Fears about TB patient overblown, doctors say


 
 

Allison Young | | Thursday, June 14, 2007


DENVER The health scare hysteria surrounding an Atlanta man with a dangerous strain of tuberculosis bears little relationship to the reality of the low risk he poses to others, doctors treating the man at a Denver hospital said Friday.

"He's about as noninfectious as you can be," said Dr. Charles Daley, chief of infectious disease at National Jewish Medical and Research Center, where Andrew Speaker is undergoing treatment for extensively drug-resistant tuberculosis. "It's gotten attention undeservedly --- at least in terms of this fear," Daley said.

While Daley said the Centers for Disease Control and Prevention has good reason to contact and test passengers who sat in rows near Speaker on two trans-Atlantic flights --- as a precaution --- the health fears are unfounded for members of the general public or those who may have had brief encounters with the man.

Speaker's travel to Europe for his wedding, and evasion of U.S. health authorities in his attempts to get to the Denver hospital rather than be treated in Italy, have sparked an international health scare. The CDC has Speaker under a federal isolation order --- the first such order in more than 40 years.

While Speaker had an armed guard outside his room at Atlanta's Grady Memorial Hospital and was accompanied by U.S. marshals on an air ambulance flight Thursday to Denver, there are no guards outside his room in Denver, hospital officials said.

Daley noted that Speaker has no desire to go anywhere and that his earlier travels had been to get to this hospital.

CDC is still working to contact passengers on two transatlantic flights who sat in rows near Speaker so they can be tested. But even passengers cooped up in the planes near Speaker for the long flights have a low risk of becoming infected, Daley said.

CDC officials have said the same thing, but said a health alert was necessary because though the risk was small, if someone contracted Speaker's TB strain, few treatments would be available to them. And an infection for someone with a compromised immune system could be a death sentence.

"It's because the consequences are so great," Daley said.

New results from Speaker's chest X-ray and CT scan, performed Thursday night, showed "absolutely no surprises," said Dr. Gwen Huitt, who is treating Speaker. She said that the area of infection remains small and shows no change from previous tests performed in Georgia.

And Speaker continues to have no TB symptoms: no coughing and no fever, and he remains "smear negative," which means no TB germs are being identified in his sputum.

On Friday, in addition to starting Speaker on a course of drugs, Huitt said those treating him put him on an exercise bike in his room to keep him fit and prepare his body for the lifesaving medications' potentially toxic side effects, which may develop in the coming weeks.

While doctors at this leading TB treatment center stressed that the risk to the public is small, many people are angry and scared --- to the point that patients are even canceling treatments at the National Jewish Medical and Research Center out of fear of contracting Speaker's strain of XDR TB, as the drug-resistant strain is known.

TB --- whether drug-resistant or not --- is not that easy to catch, Daley said. Only about one-third of family members of someone with TB will become infected, he said. "These are people living with the person for months," he said, emphasizing the long and close contact and limited spread of the disease.

And even among those who are infected, only 10 percent will become ill, he said. None of Speaker's family or close contacts has tested positive, health officials have said.

Despite such careful wording about risks by experts, massive worldwide media coverage has fueled needless fears among many. Dr. Henry Blumberg, an infectious disease specialist and epidemiologist at Grady Memorial Hospital, where Speaker was previously held in isolation, said there is a huge stigma attached to TB. "I think in a lot of ways the stigma is more significant than it is for HIV," said Blumberg. "You rarely see someone with TB announce to the world they have TB."

Blumberg and other experts emphasized that TB isn't spread by touching surfaces or casual contact. Rather, it's airborne --- and requires close and continuous contact. Family members and close friends are the most likely to catch it --- if anyone does. In this case, Speaker's wife, Sarah, continues to test negative.

Doctors suspect that Speaker contracted TB during his many travels abroad, Daley said.

Transmission aboard aircraft, while possible, is rare, hospital officials said.

"Local news has asked whether Denver's citizens should be afraid," Daley noted.

Indeed, he said, National Jewish has been treating drug-resistant TB patients like Speaker for years --- the hospital's work just never before gained this level of attention. The hospital began in 1899 as the National Jewish Hospital for Consumptives. It today is a world leader in treating drug-resistant strains of TB. That's the reason, Speaker told The Atlanta Journal-Constitution on Tuesday, that he fled from the CDC and back to the United States rather than be confined for treatment in an Italian hospital.

Doctors expect Speaker to remain at the Denver hospital for at least eight weeks, and he'll need to remain on large combination doses of medications --- perhaps a dozen or more pills a day --- for two years, they said. The cure rate for people around the world with XTR TB is 30 percent to 50 percent, said Dr. Ken Castro, director of the CDC's Division of Tuberculosis Prevention.




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