Quarantine for TB risk. Did patient ignore no-travel advice?

[Hawkeye]

Quarantine for TB risk
Did patient ignore no-travel advice?

May 30, 2007
BY MIKE STOBBE Associated Press
ATLANTA---- A man with a form of tuberculosis so dangerous he is under the first U.S. government-ordered quarantine since 1963 told a newspaper he took one trans-Atlantic flight for his wedding and honeymoon and another because he feared for his life.

Health officials have questioned his decision to fly from Atlanta to Paris, and later from Prague to Montreal, citing the possibility that he could expose other passengers. The man told the Atlanta Journal-Constitution that while doctors told him they preferred that he put off his long-planned wedding in Greece, they didn't order him not to fly.


TB FYI
Here are some questions and answers about TB:

What kind of TB does the man have?

It's called ''extensively drug-resistant tuberculosis,'' or XDR TB. It can't be cured by the two best first-line drugs, isoniazid and rifampin, or the best second-line medications.

What can doctors do?

There are less effective options. Some programs have achieved cure rates for about 30 percent of affected people. Success depends on how resistant the germ is, how severe the disease is and whether the patient's immune system is weakened.

How rare is his form of TB?

Only 49 cases were reported in the United States between 1993 and 2006.

AP
He knew that he had tuberculosis, but didn't think he was a danger, he said.
''We headed off to Greece thinking everything's fine,'' said the man, who declined to be identified in the newspaper because of the stigma attached to his diagnosis.

Dr. Steven Katkowsky, director of the Fulton County Department of Health & Wellness, said the man was told traveling was not advised.

The 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, then drove into the United States at the Champlain, N.Y., border crossing.

The man, whom officials also did not identify, is at Atlanta's Grady Memorial Hospital in respiratory isolation.

He told the newspaper he flew into Canada to avoid U.S. authorities after they told him when he was in Italy to turn himself over to officials there due to the seriousness of the disease. He said he believed he had to return to the U.S. to get the treatment he needed to survive.

Officials at the Centers for Disease Control and Prevention have recommended medical exams for cabin crew members and passengers who sat within two rows of the man.

''This is a bacteria that is really transmitted through the air, and generally to people who are in closed spaces for very long periods of time,'' Dr. Julie Gerberding, director of CDC, told ABC's ''Good Morning America'' on Wednesday.

''So long air flights can pose a risk to some passengers, but short flights, or people who go onto an aircraft after a patient has left, are not at risk,'' she said.

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

CDC officials said the airlines were working with health officials to contact passengers. Those who should be tested will be contacted by health officials from their home countries.

Dr. Howard Njoo of the Public Health Agency of Canada said there appeared to be little chance that the man spread the disease on the flight into Canada. Still, the agency was working with U.S. officials to contact passengers who sat near him.

Air France-KLM has been asked by French health authorities to provide lists of all passengers seated within two rows of the infected man, a spokeswoman said Wednesday.

Daniela Hupakova, a spokeswoman for the Czech airline CSA, said the airline was informed about the man by U.S. officials. The crew of the flight underwent medical checks and all are fine, she said.

The airline was contacting passengers to recommend they undergo testing, and was cooperating with Czech and foreign authorities, she said.

The man told the Journal-Constitution the CDC contacted him in Rome during his honeymoon, telling him that he had to turn himself in to Italian authorities to be isolated and be treated. The CDC told him he couldn't fly aboard commercial airliners.

''I thought to myself: You're nuts. I wasn't going to do that. They told me I had been put on the no-fly list and my passport was flagged,'' the man said.

He told the paper he and his wife decided to sneak back into the U.S. via Canada. When he arrived back in the United States, he voluntarily went to a New York hospital, then was flown by the CDC to Atlanta. He is not facing prosecution, health officials said.

''I'm a very well-educated, successful, intelligent person,'' he told the paper. ''This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary-confinement-in-Italy thing.''

CDC officials told The Associated Press they could not immediately comment on the interview.

The man's wife tested negative for TB before the trip and is not considered a public health risk, health officials said. Health officials said they don't know how the Georgia man was infected.

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

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.

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.

[Hawkeye]

Here is more about that same guy.

Passengers on TB flights sought
www.suntimes.com/news/nation/408339,CST-NWS-tb31.article

May 31, 2007

BY MIKE STOBBE Associated Press
ATLANTA---- Health officials in North America and Europe sought passenger lists Wednesday for two trans-Atlantic airline flights in their effort to find about 80 people who sat near a honeymooner infected with a dangerous drug-resistant form of tuberculosis.

Authorities also disclosed that the man was on several flights between various European locales over the course of two weeks earlier this month. Passengers lists for those flights were also being tracked down, they said.

''The investigation is just beginning. It's very challenging,'' said Dr. Martin Cetron, director of the Centers for Disease Control and Prevention's division of global migration and quarantine.

The man, who is under the first U.S. government-ordered quarantine since 1963, told a newspaper he flew from Atlanta to Greece for a wedding and then traveled to Italy for a honeymoon. Later he flew back to North America because he feared he might die without treatment in the United States.

CDC officials are concentrating on the trans-Atlantic flights, when the likelihood of spreading the disease was greatest because he was in a confined space with other people for hours. Officials were trying to contact 27 crew members and about 80 passengers who sat in the five rows surrounding the man for testing.

Other passengers on the flights are not considered at high risk of infection because tests indicated the amount of TB bacteria in the man was low, Cetron said.

''Our big concern is that no one has told us which row he might have sat on,'' passenger Shannon Boccard, whose 10-year-old son was on the same flight, told WSB-TV in Atlanta.

Health officials in France have asked Air France-KLM for passenger lists, and the Italian Health Ministry also is tracing the man's movements. A spokeswoman for Czech airline CSA said medical checks showed no infections among its crew members who flew with the man, but the airline was contacting passengers.

The man had a supply of masks to wear for the protection of other passengers, but it is not clear whether he donned them, Cetron said. The man continues to feel well and shows no symptoms, Cetron said.

The man told The Atlanta Journal-Constitution that doctors did not order him not to fly and only suggested he put off his long-planned wedding. He knew he had a form of tuberculosis and that it was resistant to commonly used drugs, but he did not realize until he was already in Europe that it could be so dangerous, he said. The man's wife has tested negative.

''We headed off to Greece thinking everything's fine,'' he told the newspaper. The newspaper did not identify him at his request, because of the stigma attached to his diagnosis.

He flew to Paris on May 12 aboard Air France Flight 385, also listed as Delta Air Lines codeshare Flight 8517.

He and his bride took then took four more flights within Europe, flying from Paris to Athens on May 14; from Athens to Thira Island on May 16; from Mykonos Island to Athens on May 21; and from Athens to Rome on May 21.

The passengers on the shorter European hops are not considered to be at the same level of risk for infection as the passengers on the trans-Atlantic flights, which each lasted eight hours or more, CDC officials said.

While he was in Rome, health authorities reached him with the news that further tests had revealed his TB was a rare, ''extensively drug-resistant'' form, far more dangerous than he knew. They told him to turn himself over to Italian health officials and not to fly on any commercial airlines.

Instead, on May 24, the man flew from Rome to Prague on Czech Air Flight 0727. From Prague, the couple left for Montreal the same day, aboard Czech Air Flight 0104, according to CDC officials.

The man then drove into the United States at Champlain, N.Y. He told the newspaper he was afraid that if he did not get back to the U.S., he wouldn't get the treatment he needed to survive.

The man is now at Atlanta's Grady Memorial Hospital under the first federal quarantine order since the government quarantined a patient with smallpox in 1963. A sheriff's deputy was assigned to guard him. He is not facing prosecution, health officials said.

A spokesman for Denver's National Jewish Hospital, which specializes in respiratory disorders, said Wednesday that the man would be treated there. It was not clear when he would arrive.

Contributing: AP writers Daniel Yee in Atlanta and Colleen Slevin in Denver

[Hawkeye]

Here is a related story.

TB on a plane? Such cases rare so far, but more likely in the future, experts say

May 31, 2007
BY MIKE STOBBE Associated Press
ATLANTA---- SARS on a plane. Mumps on a plane. And now a rare and deadly form of tuberculosis, on at least two planes.
Commercial air travel's potential for spreading infection continues to cause handwringing among public health officials, as Tuesday's news of a jet-setting man with a rare and deadly form of TB demonstrates.

''We always think of planes as a vehicle for spreading disease,'' said Dr. Doug Hardy, an infectious disease specialist at UT Southwestern Medical Center in Dallas.

In the latest incident, reported by health officials on Tuesday, a Georgia man with extensively drug-resistant TB ignored doctors' advice and took two trans-Atlantic flights, leading to the first U.S. government-ordered quarantine since 1963.

The man, who officials did not identify, is at Atlanta's Grady Memorial Hospital in respiratory isolation. He was not considered highly contagious, and there are no confirmed reports that the illness spread to other passengers.

But his case illustrates ongoing concerns about the public health perils of plane travel, as well as the continuing problem of Typhoid Mary-like individuals who can almost be counted on to do the wrong thing.

The man decided to proceed with a long-planned wedding trip despite being advised not to fly.

''There's always going to be situations where there is a lack of understanding and appreciation of responsibility to the community in a situation like this,'' said Dr. John Ho, an infectious diseases specialist at New York-Presbyterian Hospital/Weill Cornell Medical Center.

The incident also points out weaknesses in the system: The man was able to re-enter the United States, even though he said he had been warned by federal officials that his passport was being flagged and he was being placed on a no-fly list.

CDC officials said they contacted the Department of Homeland Security to put the man on a no-fly list, but it doesn't appear he was added by the time he flew from Prague to Montreal and drove across the border from Canada.

A Transportation Security Administration spokesman could not be reached for comment Wednesday.

Challenges in coordinating with airlines and in communicating with the media also have emerged, said Glen Nowak, a spokesman for the U.S. Centers for Disease Control and Prevention.

''This clearly is going to have some relevance to our pandemic influenza preparedness,'' Nowak said.

There have been several prominent disease-on-a-plane incidents in recent years.

Perhaps best known is severe acute respiratory syndrome, or SARS, which erupted in Asia in 2003. Over three months, CDC workers delayed on the tarmac 12,000 airplanes carrying 3 million passengers arriving from SARS-affected countries, isolating people with SARS symptoms.

Last year, CDC officials worked with airlines and state health departments to track two infected airline passengers who may have helped spread a mumps epidemic throughout the Midwest.

And in March, a flight from Hong Kong was held at Newark International Airport for two hours because some on board reported feeling ill from a flu-like illness. They were released when it became clear they had seasonal flu, and not an avian variety.

Medical experts say TB is significantly less contagious than flu, SARS and other maladies that have led to airport alerts.

''This is not as easily transmissible as what we're concerned about with a flu pandemic,'' said Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University.

A more contagious bug, carried by a stubborn or evasive passenger, could be much more problematic, experts said.

It's remarkable how rarely serious contagions are on planes, Ho noted.

''If you count the number of international flights there are on a daily basis, this is really a minuscule event'' in terms of rate of occurrence, he said.

''However, this underscores the interrelatedness of the global community. We can no longer escape things considered foreign'' in this age of jet-travel, Ho said.

[thegrammalady]

the man is now here in colorado ant national jewish, a hospital dedicated to respiratory care.

[Rerun]

The Ass Hole Needs to be in Jail!

                           

[st789]

WTF.....an asholes.....isn't he a lawyer.

I hope no passengers on the plane caught the viruses.

[thegrammalady]

The Ass Hole Needs to be in Jail!

                           

yes he's an ass hole.  yes he's stupid. yes he's a laywer.  however he unfortunately didn't do any thing illeagle, just unthinking, uncaring and selfish

[Rerun]

Can't they prosecute someone with Aids who continues sexual activity without telling the prospective partner?  (Gross Never Mind!!!)

[thegrammalady]

Can't they prosecute someone with Aids who continues sexual activity without telling the prospective partner?  (Gross Never Mind!!!)

i believe there are laws regarding aids.

[jbeany]

I thought the AIDS charges were filed as "reckless endangerment".  This guy seems to qualify for that!

[st789]

AIDS and TB, no way.  Incredible. 

Someone needs to whop his ass.

[Sluff]

Someone should use this idiot for target practice. Could he be a terrorist out to infect scores of people with deadly diseases? I know probably my imagination running a muck. Lawyer gone terrorist.  Sounds like a good book. 

[Hawkeye]

Someone should use this idiot for target practice. Could he be a terrorist out to infect scores of people with deadly diseases? I know probably my imagination running a muck. Lawyer gone terrorist.  Sounds like a good book. 

The amount of people this guy could have infected is astronomical when you get down to it.  Anyone he came in close contact with is endangered.  In dialysis we have a special isolation room and special PPE (Personal Protective Equipment) we have to wear while treating a person with TB so we don't become contaminated.  Also you have to think that if anyone else got sick they can now spread it about too without even knowing they contacted it from some jackass on a plane, or on a bus, or in a taxi, or anywhere else this guy went while on his little holiday.  He said he had masks to wear to protect other people, and if he wore them like he was supposed to then they should be ok, but there is no guarantee he wore the masks 100% of the time.  Being a lawyer he should have known far better than to do what he did, but being a lawyer also probably made him not care about doing the right thing in the first place.

[thegrammalady]

the local news is saying he could be at national jewish medical center for up to 6 months. the doctor's there said on last nites news that other than the tb he doesn't appear or act sick. and while the people he came in contact with should be checked the chances of him spreading the infection is limited.

the boarder guard who ignored the order to restrict his entrance into the country has been relieved of duty. my question is how much attention are they paying to other bulletins, such as restricting other people who are deemed a threat to this country. or are they just allowed to walk on in, have a nice visit! (don't even get me started on illeagle immigrants)

[thegrammalady]

here's the latest...................

DENVER (AP) - A federal microbiologist, the father-in-law of the man quarantined with a drug-resistant form of tuberculosis, will be investigated to see how he was involved in the case, the Centers for Disease Control and Prevention said Saturday.


Andrew Speaker, the first person placed under federal quarantine since 1963, has said he, his doctors and the CDC all knew he had TB that was resistant to some drugs before he flew to Europe for his wedding and honeymoon last month.

Robert Cooksey, whose specialty at the CDC is TB and other bacteria and who attended his daughter's wedding, has said he provided "fatherly advice" to Speaker about travelling with the illness.

Speaker said he was advised at the time by Fulton County, Ga., health authorities that he was not contagious or a danger to anyone. Officials told him they would prefer he did not fly, but no one ordered him not to, he said.
 
Speaker was in Europe when he learned tests showed he had not just TB, but an extremely drug-resistant strain known as XDR.
 
Federal health officials said Friday that Cooksey had helped to find Speaker and diagnose his condition. They would not give any more information about the investigation.

Despite warnings from federal health officials not to board another long flight, Speaker flew back for treatment, fearing he wouldn't survive if he didn't reach the U.S., he has 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.

Speaker settled in Saturday for what could be a two-month hospital stay by taking antibiotics and fielding phone calls. He had breakfast and spent much of the day on the phone with well-wishers, his nurses at National Jewish Medical and Research Center reported.

Accompanied by his new bride, the 31-year-old Georgia attorney also used a laptop to communicate from his second-floor isolation room, hospital spokeswoman Geri Reinardy said.

Speaker was taking antibiotics to battle a tennis-ball-size infection in his lung, Reinardy said. Doctors said his treatment could include surgery to remove the infected tissue if the drugs don't work.
 
Tests so far indicate Speaker's risk of spreading the infection are low, doctors said. No medical briefings for the news media were planned during the weekend.

Doctors hope to determine where Speaker contracted the disease, which has been found around the world and exists in pockets in Russia and Asia. The tuberculosis was discovered when Speaker had a chest X-ray in January for a rib injury.

Since 2000, National Jewish has successfully treated two other patients with XDR. Dr. Gwen Huitt said they were under quarantine in their home counties, then placed under quarantine in Denver once they arrived at National Jewish, driven there nonstop by family members.

Health officials have contacted 160 of the 292 U.S. citizens who were on the May 12 flight from Atlanta to Paris, according to the CDC. That count includes all 26 who sat in the five rows around Speaker -- the ones considered at greatest risk.

The CDC initially said there were 310 aboard the flight but reduced the number because of duplicate names.

[nextnoel]

In my opinion, the guy is a selfish idiot, his wife is one, too, and his father is, too!  I think there should be some prosecution, especiallly if someone comes down with TB as a result of exposure to him.  These were all well-educated people who were well aware of the risks he was taking, and chose to take them anyway, regardless of the outcome. Boo!  Hiss!