Drug-resistant TB patient quarantined for life… and what this means for bird flu

Until doctors can find another drug that can treat his tuberculosis, Robert Daniels is spending the rest of his life in jail-like isolation.

Daniels has what the World Health O. dubbed as XDR-TB, or extremely drug resistant tuberculosis , which is virtually untreatable using current anti-TB drugs. Daniels was considered “uncooperative and a danger to the public” and was ordered locked up because he did not take precautions to avoid infecting others or even to wear a mask in public. Although currently rare in the US, XDR-TB broke out in Africa last year with an alarmingly high mortality rate. XDR-TB is transmitted the same as other forms of tuberculosis – by aerosol droplets expelled by an infection person with a cough, sneeze, kiss, spit, or sharing of utensils.

Now, though TB is a bacterial infection (and technically not a “concern” of this blog), INFLUENZA has the potential of becoming drug-resistant** as well.

In the face of increasing use (and misuse) of flu drugs, the potential of developing drug-resistant flu viruses, the problem of containing H5N1 across much of Asia, and likened to the days when the world dealt with smallpox and leprosy, once again we face the the issue of dealing with infected persons with untreatable symptoms.

Putting people and whole villages quarantined have been in practice and found highly effective. But as H5N1 spreads to less isolated cities and across nations, it is getting much harder to control the transmission of flu viruses.

Now, I have no answers to the issues/questions below, but I pose them because I myself am looking for more concrete solutions to the global health threat of a drug-resistant influenza/bird flu/pandemic flu/ virus.

1. Should uncooperative contagious persons (as Daniels was charged) be locked up?

2. What needs to be done about infected persons wishing to travel? Do airlines or cruise ships have the right to refuse a sick person from boarding? Should there be an international law to govern the travel of contagious persons sick with life-threatening diseases?

3. How long should a quarantine (or shelter-in-place) last? A survey last year posed that Americans will only stay home 7 days at the most in the event of a flu pandemic. The need to work is the top reason for not staying home. Will this number of days be enough?

4. What kind of regulations should there be in place to prevent the overuse of drugs that may cause resistance?

Certainly, there are more questions than the above, but if you have answers or ideas or more questions, feel free to fill the comment and begin a discussion.

**The U.S. Centers for Disease Control reported last year that 92% of influenza A (H3N2) viruses isolated from patients demonstrated an amino acid change that confers resistance to adamantanes. Two of eight type A flu viruses were in fact resistant. Canadian authorities report the same mutations in isolates recently tested. These findings prompted the CDC to recommend against the use of amantadanes for flu treatment last season. In addition, a small study of Japanese children treated with oseltamivir also reported a high frequency of resistant viruses. However, no transmission of neuraminidase inhibitor-resistant viruses in humans has been documented to date.

[Source: MSNBC; image]

Tags: drug-resistance, XDR-TB, tuberculosis, influenza, bird flu, pandemic, oseltamivir, adamantanes, world health, virus, viral disease, viral illness