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To the Editor: The Commentary by Dr Markel and colleagues¹ regarding the recent case of extensively drug-resistant tuberculosis (XDR-TB) in Andrew Speaker raises important points about the balance between public health and civil liberties. Missing, however, is an understanding of the public health risk engendered by his travels, of whether changing quarantine laws reduces this risk, and of how best to control global XDR-TB.

Mr Speaker reportedly was asymptomatic; his TB was coincidentally identified during evaluation for another problem.² Each year, thousands of individuals posing a similar risk for TB transmission enter the United States with the knowledge of the US Centers for Disease Control and Prevention (CDC).³ Immigrants, refugees, and those seeking asylum in the United States who are 15 years or older undergo mandatory TB screening; those whose chest radiograph findings are consistent with active TB and who are sputum-smear–negative (like Speaker) are classified as B1 (active TB, . . . [Full Text of this Article]

Timothy Brewer, MD, MPH
timothy.brewer@mcgill.ca
McGill University Medical School
Montreal, Quebec, Canada

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