Moron with Drug Resistant TB Gets on Plane, CDC Looking for people now

[sterlingice]

Hadn't seen a thread on this yet...

Originally Posted by NYTimes

TB Patient Was Advised Not to Fly
By ANAHAD O’CONNOR
Published: May 30, 2007

A man who may have exposed passengers and crew members on two trans-Atlantic flights earlier this month to a highly drug-resistant form of tuberculosis knew he was infected, and had been advised by health officials not to travel overseas.

The man flew to Paris from his home in Atlanta on May 12 for his wedding and honeymoon, even though health officials told him they “preferred” that he not get on the flight, he said in an interview published today in The Atlanta Journal-Constitution.

Days later, while he was in Italy, he was contacted by officials of the Centers for Disease Control and Prevention, and was told that he had a rare and potentially virulent form of the disease and should turn himself over to Italian health authorities immediately.

Officials of the centers said at a news conference today that they had begun to make arrangements with the Italian authorities to isolate and treat the man in Rome. But instead of cooperating with the plans, the man traveled to the Czech Republic and took a flight from Prague to Montreal.

He said in the published interview that he did that in the belief that he had been put on a no-fly list and would not be allowed to board a flight bound for the United States.

From Canada, he drove to the United States, and then turned himself in at a tuberculosis isolation hospital in New York City.

The director of the C.D.C., Julie Gerberding, said today that the man, whose name has not been released, was not highly infectious, but that there was nonetheless a possibility that others could catch the disease from him.

Dr. Martin Cetron, director of the CDC’s division of global migration and quarantine, said at a news conference today that federal and international officials were still trying to track down passengers and crew members who were on the two trans-Atlantic flights the man took: Air France 385 on the night of May 12-13, and Czech Air 104 from Prague to Montreal on May 24.

Dr. Cetron said the agency was looking in particular for the passengers who sat in the two rows behind the man and the two rows in front of him, which together could add up to more than 80 people.

According to investigators, the man apparently sat in row 51 on the Air France flight, and near row 12 on the return flight to North America.

“Our focus has been on these two international flights, but we are piecing together the patient’s full itinerary,” Dr. Cetron said. “At this time, the patient continues to feel well and to be asymptomatic.”

He told reporters at the news conference that the patient was never formally ordered not to travel, that he apparently had not broken any laws, and that he was cooperating with federal health authorities now.

Dr. Cetron said that the man flew on five other flights as well during his honeymoon, but those flights, all within Europe, were too short to pose a significant risk of transmitting the disease.

Kristen Loughman, a spokeswoman for Air France, said today that the airline provided investigators with the names of passengers who were on the flight. A spokesman for Czech Air said that his airline, too, was cooperating with the authorities.The infected man is now at Grady Memorial Hospital in Atlanta under federally enforced isolation; he was flown there from New York City on Monday on a plane owned by the C.D.C.

He told The Atlanta Journal-Constitution that he was planning to undergo an intensive 18-month treatment at a hospital in Denver, and that he did not understand why he was not ordered into isolation before he left for his wedding in Europe. “I’m a very well-educated, successful, intelligent person,” the man, who declined to give his name, was quoted in the newspaper interview as saying. “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.”

Dr. Cetron said the man’s wife had been tested for tuberculosis and the results were negative, and that the authorities were getting touch with his coworkers and others with whom he came in regular contact.

The Centers for Disease Control and Prevention said that because this was the first airline-contact investigation for extremely drug resistant tuberculosis, it was not sure that current recommendations were adequate to determine the possible range and risk of transmission on infection.

The agency said it was advising all passengers and crew members who were on the two commercial flights to be tested for tuberculosis, even though they are believed to be at low risk of having been infected.

That appraisal was based on test results showing that the number of tuberculosis bacteria in the man’s sputum was too low to detect, though it would still be enough to infect others under the right conditions.

Dr. Gerberding said at a news conference on Tuesday that her agency was erring on the side of caution because the form of tuberculosis, known as XDR TB, was often fatal and had become a growing public health threat in many countries.

Drug-susceptible, or regular, TB and XDR TB are thought to be spread the same way. Fluids containing the TB bacteria become aerosols when a person coughs, sneezes, speaks or sings. The bacteria can float in the air for several hours, depending on the environment. People who breathe air containing these bacteria can become infected.

The risk of acquiring any type of tuberculosis appears to depend on several factors, including the extent of disease in the person who is the source of the bacteria, the duration of exposure and how well the area is ventilated.

It usually takes several hours or days of exposure in poorly ventilated or crowded environments for a person to become infected. An important way to prevent the spread and transmission of the disease is by limiting an infectious person’s contact with other people.

People who have a confirmed diagnosis of TB or XDR TB are generally treated in isolation and kept there until they are no longer infectious.

Thank god it has a low communicability rate.

His quote almost tells me just what kind of person he is:

Originally Posted by moron

"“I’m a very well-educated, successful, intelligent person,” the man, who declined to give his name, was quoted in the newspaper interview as saying. “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.”

There seem to be 3 easy points here:
1) I love that he has to tell everyone he's a successful, educated, and intelligent person. Clearly not the case
2) Again, he takes issue with the fact that he's quarantined despite only having issues with the "whole solitary-confinement-in-Italy thing" - no remorse or anything; he thinks this is just a minor disagreement of issues, not a "Oh crap, I could kill people", in his words, "thing".
3) Oh, and clearly he forgot that he was told to not travel and did it anyways. And then did it again.

It's going to be some jackass like this who is patient zero in any major plague.

SI

[Fonzie]

Like we needed another reason to avoid successful, educated, and intelligent people.

[MrBigglesworth]

If someone told me that they would 'prefer' it if I canceled my wedding in Paris and stay home, I would probably tell them thanks, but no thanks. If the situation was as serious as they now make it out to be, he should have been put in solitary confinement right away. After he had been contacted in Italy I don't know what he was thinking, but it's possible that he had a good reason for thinking the way that he did.

[albionmoonlight]

He said in the published interview that he [flew into Canada] in the belief that he had been put on a no-fly list and would not be allowed to board a flight bound for the United States.

This fact puts the kibosh on his whole "I had no idea that I was not actually allowed to fly; I thought that it was just a suggestion" excuse.

If he knew enough to fly into Canada to circumvent the government, then he knew enough to know that he was not allowed to fly.

[albionmoonlight]

According to CNN, the guy is Andrew Speaker

http://atlantadivorce.poweradvocates.com/about.html

[JPhillips]

So am I right in thinking he's a Naval Academy dropout?

[molson]

Originally Posted by MrBigglesworth

If someone told me that they would 'prefer' it if I canceled my wedding in Paris and stay home, I would probably tell them thanks, but no thanks. If the situation was as serious as they now make it out to be, he should have been put in solitary confinement right away. After he had been contacted in Italy I don't know what he was thinking, but it's possible that he had a good reason for thinking the way that he did.

I agree with this. This was his wedding and honeymoon, and it seems like it was a pretty elaborate/expensive trip, probably nonrefundable. If some government guys told me it "probably wasn't a good idea to travel", but didn't order me to do anything, I felt fine, and had treatement lined up in Denver when I returned, I'd take the trip.

[Brillig]

He's a lawyer.

Really, can't we just kill them all now?

[ISiddiqui]

Originally Posted by albionmoonlight

This fact puts the kibosh on his whole "I had no idea that I was not actually allowed to fly; I thought that it was just a suggestion" excuse.

If he knew enough to fly into Canada to circumvent the government, then he knew enough to know that he was not allowed to fly.

Yep. Maybe we can buy it for the initial leg of the trip, but after he was contacted in Italy to turn himself in and then found out he was on the no-fly list, sorry... doesn't work.

[molson]

Originally Posted by ISiddiqui

Yep. Maybe we can buy it for the initial leg of the trip, but after he was contacted in Italy to turn himself in and then found out he was on the no-fly list, sorry... doesn't work.

It was a selfish move, but not completely unreasonable. He didn't want to end up quarantined in Italy.

In your head, if you thought you increase your chances of survival by say, 25%, by increasing the risk of contaminating people on a plane by maybe >.01%, it's not a ridiculous decision.

[sterlingice]

Originally Posted by molson

It was a selfish move, but not completely unreasonable. He didn't want to end up quarantined in Italy.

In your head, if you thought you increase your chances of survival by say, 25%, by increasing the risk of contaminating people on a plane by maybe >.01%, it's not a ridiculous decision.

Which would be legit... if he was a doctor and he wasn't just pulling stats out of his backside. Not his call to make, it's the doctor's.

SI

[sterlingice]

Aside from him being a personal injury lawyer, the second most entertaining part to come out of this story from today:

Originally Posted by Yahoo

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.

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.

That next family gathering's going to be a bit awkward.

SI

[Rizon]

Bueller .... Bueller ... Bueller ...

[Senator]

With the picture, his douche level tripled.

[JediKooter]

"All right, 'lunger'. Let's do it. "

[ISiddiqui]

Originally Posted by molson

It was a selfish move, but not completely unreasonable. He didn't want to end up quarantined in Italy.

In your head, if you thought you increase your chances of survival by say, 25%, by increasing the risk of contaminating people on a plane by maybe >.01%, it's not a ridiculous decision.

As said, when he'd have some proof of such claims then perhaps it isn't unreasonable. When the doctor, who you'd think would KNOW BETTER than the lawyer about these things tells the lawyer to stay put... yeah, it's completely unreasonable.

It isn't exactly like Italy is a 3rd world country.

[JonInMiddleGA]

http://www.ajc.com/health/content/he...04speaker.html

Tuberculosis patient's disease less severe than thought

By CRAIG SCHNEIDER, ALISON YOUNG
The Atlanta Journal-Constitution
Published on: 07/03/07

The Atlanta man who set off an international scare while traveling with what federal officials said was a highly feared form of tuberculosis actually has a less severe form of the disease, his doctors said today.

Andrew Speaker previously had been classified with the form of TB considered most difficult to treat — called extensively drug resistant or XDR TB — and had been scheduled to undergo lung surgery this month.

But doctors at National Jewish Medical and Research Center in Denver said today that recent testing shows Speaker may now be treated with medications previously thought ineffective against his disease.

As a result, they reclassified his condition as multi-drug-resistant tuberculosis. They have changed his medication and put on hold a decision about his lung surgery.

"His prognosis has improved," said Dr. Charles Daley, the hospital's head of infectious diseases. He added that "we may be able to treat him successfully without surgery."

The cure rate for nonresistant strains of TB is about 90 percent, according to the American Lung Association, while those who have multi-drug-resistant TB or MDR TB have a cure rate of 50 percent or less.

The World Health Organization, which counts about 424,000 new cases of MDR TB every year, says the cost of treating MDR TB can be 1,000 times more than treating standard TB.

WHO says XDR TB first became apparent in March 2006 after researchers reported the highly resistant strains of the disease. Six months later, a cluster of "virtually untreatable" XDR TB cases was reported in an area of South Africa with a high prevalence of HIV. All but one of the 53 patients died in an average of 25 days after they were tested for drug resistance.

WHO estimates the spread of the disease to equal about 25,000 to 30,000 new cases of XDR TB every year, with 37 countries confirming cases of the disease.

Speaker's earlier diagnosis of XDR TB was instrumental in setting off an international health scare last month, since Speaker had flown to Europe for his wedding and honeymoon.

After that earlier diagnosis, the U.S. Centers for Disease Control and Prevention held a press conference to announce that they had issued a rare federal isolation order against Speaker specifically because he had XDR TB. The CDC called for testing of passengers from several countries who were on the trans-Atlantic flights with Speaker.

The National Jewish mycobacteriology laboratory conducted extensive drug-susceptibility tests on tuberculosis organisms taken from Speaker on three different occasions: April 25 in Atlanta, May 27 in New York, and June 1 in Denver.

All three isolates indicated definite resistance to three first-line drugs for tuberculosis: isoniazid, rifampin and pyrazinamide. All the isolates, however, were susceptible to all the fluoroquinolone drugs (ofloxacin, levofloxacin, moxifloxacin and ciprofloxacin), and the injectable drugs (amikacin, kanamycin, and capreomycin). Results on all three samples were consistent for both testing methods used.

Previous test results from the U.S. Centers for Disease Control and Prevention had indicated that Speaker's tuberculosis was resistant to the fluoroquinolones and to the injectable drug kanamycin, and was therefore classified as extensively drug resistant.

"The new results indicate his tuberculosis is, instead, multi-drug-resistant," said a written hospital statement issued today.

The statement was issued moments before a press conference.

CDC spokesman Tom Skinner declined to comment until after the news conference this afternoon.

The Speaker case set off a furor in the United States, as well as in Italy, in Greece and at the World Health Organization. Three congressional committees are investigating because serious questions were raised about how Fulton County and Georgia state health officials and the CDC handled the case before he left the U.S. for his wedding abroad. They also are questioning how Speaker managed to get back into the country despite the flagging of his passport and addition of his name to a no-fly list.

Before leaving the United States, Speaker was diagnosed with the serious, but slightly less difficult to treat form of TB, called multi-drug-resistant TB.

When he was later diagnosed with the more serious form of the disease, CDC Director Julie Gerberding said that while the risk of transmission was small because Speaker had no symptoms and was not coughing, the risk wasn't zero and said the extreme difficulty of finding antibiotics to effectively treat XDR TB made the international alerts and precautions necessary.

Doctors at National Jewish Medical and Research Center, considered world experts in treating drug-resistant TB, had been planning to remove part of Speaker's TB-infected lung to reduce the area of infection that is being treated with antibiotics.

Speaker has never had any symptoms or cough. His TB was only identified by chance: Doctors in January saw a spot on his lung after he had an x-ray for an injury.