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2007 tuberculosis scare

The 2007 tuberculosis scare occurred when Atlanta personal-injury lawyer Andrew "Drew" Speaker (dubbed the 'TB Guy' by major American news organizations) flew from Atlanta, Georgia to Paris, France and then returned on a flight from Prague, Czech Republic to Montreal, Canada, when he crossed over the border and back into the United States while infected with multi-drug-resistant tuberculosis. The Centers for Disease Control and Prevention believed at the time that Speaker was suffering from extensively drug-resistant tuberculosis (XDR-TB). The incident sparked a debate in Congress on the failure of federal customs agents to stop him. Upon Speaker's return to the United States, the CDC placed him under involuntary isolation (similar to quarantine) using a provision of the Public Health Service Act. With this action, Speaker became the first individual subjected to a CDC isolation order since 1963.

Travel sequence

In January 2007, Speaker suffered a fall and went to the doctor, concerned that he had bruised a rib. Doctors X-rayed his chest and found an abnormality that required further testing. Andrew Speaker was first diagnosed with TB when a positive PPD test came back on March 2, 2007. His third CT scan was done on March 3 and a bronchoscopy was done on March 8. After 18 days of incubation the isolate was sent to CDC for confirmation of his susceptibility results that were done by the Georgia Department of Human Resources (DHR). On March 28, 2007 his doctors and the health department believed the TB strain Speaker had was a resistant one and communicated this to the CDC. On May 1 the apparent MDR TB infection was discussed with the CDC lab by his doctors and they discussed discontinuing the treatment he was on at that time. On May 9 the suspicion of MDR TB was confirmed. A meeting was held with Fulton County Health Officials, his doctors, his fiancée and his father and father-in-law on May 10, 2007. At this time he was told that he was not contagious and not a threat to anyone, but that he would need to go to Denver for treatment. It would take a few weeks to arrange this. However, he was advised, or according to some accounts, strongly recommended not to travel. Nonetheless, he did travel, during which he potentially exposed hundreds of people on various aircraft to the disease (see below for travel schedule).

On May 12, 2007, Speaker flew from the U.S. to Paris. On May 14, he flew on to Athens and, two days later, flew to the Aegean holiday island of Santorini for his wedding. (The mayor of Santorini, Angelos Roussos, states that Speaker had not filed the necessary paperwork for the civil ceremony.) Speaker then flew to Rome for his honeymoon.

Doctors say that only after Speaker left the United States did they realize he likely had XDR-TB. Speaker says that he was informed of MDR TB before leaving the country, and that while officials preferred him not to fly, they said that he was not a threat and was not required to wear a mask. "Once Speaker was in Europe, however, test results showed his strain of tuberculosis was even rarer than originally thought leading public health officials to try to persuade Speaker to turn himself in to Italian health authorities." The CDC informed him that there were no options for the CDC to get him home, and that he would have to arrange private transportation. Instead, he flew by commercial jet to Prague and then on to Montréal. Both Speaker and his new wife claimed that, had they been offered transport, they would have accepted it and would have waited in Rome. Speaker has also said that the CDC told him they were going to send officials to put him in Italian quarantine for up to two years, and that he was not told special transportation was arranged.

Once in Montréal, Speaker rented a car and drove across the Canada – United States border. A United States Border Patrol agent failed to detain him at the frontier, disregarding a warning after he had passed Speaker's passport through the Treasury Enforcement Communications System (TECS) to hold the traveler, wear a protective mask when dealing with him, and call health authorities because he "did not look sick".

Flight itinerary

According to the CDC, Speaker flew on the following flights:

Flight Itinerary of U.S. Traveler
Airlines Flight# Aircraft Date Departing Scheduled Departure Calculated Scheduled Duration Arriving Number of Passengers Patient Seat Row Number
Air France / Delta 385 / 8517 Boeing 747-400 2007-05-12 Atlanta, Georgia 8:45 PM Local 8 Hr 27 Min Paris, France 433 30
Air France 1232 Airbus A320 2007-05-14 Paris, France 7:35 AM Local 3 Hr 11 Min Athens, Greece not more than 172 unknown
Olympic Air 560 ATR 72-202 2007-05-16 Athens, Greece 7:25 PM Local 0 Hr 40 Min Thira Island, Greece not more than 74 unknown
Olympic Air 655 ATR 72-202 2007-05-21 Mykonos Island, Greece 1:45 PM Local 0 Hr 40 Min Athens, Greece not more than 74 unknown
Olympic Air 239 Boeing 737-400 2007-05-21 Athens, Greece 5:30 PM Local 2 Hr 05 Min Rome, Italy not more than 168 unknown
Czech Airlines 727 Boeing 737-400 2007-05-24 Rome, Italy 8:50 AM Local 1 Hr 55 Min Prague, Czech Republic not more than 168 unknown
Czech Airlines 0104 Airbus A310 2007-05-24 Prague, Czech Republic 12:25 PM Local 8 Hr 25 Min Montreal, Canada 191 12

Tuberculosis case notes

On May 31, 2007, Speaker was moved from Grady Memorial Hospital in Atlanta to the National Jewish Medical and Research Center in Denver, Colorado, for further treatment.

It was reported that Speaker's father-in-law, Robert C. Cooksey, works for the Centers for Disease Control and Prevention and is a microbiologist who has conducted research on tuberculosis, according to his CDC biography posted on the agency's Web site. However, Cooksey has never worked with the strain of tuberculosis Speaker has been diagnosed with.

Wearing a medical mask, Speaker was interviewed by Diane Sawyer on the June 1 edition of the American talk show Good Morning America on ABC and apologized to all passengers, explaining that he had not intended to endanger them.

Drug-resistant tuberculosis is typically much less contagious than wild strains that have not evolved multiple drug resistance (see extensively drug-resistant tuberculosis). According to an interview on Larry King Live, Speaker said that he had not been told that there was any risk of transmitting the disease to others, nor did the May 10 letter recommending against his travel state this, which Speaker in any case had not received before leaving May 14. His wife, with whom he lived for five months without precautions, including traditional celebration of the first few days of a honeymoon, remains uninfected.

New diagnosis

On July 4, 2007 the National Jewish Medical and Research Center announced, and the CDC confirmed, that Mr. Speaker's earlier diagnosis was incorrect and that he instead had multi-drug-resistant tuberculosis (MDR-TB), a more treatable form of tuberculosis.

Isolation and law

Before a Congressional hearing, Speaker and his father played audio recordings from CDC and Fulton County health officials which say he was not a danger to others. He asked such questions on five recordings repeatedly and was given the same answers even after stating on two recordings that he was going out of the country and the CDC later admitted they were aware and waited until he had already left before further actions.

Speaker was in New York when the CDC served him with an isolation order but CDC director Julie Gerberding stated that the government was legally constrained prior to that order. The federal statute granting quarantine authority allows isolation or quarantine but only for individuals coming into the country from a foreign country or territory.

Georgia TB law should have required Speaker confined for two weeks and only allowed travel for medical appointments. A court confinement order can isolate a patient only after the infected patient ignores medical advice. This method can be overridden by a declaration of public health emergency by the governor of Georgia.

On July 12, 2007 it was announced that seven Canadians and two Czechs will launch $1.3 million in civil lawsuits in Montreal. Eight were on the same flight as Andrew Speaker and one was a roommate of one of those on the same flight.

References

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