MERS, XDR-TB Remind U.S. That Public Health Protocols Matter All the Time

June 10th, 2015 by Trudy Henson

Although the Ebola outbreak in Africa has been largely contained, the global public health community is far from getting a break. Hong Kong just announced a “red alert” against non-essential travel to South Korea due to its concern about Middle Eastern Respiratory Syndrome, or MERS; and late yesterday the story broke that a traveler in the U.S. from India has been sent to the National Institutes of Health (NIH) with extensively drug resistant tuberculosis (XDR-TB).  Both stories drive home the importance of rapid diagnosis and proper response procedures, especially in the age of international travel.

Although MERS, has been present in South Korea since May, the number of cases have quickly expanded. Initially imported by a man traveling from the Middle East, by June 5th, South Korea had more cases than any country outside of Saudi Arabia, and its number of cases (and death toll) have risen quickly, from 41 cases and four deaths on June 5th, to 95 cases with seven fatalities as of June 9th.

Hong Kong’s “red alert” advisory against travel to South Korea is one example of a country’s serious response to an outbreak. Since its “self-confessed initial stumble,” South Korea has responded “aggressively” to the outbreak, quarantining over 2,800 people, closing over 2200 schools, including 20 universities, and taking steps to limit the potential economic impact. The response appears to be working, as new cases have dropped, and officials are saying they’re hopeful the outbreak is contained and will diminish.

Although the MERS outbreak may seem far away, the announcement yesterday that a traveler from India to the U.S. had been diagnosed with XDR-TB brings the reality of communicable disease outbreaks much closer to home. A form of tuberculosis that resists nearly all kinds of drugs, XDR-TB is extremely difficult to treat; only about a third to a half of cases can be cured. Although XDR-TB is not spread by casual contact, bacteria put in the air when an infected person coughs, sneezes, shouts, or sings, can float in the air for several hours with the potential to infect people who then breathe that air in.

Even in confined spaces, such as airplanes, the chance of catching TB is low. However, the patient, who traveled to the U.S through Chicago O’Hare airport, has been in the country since April, and had traveled to Missouri and Tennessee before seeking treatment and being diagnosed with XDR-TB. Once diagnosed, she was isolated and transferred to NIH. State and public health officials have begun contact tracing, and are tracking down hundreds of people to alert them to the potential exposure.

Unlike South Korea, however, where experts say part of the reason MERS spread so quickly was initial lax hospital quarantine procedures for the infected, as well as those in contact with them, health officials in the U.S. are following strict protocols to prevent infection: once diagnosed, the patient was isolated and transferred to NIH via special air and ground ambulances. She is being treated in a room that controls the air flow and prevents germs from entering the rest of the hospital.

As both South Korea and the U.S. continue their respective responses, the lesson from infectious disease control—be it SARS, Ebola, MERS, or XDR-TB—remains the same: vigilance and rigorous response are critical steps in keeping disease contained.

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