Man knew he had TB before flying to Europe

[Kezza]

Man knew he had TB before flying to Europe
POSTED: 6:15 p.m. EDT, May 30, 2007 on cnn.com

ATLANTA, Georgia (CNN) -- A man infected with the extensively drug-resistant form of TB known as XDR TB knew he was not supposed to travel overseas but did so anyway, director of the Centers for Disease Control and Prevention Dr. Julie Gerberding told CNN's "American Morning" on Wednesday.

The man, who is quarantined at an Atlanta, Georgia, hospital, told the Atlanta Journal Constitution that Fulton County health officials had said they "preferred" he not travel, but knew about his plans for an overseas wedding and honeymoon.

CNN is trying to contact the man and his family.

The man and Gerberding both said it wasn't until he was in Europe that his diagnosis of XDR TB was confirmed by lab tests.

He was then contacted while on his honeymoon in Italy last week by CDC officials and asked to turn himself over to Italian health authorities, he told the newspaper. (Patient disputes what CDC told him Video)

Gerberding said health officials "usually rely on a covenant of trust to assume that a person with tuberculosis just isn't going to go into a situation where they would transmit disease to someone else."

"The patient really was told that he shouldn't fly," she added.

"The patient himself was not highly infectious" but there still was a small risk he could transmit the disease to someone else, Gerberding told CNN.

It is the first time in 40 years the federal government has issued a quarantine order for an individual. Gerberding acknowledged that "we kind of had to make up a plan as we went along."

The CDC director announced Tuesday that federal health officials are looking for people who may have been seated near the man during the two trans-Atlantic flights. (XDR TB leaves doctors with few treatment options)

He departed Atlanta on May 12 aboard Air France Flight 385 and arrived in Paris the next day, she said at the news conference. He returned last Thursday to North America aboard Czech Air Flight 0104 from Prague, Czech Republic, to Montreal, Canada, then drove into the United States.

Those most at risk would have been seated within two rows of the man, Gerberding said.

Newer-model planes use HEPA filters that are able to trap the long, rod-shaped tuberculosis bacilli, according to the CDC.

The man told the newspaper he was aware he was placed on a no-fly list in the United States after his recent diagnosis with XDR TB, which is why he decided to fly into Canada.

He told the newspaper that he asked the CDC whether they would provide a jet for him to return home, and was told there was no money for it.

But Gerberding told CNN, "I don't think that that's an accurate description of what actually happened involving the CDC."

"We were doing everything we could to try to find a way to get him home," she said. "In fact, the irony is that when we were no longer able to reach him, we were even preparing to send the CDC plane to Europe to bring him home at government expense."

She noted that it was Memorial Day weekend and because of the holiday, "it took some time to get all the pieces together."

The man told the newspaper that a CDC staff member told him to turn himself into Italian health authorities where he would be put in isolation and given medical treatment. He said he sneaked back into the country because he feared "an unsuccessful treatment in Italy would have doomed him," the newspaper reported.

The man is in isolation at Atlanta's Grady Memorial Hospital and "is required to stay in isolation until the responsible public health officials deem that he is no longer infectious to others," according to Gerberding.

An armed guard stands outside his room.


The diagnosis
XDR TB was recently defined as a subtype of multiple-drug resistant tuberculosis.

People with XDR TB are resistant to first- and second-line drugs; their treatment options are limited and the disease often proves fatal.

It can take between six and 16 weeks for a final diagnosis of XDR TB.

Health officials determined the man had a multiple-drug resistant form of TB on May 11, a day before he left for Paris, Dr. Stuart Brown, director of Georgia's Division of Public Health, told CNN.

He had met with county health officials and his doctors that same day to discuss his risk, Brown said.

"The Fulton County folks gave him a verbal warning of the danger and the prohibition against travel on May 11," Brown said, noting that the patient's reaction set off some alarm bells.

"They were so concerned by his interaction in this discussion that they went back and hand-delivered a letter reiterating that he remain isolated and not travel," Brown said, adding that at that time, "a plan of treatment was put together."

However, when they arrived to deliver the letter later that day, he had already left, Brown said.

On May 17, the CDC was called in to test for XDR TB and the tests came back positive on either May 21 or 22, he said.

The man told the Atlanta Journal-Constitution that he planned to undergo an 18-month "cutting-edge treatment" at a Denver, Colorado, hospital after his honeymoon, something he said his private doctor and government health officials were aware of.

The man returned via Canada and entered the United States by driving through the border crossing at Champlain, New York.

Customs and Border Protection spokesman Kevin Corsaro said the man did not appear sick to border agents.

CBP said it has not changed its screening or security precautions as a result of the case.

Once he returned to the United States, the man was contacted by health officials, who required that he go to an isolation hospital in New York City for evaluation, said Dr. Martin Cetron, the CDC's chief of quarantine.

"He drove himself there voluntarily."

A spokesman for New York's Bellevue Hospital confirmed that the man was treated at the medical facility for 72 hours.

He was kept under quarantine at the hospital and did not travel on any form of public transportation while in New York, the city's health department said,

"We have no information to suggest anyone in New York City is at any risk associated with this case," the department said in a news release.

Asked if he preferred to stay in New York or return to his family in Atlanta for treatment, the man chose the latter option, said Cetron. At that point, the CDC used one of its planes to fly the patient to Atlanta on Monday, an unusual use of agency resources, Gerberding acknowledged.

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This story makes my blood boil!!

What a f***ing selfish dickhead. Yeh, customs/ border patrol/ security failed in catching him after an alert was issued, but this asshole KNEW he could possibly infect, and ultimately injure or ultimately kill, other people. He said he was AWARE that he was on a no-fly list to the USA, so he flew into Canada instead?

I'm glad there's an armed guard outside his hospital room. Since this narcissistic twat does not hold regard for other's safety, he should be under lock and key. I just sincerely hope that he did not cause harm to someone with a lowered immune system, such as an elderly person or a child.

OK, I feel better and I'm stepping off my soapbox now.

[SpursFan1902]

Makes it kinda scary for those of us that travel alot. I am planning a trip to Germany and possibly England at the end of the summer. Hopefully I won't have to travel with a sugical mask!

[Skylace]

That's more the bloody selfish it's down right cruel. This man could have seriously caused a lot of illness.
I had my mono and I was very careful and didn't let others come over because it is spread through the saliva with coughing and such. TB is serious stuff.
Like you said, what if someone with a lowered immune system were on board got it? Or in the airport or wherever? Scum.

[faceless]

Sadly, many people still die from TB here in Britain. We don't hear about it much because it's usually the homeless and destitute who die. From what I've read in the past, TB has been linked to AIDS in its long-term effect, as both are more affected by the general lifestyle of the victim.

[SpursFan1902]

And to top it all off, supposedly, this guy has some mondo strain that is resistant to the normal meds. What a guy, huh? The other point that they made on CNN Headline (Dr Sanjay Gupta - down Marcella, down) was that unlike the last time TB was a major threat, today, we have millions of folks walking around with compromised immune systems. This poses even more of a threat as it will spread faster. All so that this guy could go on his honeymoon. Hope he is happy....

[eefanincan]

This makes my blood boil as well, Kezza! Personally I think this guy should face some sort of criminal charges for potentially putting so many people at risk.

As a general rule TB is a very hard thing to catch..... you have to be around someone for several hours a day, for several days, and the risk is decreased as well, if you aren't sharing saliva. Realistically, we are probably exposed to people in our everyday lives who have TB and we don't even know it. Also, the hepa-air filtering system on airplanes should filter out most of the TB bacteria (sadly it can't do this for many of the common cold viruses!)--- so overal the risk of him infecting people was very low. That being said, it was still a selfish and foolish thing for him to do.

It's actually a little more concerning because of the type of TB that he has. Regular TB is normally treated with several months worth of a couple of first-line drugs and the person recovers. As Face pointed out though, people are still dying from TB and that's likely because we are getting some stronger strains of it. With the overuse of antibiotics and anti-infectives and medical mismanagement, we have developed a strain that we call MDR-TB (Multi Drug Resistant)----- it is resistant to the two regular medications used for TB, so there are six "second-line" drugs that can be used. Unfortunately, if the TB becomes resistant to three or more of these six medications, it becomes classifed as XDR-TB (eXtreme Drug Resistant)--- this is the strain this guy has. If you have XDR-TB you are 64% more likely to die than with MDR-TB. (CDC 2007).

[Marcella-FL]

I heard today that he took 7 flights in that time period ...????? what the heck was he doing?

[Skylace]

[Marcella-FL]

I saw on CNN that he went to Greece to get married and then to Italy for his honeymoon. CDC contacted him there but then he "feared" for the treatment he would receive there so he fled to the Czech republic to hop a plane to Montreal. Supposedly he wanted the CDC to fly him back from Italy. Something just sounds super fishy with this situation ...

[Mandy]

Unfortunately the rise of multi-drug resistant diseases is inevitable. This could cause "grid-lock" if there is a serious outbreak (e.g. SARS, bird-flu etc.)

[Marcella-FL]

TB patient's name released; father-in-law works at CDC
Story Highlights
• NEW: Patient's father-in-law works at CDC, has studied tuberculosis
• Patient identified as Atlanta lawyer Andrew Speaker, 31
• Speaker left Atlanta hospital, transferred to Denver hospital
• CDC looking for passengers who sat near him on earlier international flights

ATLANTA, Georgia (CNN) -- The man infected with potentially fatal tuberculosis is receiving treatment at a Denver, Colorado, hospital as federal health officials continue to track down airline passengers who may have been exposed to the illness.

The man has been identified by multiple medical and law enforcement sources as Andrew Speaker, 31, a lawyer from Atlanta, Georgia. Hospital officials have not disclosed his name.

Speaker's father-in-law works for the Centers for Disease Control and Prevention in Atlanta, an agency spokesman said Thursday.

The father-in-law, Robert C. Cooksey, is a microbiologist who has conducted research on tuberculosis for the National Center for Infectious Diseases, according to a CDC biography posted on the agency's Web site.

CNN affiliate WSB-TV reported that Cooksey gave his son-in-law, Speaker, "fatherly advice" after he found out his son-in-law had contracted the infectious disease, but did not advise him in any official capacity.

Cooksey did not immediately return a call to his work number seeking comment.

Speaker was put in isolation at Atlanta's Grady Hospital after tests last week confirmed he had extremely drug-resistant TB, or XDR TB, the most dangerous form of the illness.

He was transferred to Denver on Thursday morning on a private aircraft, hospital officials said.

A spokesman for Denver's National Jewish Medical and Research Center said Speaker was wearing a mask and was escorted by federal marshals when he arrived, but seemed normal otherwise.

"He looked kind of like you guys, more or less," spokesman William Allstetter told reporters.

He said Speaker told him he felt fine.

Allstetter said the patient would go through a series of tests and would be given two antibiotics.

The Centers for Disease Control and Prevention in Atlanta is tracking down airline passengers who may have come in contact with Speaker, who traveled to Europe while he was infected.

They have identified about 80 air passengers on the two trans-Atlantic flights they feel are most at risk for exposure. (Watch passengers discuss their frustrations over the TB scare)Video

Speaker was in Europe for his wedding and honeymoon at the time his XDR TB was diagnosed, although he was aware before the trip that he had a form of drug-resistant TB. (CNN's Dr. Sanjay Gupta on other passengers' fears, frustrations)

Health officials said they advised him not to travel, but they had no authority to prevent him from doing so.

After making it clear that he was set on traveling despite the warnings, the man asked during a meeting with county health officials whether it would help if he wore a mask, Fulton County's Dr. Eric Benning told CNN.

Since the county was not able legally to stop him from traveling, the officials recommended he at least wear a mask, Benning said. Speaker left for Europe a few days later.

Speaker told the Atlanta Journal-Constitution that health officials told him they preferred he not travel, but knew about his plans for an overseas wedding and honeymoon.

He told the newspaper that he had planned to undergo an 18-month "cutting-edge treatment" at the Denver hospital after his honeymoon.
Border security issues

Speaker, who was not identified by the Atlanta Journal-Constitution, told the newspaper he was aware he was placed on a no-fly list in the United States after his diagnosis with XDR TB, which is why he decided not to fly into a U.S. airport.

The CDC had alerted Customs and Border Protection authorities about the man on May 22, noting that they anticipated he might board his scheduled June 5 flight into Atlanta, the official said. Instead, Speaker took a Czech Air flight from Prague to Montreal, along with 199 other passengers and crew members, and then drove into the United States.

But the CBP also put the information out to all ports of entry, which is "routine practice," according to the official.

Speaker's passport was checked at the Champlain, New York, border crossing, and although it triggered an alert on the Customs and Border Protection computer system, he was still allowed in the country, a Homeland Security official told CNN.

The CBP agent who processed his entry on May 24 has been placed on administrative duties while the investigation is continuing, the official said. (Watch how patient slipped past authoritiesVideo)
XDR TB

XDR TB was recently defined as a subtype of multiple-drug resistant tuberculosis.

People with XDR TB are resistant to first- and second-line drugs; their treatment options are limited and the disease often proves fatal.

It can take between six and 16 weeks for a final diagnosis of XDR TB.

Between 1993 and 2006, 49 people were diagnosed with XDR TB in the United States, said Dr. Ken Castro, director of the division of TB Elimination at CDC, which is based in Atlanta.

The disease is more common elsewhere, he said. "When they looked, they found it in every single continent of the world," he said.

The World Health Organization estimates that there were almost half a million cases of multiple-drug-resistant tuberculosis worldwide in 2004.

People with TB of the lungs, the organs most commonly affected, can spread the disease by coughing, sneezing or even talking.

"A person needs only to breathe in a small number of these germs to become infected (although only a small proportion of people will become infected with TB disease)," WHO said on its Web site.

"The risk of becoming infected increases, the longer the time that a previously uninfected person spends in the same room as the infectious case," it added.

Cure is possible for up to 30 percent of cases, it said.

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OF COURSE HE IS A LAWYER! Selfish Bastard!

[SpursFan1902]

[Kezza]

Even though the authorities may not be able to charge him with any criminal acts, he is still WIDE OPEN to potential civil lawsuits. I hope the bastard gets sued into bankruptcy by every person he put at risk. It's just plain reckless endangerment of human lives, just as if he were driving drunk.

[eefanincan]

I think he'd find a way to weasel out of it Kez. But still, I think they should try.

[pirtybirdy]

That father in law from the CDC let his daughter marry him? Is his daughter downright crazy? Am I missunderstanding something here?