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Extensively Drug-Resistant Tuberculosis and Public Health—Reply
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In Reply: We disagree with Dr Brewer regarding his CDC classification of Andrew Speaker. The CDC has recently revised its tuberculosis screening protocols for immigrant visa applicants, emphasizing the importance of TB cultures in addition to acid-fast bacilli (AFB) smear microscopy. The Centers for Disease Control and Prevention's Division of Global Migration and Quarantine (DGMQ) and Division of Tuberculosis Elimination (DTE) have posted new TB technical instructions for overseas panel physicians performing screening examinations for individuals applying for permanent visas.1 These technical instructions have been revised over the past 2 years with the accretion of new scientific evidence documenting TB transmission from smear-negative, culture-positive patients and the continued emergence of drug-resistant TB (MDR and XDR).2-4
The new technical instructions classify an individual with Speaker's signs and symptoms as class A pulmonary TB (active and infectious), not as class B1, as Brewer states. Consequently, if a man presenting like Speaker were . . . [Full Text of this Article]
Howard Markel, MD, PhD
howard@umich.edu
Center for the History of Medicine
University of Michigan
Ann Arbor
Lawrence O. Gostin, JD
O’Neill Institute for National and Global Health Law
Georgetown University Law Center
Washington, DC
David P. Fidler, JD
Indiana University School of Law
Bloomington
RELATED LETTER
Extensively Drug-Resistant Tuberculosis and Public Health
Timothy Brewer
JAMA. 2007;298(16):1861.
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