CDC Webcast on XDR TB Case - Failure of our Current Beauracracy to Protect Against Biological Dissemination

A webcast was published today by the CDC on the XDR TB case which I reported yesterday. Thankfully the patient seems to be stable and it seems that he is still "smear negative". This is important becuase it is believed that the infectivity of a person with TB is directly related to the amount of bacteria found in the sputum; thus, it could be surmised that this person very well has not infected any of the other people who were on these trans-atlantic flights. However, I recall that there is evidence that transmission rates are still about 15% for culture positive/smear negative cases.

There does not seem to be much other information at this time as the investigation is still early. The CDC is proceeding with contact tracing, but it seems that there is quite a bit of beauracracy in this process. big surprise...

Here is the timeline as I understand it:

• January 2007??? incidental finding on a chest x-ray is consistent with right upper lobe tuberculosis - the date needs to be clarified per this webcast, furthermore, they did not have any other information on any other preceding events
• May 10th: Patient has laboratory documentation of MDR TB and he was instructed "Not to travel"
• May 12th: This patient chooses to go ahead and travel from the U.S. to Europe
• May 22nd: Laboratory results are made available which shows that this patient's isolate is an XDR strain
• May 23: The patient was finally contacted and was again instructed "Not to do any further travel"
• May 24th: This patient chooses to go ahead and fly back to the Canada and drives via automobile to the United States
• May 25th: The patient is finally quarantined by federal order and placed into inpatient treatment

I would submit that this ought to be taken into consideration in legislation and planning issues when it comes to other areas of "homeland security". I mean, seriously, how damn hard should it be for an Epidemic Intelligence Service Officer (EIS) to be able to gather simple information such as a flight manifest? I understand that there are issues of privacy, but what if this was something a bit more contagious and rapidly progressing? What if this was a case of a terrorist self-inoculated with a rogue sample of Smallpox and we were dealing with a situation where extra hours of delay in contact tracing literally translates into many new infections. And, FYI, the mortality of smallpox is approximately 30%, so let me ask you, would it be acceptable to not have a basic manifest of potential contacts nearly a week after a case was identified? In this regard, thank God this is just uber-resistant tuberculosis...