The Wall Street Journal has a superb write-up of a Nepalese man infected with extremely drug resistant tuberculosis (XDR-TB) who is currently detained at the US border in South Texas. XDR-TB is resistant to four of the major types of antibiotics that are used to treat and control TB infections and this man is the first person with this particularly dangerous strain of TB to cross the border and be quarantined in this country (1).
Traveling in all of the modern ways known to man - by foot, car, boat and plane - the man ventured from his home in Nepal, traipsing through South Asia, flying to Brazil and hoofing it through Central America until reaching the southernmost tip of Texas.
From the WSJ,
His three-month odyssey through 13 countries - from his homeland of Nepal through South Asia, Brazil, Mexico, and finally into Texas - shows the way in which dangerous new strains of the disease can migrate across the world unchecked.
The Nepalese patient was taken into custody by the U.S. Border Patrol in late November as he tried to cross the border illegally near McAllen, Texas, according to Department of Homeland Security officials. The government declined to name him. He was transferred five days later to an Immigration and Customs Enforcement detention facility in Los Fresnos, Texas, and put into "medical isolation" with suspected tuberculosis.
His XDR strain has been seen only once before in the U.S., in another patient of Nepalese origin, according to the government description.
A map of the U.S. Quarantine Stations. Staffed with quarantine medical and public health officers from CDC, they're located at 20 ports of entry and land-border crossings where international travelers arrive. Image: CDC. Click for source.
Our Nepalese man has innocently launched a global public health dilemma: of the potentially thousands of people that this man came across in his odyssey, who else has he infected? It will be a herculean and futile task for public health officers as many of the people that he may have passed on this pathogen are in a similar socioeconomic, nomadic situation - fellow tenacious migrants that quickly move from one place to another in their journey for economic sanctuary and personal salvation.
This case is a powerful reminder that globalization and innovations in travel have radically changed the rules of the game for dangerous and communicable infectious diseases. Of the 950,000 international travelers that arrive in the United States every single day, good public health institutions like the US quarantine stations scattered throughout the country are vital to monitoring hitch-hiking drug-resistant pathogens (2).
Please click here to read the WSJ's article "Dangerous TB Patient Detained on U.S. Border."
Note:To be specific, XDR-TB is resistant to the two first-line drugs, isoniazid and rifampin, used to treat TB initially, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).
Resources
A fact sheet from the CDC on XDR-TB.
Reference
(1) B McKay (March 1, 2013) Dangerous TB Patient Detained on U.S. Border. Wall Street Journal. Accessed on March 7, 2013 here.
(2) CDC (August 3, 2012) Public Health Interventions Involving Travelers with Tuberculosis — U.S. Ports of Entry, 2007–2012. MMWR. 61(30); 570-573.
Centers for Disease Control and Prevention (CDC) (2012). Public health interventions involving travelers with tuberculosis--U.S. ports of entry, 2007-2012. MMWR. Morbidity and mortality weekly report, 61 (30), 570-3 PMID: 22854625
