and given it to them through breast-feeding. so sad.....

There's always the CYA factor, so if there was a CMV infection in the unit, it's possible the infection came from there, as well as the possibility that it came from the mother. The whole thing is truly horrible; we have to fight as hard as we can for the lives of those unable to do so for themselves, especially lives with so much promise.

Crypto6

 

[MSM]

CMV and MRSA are extremely common. I don't recall the exact numbers, but about half of us are CMV positive. The virus usually causes no problems except in immunocompromised people or when it is transmitted in utero or during birth as congenital CMV.

MRSA is so prevalent in hospitals and institutions that if you swabbed the nose of every healthcare worker, almost all of us would be colonized with it. It is not transmitted through respiratory droplets, only by direct contact.

If you eliminated all healthcare workers with CMV or MRSA, you would have no healthcare workers left. And if you replaced us all with new ones, it wouldn't take long for the new folks to be colonized as well. Patients and healthcare workers trade germs back and forth. Being religious about handwashing, and using proper isolation procedures for people known to be colonized or infected, is the best we can do to control the spread of hospital-acquired infections.

Regarding TB, all healthcare workers are required to get an annual skin test. I've had to get one every year since my first year of med school.

 

[JBean]

CMV and MRSA are extremely common. I don't recall the exact numbers, but about half of us are CMV positive. The virus usually causes no problems except in immunocompromised people or when it is transmitted in utero or during birth as congenital CMV.

MRSA is so prevalent in hospitals and institutions that if you swabbed the nose of every healthcare worker, almost all of us would be colonized with it. It is not transmitted through respiratory droplets, only by direct contact.

If you eliminated all healthcare workers with CMV or MRSA, you would have no healthcare workers left. And if you replaced us all with new ones, it wouldn't take long for the new folks to be colonized as well. Patients and healthcare workers trade germs back and forth. Being religious about handwashing, and using proper isolation procedures for people known to be colonized or infected, is the best we can do to control the spread of hospital-acquired infections.

Regarding TB, all healthcare workers are required to get an annual skin test. I've had to get one every year since my first year of med school.

As you know, MRSA has moved up and out into the community, in a big way. It is not just confined to the health care facilites and institutions anymore.

 

[crypto6]

MRSA is so prevalent in hospitals and institutions that if you swabbed the nose of every healthcare worker, almost all of us would be colonized with it. It is not transmitted through respiratory droplets, only by direct contact.
If you eliminated all healthcare workers with CMV or MRSA, you would have no healthcare workers left. And if you replaced us all with new ones, it wouldn't take long for the new folks to be colonized as well. Patients and healthcare workers trade germs back and forth. Being religious about handwashing, and using proper isolation procedures for people known to be colonized or infected, is the best we can do to control the spread of hospital-acquired infections.

.

I thought so too, but went on medline and found enough articles like these to convince me otherwise:

Wilson RD, Huang SJ, McLean AS.
Department of Intensive Care Medicine, University of Sydney, Nepean Hospital, Penrith, New South Wales.

Air sampling directly onto a methicillin-resistant Staphylococcus aureus (MRSA) selective agar was performed at six locations three times weekly over a period of 32 weeks in a new, initially MRSA-free Intensive Care Unit to examine if MRSA is present in air sample cultures and, if so, whether it is affected by the number of MRSA colonized patients present. A total of 480 air samples were collected on 80 days. A total of 39/480 (8.1%) samples were found to be MRSA positive of which 24/160 (15%) positive air samples were from the single rooms, where MRSA colonised patients were isolated, and 15/320 (4.7%) were from the open bed areas. A significant correlation was found between the daily number of MRSA colonized or infected patients in the Unit and the daily number of MRSA positive air samples cultures obtained (r2=0.128; P<0.005). The frequency of positive cultures was significantly higher in the single rooms than in the open bed areas (relative risk=3.2; P<0.001). The results from one of the single rooms showed a strong correlation between the presence of MRSA patients and MRSA positive air samples (relative risk=11.4; P<0. 005). Our findings demonstrate that the presence of airborne MRSA in our unit is strongly related to the presence and number of MRSA colonized or infected patients in the Unit.

PMID: 15957717 [PubMed - indexed for MEDLINE]


Shiomori T, Miyamoto H, Makishima K.
Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu 807-8555, Japan.

OBJECTIVES: To quantitatively investigate the existence of airborne methicillin-resistant Staphylococcus aureus (MRSA) in a hospital environment and to perform phenotyping and genotyping of MRSA isolates to study MRSA epidemiology. DESIGN: Prospective surveillance of patients with MRSA infections or colonizations was performed, as was an observational study of environmental airAirborne samples were taken by an air sampler; samples were obtained from object surfaces by stamping or swabbing. Epidemiological study of MRSA isolates was performed with an antibiotic susceptibility test, coagulase typing, and pulsed-field gel electrophoresis. SETTING: Three single-patient rooms in a 37-bed otolaryngology-head and neck surgery unit. PATIENTS: Three patients with squamous cell head and neck cancer were observed to have been colonized or infected with MRSA after surgery. RESULTS: The MRSA samples were collected from the air in single-patient rooms during both a period of rest and when bedsheets were being changed. Isolates of MRSA were detected in all stages (from stage 1 [>7 microm] to stage 6 [0.65-1.1 microm]). About 20% of the MRSA particles were within a respirable range of less than 4 microm. Methicillin-resistant S aureus was also isolated from inanimate environments, such as sinks, floors, and bedsheets, in the rooms of the patients with MRSA infections as well as from the patients' hands. An epidemiological study demonstrated that clinical isolates of MRSA in our ward were of one origin and that the isolates from the air and from inanimate environments were identical to the MRSA strains that caused infection or colonization in the inpatients. CONCLUSIONS: Methicillin-resistant S aureus was recirculated among the patients, the air, and the inamimate environments, especially when there was movement in the rooms. Airborne MRSA may play a role in MRSA colonization in the nasal cavity or in respiratory tract MRSA infections. Measures should be taken to prevent the spread of airborne MRSA to control nosocomial MRSA infection in hospitals.

PMID: 11405862 [PubMed - indexed for MEDLINE]

I have a bad feeling we are going to wind up having to wear submicron masks (like breathing through a thick cushion) or respirators around MRSA positive patients.

Crypto6

 

[crypto6]

As you know, MRSA has moved up and out into the community, in a big way. It is not just confined to the health care facilites and institutions anymore.

Yes it is, including a creeping evolution of resistance to vancomycin, our biggest first line drug against MRSA.
We haven't heard the last of this bug.

Crypto6

 

[MSM]

I thought so too, but went on medline and found enough articles like these to convince me otherwise:

Wilson RD, Huang SJ, McLean AS.
Department of Intensive Care Medicine, University of Sydney, Nepean Hospital, Penrith, New South Wales.

Air sampling directly onto a methicillin-resistant Staphylococcus aureus (MRSA) selective agar was performed at six locations three times weekly over a period of 32 weeks in a new, initially MRSA-free Intensive Care Unit to examine if MRSA is present in air sample cultures and, if so, whether it is affected by the number of MRSA colonized patients present. A total of 480 air samples were collected on 80 days. A total of 39/480 (8.1%) samples were found to be MRSA positive of which 24/160 (15%) positive air samples were from the single rooms, where MRSA colonised patients were isolated, and 15/320 (4.7%) were from the open bed areas. A significant correlation was found between the daily number of MRSA colonized or infected patients in the Unit and the daily number of MRSA positive air samples cultures obtained (r2=0.128; P<0.005). The frequency of positive cultures was significantly higher in the single rooms than in the open bed areas (relative risk=3.2; P<0.001). The results from one of the single rooms showed a strong correlation between the presence of MRSA patients and MRSA positive air samples (relative risk=11.4; P<0. 005). Our findings demonstrate that the presence of airborne MRSA in our unit is strongly related to the presence and number of MRSA colonized or infected patients in the Unit.

PMID: 15957717 [PubMed - indexed for MEDLINE]


Shiomori T, Miyamoto H, Makishima K.
Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu 807-8555, Japan.

OBJECTIVES: To quantitatively investigate the existence of airborne methicillin-resistant Staphylococcus aureus (MRSA) in a hospital environment and to perform phenotyping and genotyping of MRSA isolates to study MRSA epidemiology. DESIGN: Prospective surveillance of patients with MRSA infections or colonizations was performed, as was an observational study of environmental airAirborne samples were taken by an air sampler; samples were obtained from object surfaces by stamping or swabbing. Epidemiological study of MRSA isolates was performed with an antibiotic susceptibility test, coagulase typing, and pulsed-field gel electrophoresis. SETTING: Three single-patient rooms in a 37-bed otolaryngology-head and neck surgery unit. PATIENTS: Three patients with squamous cell head and neck cancer were observed to have been colonized or infected with MRSA after surgery. RESULTS: The MRSA samples were collected from the air in single-patient rooms during both a period of rest and when bedsheets were being changed. Isolates of MRSA were detected in all stages (from stage 1 [>7 microm] to stage 6 [0.65-1.1 microm]). About 20% of the MRSA particles were within a respirable range of less than 4 microm. Methicillin-resistant S aureus was also isolated from inanimate environments, such as sinks, floors, and bedsheets, in the rooms of the patients with MRSA infections as well as from the patients' hands. An epidemiological study demonstrated that clinical isolates of MRSA in our ward were of one origin and that the isolates from the air and from inanimate environments were identical to the MRSA strains that caused infection or colonization in the inpatients. CONCLUSIONS: Methicillin-resistant S aureus was recirculated among the patients, the air, and the inamimate environments, especially when there was movement in the rooms. Airborne MRSA may play a role in MRSA colonization in the nasal cavity or in respiratory tract MRSA infections. Measures should be taken to prevent the spread of airborne MRSA to control nosocomial MRSA infection in hospitals.

PMID: 11405862 [PubMed - indexed for MEDLINE]

I have a bad feeling we are going to wind up having to wear submicron masks (like breathing through a thick cushion) or respirators around MRSA positive patients.

Crypto6

Well, that's interesting, considering that standard isolation procedures for MRSA patients are still only contact precautions and not respiratory precautions. You are right, things probably will change if this is documented in enough studies. Maybe we will all be working in Hazmat suits in the next 50 years!

Here's more from Andrew Speaker & Co. in the CDC's email records:

http://www.cnn.com/2007/HEALTH/conditions/06/12/tb.emails.ap/index.html

E-mails from Fulton County, Georgia, officials portray groom Andrew Speaker's father-in-law, CDC microbiologist Robert Cooksey, as initially unhelpful, at least before May 22, when tests showed that Andrew Speaker had a more dangerous form of TB than previously understood.
"This is terrible news. I hope the father-in-law will be more forthcoming now," reads a May 22 e-mail written by Beverly DeVoe-Payton, director of the Georgia Division of Public Health's tuberculosis program, to other state health officials regarding the new test results.
..................
In his conversations with health officials, Speaker "placed a lot of emphasis on contagiousness. He asked questions in a way so he could hear what he needed to hear to justify his leaving," Skinner said.
...................
Dr. Andrew Vernon, a Centers for Disease Control and Prevention TB researcher who sees patients at the Fulton County Department of Health and Wellness, had earlier appealed to Cooksey to help them stop the planned wedding in Greece, according to a May 30 e-mail from a Fulton County physician. Cooksey did not put a halt to the plans; instead, he went to the wedding.
...................
Ted Speaker also could not be immediately reached for comment. He did not provide needed information either, according to e-mails from state and Fulton County health officials.
In one e-mail, Dr. David Kim of the CDC summarized a May 22 phone conversation with Ted Speaker this way:
"'I need your assistance to reach out to (Andrew) to get him back to U.S. quickly and safely,"' Kim said he told the elder Speaker.
"'I can't do that. I don't know where he is ... I appreciate your call.' End of call," Kim wrote, summarizing Speaker's response.
......................
Right after the May 10 meeting with Speaker, his fiancee, and their fathers, county health officials began researching legal measures to stop the trip to Europe, according to information released Tuesday.
On May 13, Dr. Eric Benning of the Fulton County Health Department got a call from Speaker, who said he had already flown to Greece -- a day earlier than planned.
He promised to call back May 14 with contact information. But Speaker did not check in until May 20, when he sent Benning an e-mail that said: "We have tried to use the cell phone and things just don't seem to work."

 

[pedinurse]

Angelmom, I don't think the CDC or government released Speaker's name. He identified himself to the media after the controversy was sparked, so he could tell his side of the story. It would be against the law for the government to identify him, as you pointed out.

ETA: What "irony" are you referring to? We already knew that TB occurs in this country, some of it is drug resistant, and it kills people sometimes.

why did the original articles refuse to give his name so he could remain anonymous?

someone leaked it other than Speaker. after that, there was no point in trying to hide it.