Travelers possibly exposed to drug-proof TB

[Amelia]

Travelers possibly exposed to drug-proof TB

Infected man flew from Prague to U.S.; authorities seeking those on flight

The Associated Press

May 29, 2007

msnbc.com

ATLANTA - A man with a rare and dangerous form of tuberculosis ignored doctors’ advice and took two trans-Atlantic flights, leading to the first U.S. government-ordered quarantine since 1963, health officials said Tuesday.

The man, who officials did not identify, is at Atlanta’s Grady Memorial Hospital in respiratory isolation.

He was potentially infectious at the time of the flights, so officials at the Centers for Disease Control and Prevention recommended medical exams for cabin crew members on those flights, as well as passengers sitting in the same rows or within two rows.

CDC officials did not release row numbers but said the airlines were working with health officials to contact those passengers. Passengers who should be tested will be contacted by health officials from their home countries.

The infected man flew from Atlanta to Paris on May 12 aboard Air France Flight 385. He returned to North America on May 24 aboard Czech Air Flight 0104 from Prague to Montreal. The man then drove into the United States at the Champlain, N.Y., border crossing.

The man told health officials he was not coughing during the flights. Tests indicated the amount of TB bacteria in him was low, so passengers are not considered to be at high risk of infection, said Dr. Martin Cetron, director of the CDC’s division of global migration and quarantine.

The man had been told by health officials in early May that he had a form of TB that was resistant to first-line antibiotics and was advised not to travel to Europe. “He was told traveling is against medical advice,” said Dr. Steven Katkowsky, director of the Fulton County Department of Health & Wellness.

Health officials said they don’t know how the Georgia man was infected.

Man told not to fly

The government issued the quarantine after a CDC official reached the man by phone in Rome and told him not to take commercial flights, but he flew back to North America anyway. “He was told in no uncertain terms not to take a flight back,” Cetron said.

Cetron reached the man once he was back in the United States. At that point, he voluntarily went to a New York hospital, then was flown by the CDC to the Atlanta hospital. He is not facing prosecution, health officials said.

The quarantine order was the first since 1963, when the government quarantined a patient with smallpox, according to the CDC.

The man, who went on the trip with his wife, also traveled within Europe, but CDC officials said they did not have information to release about whether the trips were by plane, train or other public transportation.

His wife tested negative for TB before the trip and is not considered a public health risk, health officials said.

CDC officials said they are concentrating on investigating the trans-Atlantic flights, when possibility of spread of the disease was greatest because he was in a confined space with other people for many hours.

TB at an all-time low

Tuberculosis is a disease caused by germs that are spread from person to person through the air. It usually affects the lungs and can lead to symptoms such as chest pain and coughing up blood. It kills nearly 2 million people each year worldwide.

Because of antibiotics and other measures, the TB rate in the United States has been falling for years. Last year, it hit an all-time low of 13,767 cases, or about 4.6 cases per 100,000 Americans.

Health officials worry about “multidrug-resistant” TB, which can withstand the mainline antibiotics isoniazid and rifampin. The man was infected with something even worse — “extensively drug-resistant” TB, also called XDR-TB, which resists many drugs used to treat the infection.

There have been 17 U.S. XDR-TB cases since 2000, according to CDC statistics.

Three-quarters were people from foreign countries. One case was a Russian man who arrived in Phoenix last year. He was jailed after he stopped taking medications and went unmasked to a restaurant and other businesses, threatening the health of others.

The CDC’s statement that the patient is at the low end of communicability “provides some reassurance,” said Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University.

The highly dangerous form is “expanding around the world,” particularly in South Africa, eastern Europe and the former states of the Soviet Union, he said.

http://www.msnbc.msn.com/id/18923867/

[there buster]

It's amazing how this man's civil rights were violated! Put in quarantine, his contacts traced and tested for the disease.

Don't they know this is counterproductive? If they inform all of those potentially infected, and place him under quarantine, it will just push new cases underground. Who would be tested for the disease if they knew all this would happen. Amazing.

[bevin]

So...

voluntary_test + quarantine => people won't get tested

voluntary_test + no_quarantine + penalty => people won't get tested

voluntary_test + no_quarantine + no_penalty => people get killed by exposure

involuntary_test + quarantine => "civil rights violated"

involuntary_test + no_quarantine + penalty => people don't get killed

involuntary_test + no_quarantine + no_penalty => people get killed

Which do you prefer?

Leviticus goes for "involuntary_test + quarantine"

/Bevin

[there buster]

Thank you for making my point.

If we had taken such steps with HIV, it wouldn't be ravaging Africa and Asia right now.

[Amelia]

A while back I posted another article about a man put in quarentine in a prison and was denied basic comforts like a TV and computer. Makes me wonder what this man is being denied?

[bevin]

We think today of TB as some kind of minor lung infection.

It isn't.

He was acting in a way that threatened people's lives - TB is a HORRIBLE disease, and the drug-resistant forms of it are going to be a huge curse.

http://www.doctorswithoutborders.org/news/2005/10-11-2005_1.cfm

http://www.beat-richner.ch/pdf/TB_Khmerkiller_ed.pdf

http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/052007dnintafricaone.601ef.html

Our education system beat TB once - we should crank it up again, and start teaching people that they need to act for the good of their society, not just their own immediate desires.

/Bevin

[Dr. Shane]

TB is an issue along the border where I live. We are tested regularly. My wife had some kind of vaccine as a child in El Salvador so she has to get an X-ray. Our missionary work also increases our chances for exposure.

[puddles]

TB patient ID'd as Atlanta lawyer

By GREG BLUESTEIN and DEVLIN BARRETT, Associated Press Writers

A globe-trotting Atlanta lawyer with a dangerous strain of tuberculosis was allowed back into the U.S. by a border inspector who disregarded a computer warning to stop him and don protective gear, officials said Thursday.

The inspector has been removed from border duty.

The unidentified inspector explained that he was no doctor but that the infected man seemed perfectly healthy and that he thought the warning was merely "discretionary," officials briefed on the case told The Associated Press. They spoke on condition of anonymity because the matter is still under investigation.

The patient was identified as Andrew Speaker, a 31-year-old personal injury lawyer who returned last week from his wedding and honeymoon trip through Italy, the Greek isles and other spots in Europe. His new father-in-law, Robert C. Cooksey, is a CDC microbiologist whose specialty is TB and other bacteria. (How ironic is that?!? )

Cooksey would not comment on whether he reported his son-in-law to federal health authorities. Nor did the Centers for Disease Control and Prevention explain how the case came to their attention. However, Cooksey said that neither he nor his CDC laboratory was the source of his son-in-law's TB.

Speaker is now under quarantine at a hospital in Denver. He is the first infected person to be quarantined by the U.S. government since 1963.

The disclosure that the patient is a lawyer — and specifically a personal injury lawyer — outraged many people on the Internet and elsewhere. Some travelers who flew on the same planes with Speaker angrily accused him of selfishly putting hundreds of people's lives in danger.

"It's still very scary," 21-year-old Laney Wiggins, one of more than two dozen University of South Carolina-Aiken students who are getting skin tests for TB. "That is an outrageous number of people that he was very reckless with their health. It's not fair. It's selfish."

Speaker said in a newspaper interview that he knew he had TB when he flew from Atlanta to Europe in mid-May for his wedding and honeymoon, but that he did not find out until he was already in Rome that it was an extensively drug-resistant strain considered especially dangerous.

Despite warnings from federal health officials not to board another long flight, he flew home for treatment, fearing he wouldn't survive if he didn't reach the U.S., he said. He said he tried to sneak home by way of Canada instead of flying directly into the U.S.

He was quarantined May 25, a day after he was allowed to pass through the border crossing at Champlain, N.Y., along the Canadian border.

The inspector ran Speaker's passport through a computer, and a warning — including instructions to hold the traveler, don a protective mask in dealing with him, and telephone health authorities — popped up, officials said. About a minute later, Speaker was instead cleared to continue on his journey, according to officials familiar with the records.

The Homeland Security Department is investigating.

"The border agent who questioned that person is at present performing administrative duties," said Homeland Security spokesman Russ Knocke, adding those duties do not include checking people at the land border crossing.

Colleen Kelley, president of the union that represents customs and border agents, declined to comment on the specifics of the case, but said "public health issues were not receiving adequate attention and training" within the agency.

On Thursday, a tan and healthy-looking Speaker was flown from Atlanta to Denver, accompanied by his wife and federal marshals, to Denver's National Jewish Medical and Research Center, where doctors planned to isolate him and treat him with oral and intravenous antibiotics.

Dr. Charles Daley, chief of the hospital's infectious-disease division, said he is optimistic Speaker can be cured because he is believed to be in the early stages of the disease.

Dr. Gwen Huitt of National Jewish described Speaker as "a young, healthy individual" who is "doing extremely well."

"By conventional methods that we traditionally use in the public health arena ... he would be considered low infectivity at this point in time," she said. "He is not coughing, he is healthy, he does not have a fever."

Doctors hope also to determine where he contracted the disease, which has been found around the world and exists in pockets in Russia and Asia.

He will be kept in a special unit with a ventilation system to prevent the escape of germs. "He may not leave that room much for several weeks," hospital spokesman William Allstetter said.

Speaker's father-in-law has worked at the CDC for 32 years and is in the Division of Tuberculosis Elimination, where he works with TB and other organisms. He has co-authored papers on diabetes, TB and other infectious diseases.

"As part of my job, I am regularly tested for TB. I do not have TB, nor have I ever had TB," he said in a statement. "My son-in-law's TB did not originate from myself or the CDC's labs, which operate under the highest levels of biosecurity."

In a brief telephone interview with the AP, Cooksey said that he gave Speaker "fatherly advice" when he learned the young man had contracted the disease.

"I'm hoping and praying that he's getting the proper treatment, that my daughter is holding up mentally and physically," Cooksey said. "Had I known that my daughter was in any risk, I would not allow her to travel."

According to a biography posted on a Web site connected with Speaker's law firm, the young lawyer attended the U.S. Naval Academy, graduated from the University of Georgia with a degree in finance, then attended University of Georgia's law school. He is in private practice with his father, Ted Speaker, an unsuccessful candidate for a judgeship in 2004.

Speaker's father told WSB-TV: "The way he's been shown and spoken about on TV, it's like a terrorist traveling around the world escaping authorities. It's blown out of proportion immensely."

Andrew Speaker recently moved from an upscale condominium complex in anticipation of his wedding, former neighbors said. He also wrote in an application to become a board member of his condo association that he was going to Vietnam for five weeks as part of the Rotary Club to act as an ambassador.

His wife, Sarah, is a third-year law student at Atlanta's Emory University.

"He's a great guy. Gregarious," said Pam Hood, a former neighbor. "He's a wonderful guy. Just a very, very pleasant man."

Health officials in North America and Europe are now trying to track down about 80 passengers who sat near him on his two trans-Atlantic flights, and they want passenger lists from four shorter flights he took while in Europe.

However, other passengers are not considered at high risk of infection because tests indicated the amount of TB bacteria in Speaker was low, said Dr. Martin Cetron, director of the CDC's division of global migration and quarantine.

Health law experts said Speaker could be sued if others contract TB.

"There are a number of cases that say a person who negligently transmits an infectious disease could be held liable," said Lawrence Gostin, a public health law expert at Georgetown University. "So long as he knew it was infectious, and knew about the appropriate behavior but failed to comply, he could be held liable."

Speaker told The Atlanta Journal-Constitution that he wasn't coughing and that doctors initially did not order him not to fly and only suggested he put off his long-planned wedding. "We headed off to Greece thinking everything's fine," he told the newspaper.

___

Devlin Barrett contributed to this story from Washington. Associated Press writers Lara Jakes Jordan in Washington; Mike Stobbe in Atlanta; Jim Davenport in Columbia, S.C.; and Colleen Slevin in Denver also contributed to this report, along with AP news researcher Judy Ausuebel in New York.

___

On the Net:

CDC: http://www.cdc.gov

Public Health Agency of Canada: http://www.phac-aspc.gc.ca/