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Old 06-03-2007, 09:14 PM
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Default TB quarantines common at local level

While the federal government rarely imposes quarantines — issuing its first in more than four decades last week — cities and states routinely isolate TB patients to prevent them from infecting others.
The federal quarantine order was issued for Andrew Speaker, who has extensively drug-resistant tuberculosis, or XDR-TB, because he had ignored earlier request not to travel, taking a trans-Atlantic flight from Europe to Canada in what he has said was an attempt to return to the U.S. for treatment.
Since the Atlanta lawyer has been isolated in a special room at the National Jewish Medical and Research Center, federal health officials lifted their quarantine order Saturday night, but it was replaced with a Denver health agency's restriction.
Now, local health officials must ensure that Speaker takes his medicine and does not endanger the public.
Such cases are best handled at the local level, where doctors alert public health officials about a new case and they all work together with the patient to treat the infection, said Dr. Randall Reves, the medical director at the Denver Metro Tuberculosis Control Program.
"Public health is really delivered at the local level," Reves said.
Most of the time, patients comply. Sometimes, a court-order is required.
An unidentified man with TB has been under court-ordered quarantine for the last two months in New Mexico. Texas has placed at least 17 tuberculosis patients into an involuntary quarantine facility this year, and California detained four TB patients last year.
In Phoenix, Robert Daniels was diagnosed with XDR-TB and has been confined to a hospital jail unit for the last 10 months after defying doctors' instructions to wear a mask in public. Health authorities obtained a court order to lock him up.
Last week, the American Civil Liberties Union filed a lawsuit seeking better conditions and treatment for Daniels.
Daniels said he's heard about Speaker and wishes him well, but he wants better treatment for himself. "He's being treated like a normal person, like a human being. ... I'm being treated worse than a dog," Daniels said.
TB bacteria can become airborne when an infected person coughs. If inhaled, the bacteria can settle in the lungs but remain dormant for years. The World Health Organization estimates that 2 billion people — about one-third of the world's population — has latent TB.
Doctors hope to learn how Speaker, 31, became infected with tuberculosis. He was initially diagnosed with multidrug-resistant tuberculosis, which can withstand mainline antibiotics. While in Europe last month for his wedding and honeymoon, he learned he had XDR-TB and flew to Canada despite warnings from federal health officials not to board another long flight.
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