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Hermes

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CDC Seeks Those Who Sat Near TB Patient
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this would totally suck - you just get married and you find out your husband has this fatal form of TB when you're on your honeymoon.  Even though he shouldn't have travelled and exposed otheres once he found out, I sure as hell wouldn't want to be stuck in a foreign country with a condition like that, so in a way, I don't blame him for sneaking back into the states... I feel sorry for him and his new wife and mad at him for putting so many people at risk at the same time.  Apparently, it took months to diagnose the TB, and he didn't know until he was overseas that he had it.

CDC Seeks Those Who Sat Near TB Patient

By MIKE STOBBE, AP Medical Writer document.write(getElapsed("20070531T102345Z"));

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.



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relrel


Marc Jacobs

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Coming from a public health perspective, this whole thing pisses me off. The gentlemen knew he had TB before he left on his honeymoon. Regardless of the drug-resistance or not (which some, NYTimes for example, is reporting that he knew about it prior to leaving), you don't freaking get on a plane with active TB. I don't care if you're not coughing or exhibiting other symptoms. It's just reckless and dangerous. And then when he is told not to fly home on a commercial plane and transportation will be provided and he violates that order? Come on, asshat. I actually do blame him for sneaking back into the States. He was told that transportation would be provided for him to get home, that's all he needed to know. But he panicked and put people in danger. Granted, his bacterial count is pretty low so he's probably not very infectious but this is how diseases and epidemics start.

I'm also very pissed at the public health system in general for this. The CDC and the County Health Department really dropped the ball on this. When the doctors figured out that the disease wasn't responding to normal treatment they should have been thinking about drug-resistance and contacted the CDC at that point. Certainly, as soon as the tests were done the CDC should have been contacted. It's ridiculous that four months passed between the time of the XRay showing TB-like lesions and the letter sent to the gentlemen advising him of his status and ordering him not to fly. Four months? Please. And a letter? He should have been telephoned by his care provider.

This whole episode really shows the lack of coordination between the CDC, local Health Departments, and physicians who are treating patients. Granted, cases of multi-drug resistant TB is extremely rare in the US (Arizona prison, anyone?) but this is why mandatory reporting is duh, mandatory. There are certain infectious diseases that are federally mandated to be reported within 72 hours (and in some cases within much shorter periods of time). I just don't understand why this took so frigging long to settle and how many gaps in care and information there were. It's like the Keystone Kops were in charge.

My question is though- where on earth did this guy get XDR-TB? Unless it was a spontaneous mutation, which is highly highly unlikely, he had to have been in contact with someone else who has XDR-TB. Has he been traveling in countries where this is more prevelant? Was he in contact with undocumented immigrants in this country that might have had it? It's got a relatively long latency period, so it will be diffucult to track back but somewhere he did come into contact with it and I hope to hell it wasn't here in this country.

-- Edited by relrel at 11:03, 2007-05-31

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D


Hermes

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relrel wrote:

The gentlemen knew he had TB before he left on his honeymoon.

Apparently, he didn't know. He was contacted while in Italy and was told to turn hisself in to the Italian health authorities (at which time he instead took a flight to Prague to catch a flight to Candada, and drove over the border to NY where he turned hisself in.)

is it hisself or himself? anyway - I guess it took several months to diagnose...



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pollyjean23


Marc Jacobs

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I, too, am so pissed about this guy.  I would like to slap him upside the head; and I'm a fairly non-violent person.  Airplanes are already traveling infirmaries with people hacking and sneezing...ugh!  Yeah--I wonder where he got this form of TB too!  NPR called him a "frequent-flier" in one of their reports, but they did not expand upon that label.

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Hermes

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coming on to correct myself - he DID know he had TB, but not the drug resistant type. should people not travel with TB at all regardless of the strain, relrel?

TB Patient ID'd As Atlanta Attorney, 31

By COLLEEN SLEVIN, Associated Press Writer document.write(getElapsed("20070531T165437Z"));
br-99962.jpg

Grady Memorial Hospital in Atlanta, Ga., is shown Wednesday ...

ATLANTA - The tuberculosis patient under the first federal quarantine since 1963 is a 31-year-old personal injury attorney who practices law with his father in Atlanta, a federal law enforcement official said Thursday.

The official, who asked to remain anonymous because he was not authorized to talk about the case, identified the patient as Andrew Speaker. A medical official in Atlanta also confirmed the name on condition of anonymity.

The man has a rare and dangerous form of tuberculosis that has proved resistant to drugs. He arrived at Denver's National Jewish Medical and Research Center for treatment Thursday, walking under his own power after flying from Atlanta with his wife and federal marshals, hospital spokesman William Allstetter said.

He looked healthy and tan, and "he said he still felt fine," Allstetter said.

Doctors plan to begin treating the man immediately with two antibiotics, one oral and one intravenous. He also will undergo a basic physical exam, a test to evaluate how infectious he is and a CT scan and lung X-ray, Allstetter said. Doctors hope to also determine where he contracted the disease.

He will be kept in a special unit with two rooms and a ventilation system, Allstetter said.

"He may not leave that room much for several weeks," Allstetter said.

According to a biography posted on a Web site connected with Speaker's law firm, he 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.

His father, Ted Speaker, unsuccessfully ran for a Fulton County Superior Court judgeship in 2004, the same year his son was admitted into the Georgia Bar.

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.

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

In a phone interview with the Atlanta Constitution-Journal from an Atlanta hospital earlier this week, he explained that he knew he had TB when he flew from Atlanta to Europe in mid-May for his wedding and honeymoon, but that he didn't find out until he was already there 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.

Health officials in North America and Europe are now trying to track down about 80 passengers who sat near him on the two trans-Atlantic flights, and they want passenger lists from four shorter flights he took while in Europe. Patients on the shorter flights are not expected to be as much at risk, health officials said.

Among those being tested are more than two dozen University of South Carolina Aiken students, school spokeswoman Jennifer Lake said Thursday. Two were apparently sitting near him, possibly in the same row, she said.

One of those students, Laney Wiggins, said she is awaiting her skin test results, expected Friday.

"I'm very nervous," Wiggins told The (Columbia) State newspaper. "It's kind of sad that this is overshadowing the wonderful time we had in Europe."

The infected man had flown to Paris on May 12 aboard Air France Flight 385, also listed as Delta Air Lines codeshare Flight 8517, according to the Centers for Disease Control and Prevention.

He and his bride also took four shorter flights while in Europe _ Paris to Athens on May 14; Athens to Thira Island May 16; Mykonos Island to Athens May 21; and Athens to Rome May 21 _ but CDC officials said there was less risk of infection during the shorter hops compared to the trans-Atlantic flights, which each lasted eight hours or more.

It was while they were in Rome that he learned further U.S. tests had determined his TB was the rare, extensively drug-resistant form, far more dangerous than he knew. Officials told him turn himself over to Italian health officials and not to fly on any commercial airlines.

Instead, on May 24, he flew from Rome to Prague on Czech Air Flight 0727, then flew to Montreal aboard Czech Air Flight 0104 and drove into the U.S., according to CDC officials.

Officials are trying to contact people who sat within five rows of him on the two longest flights for testing.

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

The infected man 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.

Dr. Charles Daley, head of the infectious disease division at National Jewish Hospital, said the hospital has treated two other patients with what appears to be the same strain of tuberculosis since 2000, although that strain had not been identified and named at the time. He said the patients had improved enough to be released.

"With drug-resistant tuberculosis, it's quite a challenge to treat this," Daley told CNN Thursday. "The cure rate that's been reported in other places is very low. It's about 30 percent for XDR-TB."

"This is a different patient, though. We're told that this is very early in the course, and most of the time when we get patients that it's very extensive and very far advanced. So I think we're more optimistic," he said. "We're aiming for cure. We know it's an uphill battle, but we hope to get there."



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pollyjean23


Marc Jacobs

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Check this;

The man infected with potentially fatal tuberculosis is a lawyer from Atlanta, Georgia, whose father-in-law works at the Centers for Disease Control. Andrew Speaker, 31, is now receiving treatment in Denver, Colorado, as health officials track down people he may have infected. His father-in-law, Robert C. Cooksey, is a microbiologist who has conducted research on tuberculosis for CDC

From cnn.com

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relrel


Marc Jacobs

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D wrote:

coming on to correct myself - he DID know he had TB, but not the drug resistant type. should people not travel with TB at all regardless of the strain, relrel?


Even more scary, is the Fulton County Health Department is reporting/claiming that they met with him two days before he left and that they told him he had drug-resistant TB. Here's the article:
http://www.nytimes.com/2007/05/31/us/31tb.html

Given that his bacterial load was low, he was probably safe to travel with a mask of some sort. TB is spread through the air, and it spreads extremely well in small, enclosed spaces with little air flow. You can travel but precautions need to be taken, like masks and the patient needs to be on meds to keep his bac-load low.

I've actually had patients at work who have latent TB listed on thier charts. It freaked the hell out of me knowing that I would be drawing thier blood only a couple of feet from thier face and mouth.

And how f'ed up is it that this guy's father in law works in in a lab at the CDC which does work with the same disease? If that's not where, somehow, he picked it up, than that's just a very very very odd coincidence.

And since we're talking about TB, please allow me to get up on my soapbox for the moment.

This gentleman was in extremely good shape and will have the best care and so will probably clear the infection from his body. Imagine living in a country where the health systems aren't even as good as the worst hospitals here, where the medicine is extremely expensive and where HIV/AIDS (TB infections are oppurtunistic, waiting for immuno-comprimised people) is very prevelant. This is where multi-drug resistance TB comes from- the inability for people who become infected to afford thier meds or who from some reason or other are non-compliant or aren't even aware of thier HIV status let alone having TB. The WHO for years has had thier heads up thier asses in terms of the best way to treat MD-TB, relying on outdated methods of treating non-MD-TB and ignoring the growing number of MD-TB cases. I won't go into the whole thing but Paul Farmer is an excellent source for all things TB, AIDS, and WHO. A sickingly large number of nations refuse to even acknowledge the high numbers of TB and MD-TB, harkening back to nations refusing to admit thier citizens have HIV/AIDS (which still happens!). Russian jails are notorious for MD-TB, and their health precautions are non-existant at best.

TB is an oppurtunistic infection- if you could work on HIV/AIDS numbers you would see a concordant drop in TB. If only.

End of soap-box. Thank you.



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Kate Spade

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relrel wrote:
And how f'ed up is it that this guy's father in law works in in a lab at the CDC which does work with the same disease? If that's not where, somehow, he picked it up, than that's just a very very very odd coincidence.
this is what i find MOST disturbing.  how could he allow him to travel before being treated?  the more information that comes to light, the more upset i become. furious

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squishy


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pollyjean23 wrote:
Check this;


The man infected with potentially fatal tuberculosis is a lawyer from Atlanta, Georgia, whose father-in-law works at the Centers for Disease Control. Andrew Speaker, 31, is now receiving treatment in Denver, Colorado, as health officials track down people he may have infected. His father-in-law, Robert C. Cooksey, is a microbiologist who has conducted research on tuberculosis for CDC

From cnn.com


AAAAAAAAAAAAAAAAAAAAAGH!#@$%^%#$

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nonsense!
relrel


Marc Jacobs

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Oh my lord- it keeps getting worse and worse. When the patient arrived at the Canadian/US border the inspector there let him through even seeing the flag on his passport that said that he needed to be detained! He thought it was a "discretionary" flag. I don't generally get all hot and bothered about lax security at our borders, but this just scares me. This inspector saw that he was a risk and that he needed to be stopped but let him through because the patient "didn't seem sick". WTF? So, you're gonna let a guy in who's passport was flagged as possible terror risk because he "seemed okay". This really really bothers me.

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squishy


Coach

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relrel wrote:
Oh my lord- it keeps getting worse and worse. When the patient arrived at the Canadian/US border the inspector there let him through even seeing the flag on his passport that said that he needed to be detained! He thought it was a "discretionary" flag. I don't generally get all hot and bothered about lax security at our borders, but this just scares me. This inspector saw that he was a risk and that he needed to be stopped but let him through because the patient "didn't seem sick". WTF? So, you're gonna let a guy in who's passport was flagged as possible terror risk because he "seemed okay". This really really bothers me.
again, AAAAAAAAAAAAAAAAAAAAAGH!#@$%^%#$

eta: diane sawyer landed an interview with this dude. ugh.

-- Edited by squishy at 16:52, 2007-06-01

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nonsense!
Teresa


Kate Spade

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what a selfish ass

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Kate Spade

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squishy wrote:

eta: diane sawyer landed an interview with this dude. ugh.

i saw that earlier today.  the whole thing makes me sick.  i hate that his dad recorded the doctor.  the interview w/his wife was even worse.  grrr.



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blink


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relrel wrote:

My question is though- where on earth did this guy get XDR-TB? Unless it was a spontaneous mutation, which is highly highly unlikely, he had to have been in contact with someone else who has XDR-TB. Has he been traveling in countries where this is more prevelant? Was he in contact with undocumented immigrants in this country that might have had it? It's got a relatively long latency period, so it will be diffucult to track back but somewhere he did come into contact with it and I hope to hell it wasn't here in this country.

-- Edited by relrel at 11:03, 2007-05-31


The first reports I saw on Wednesday, before his name was released, said that he had been traveling in Asia going to hospitals months ago...but for some reason I can't search and find the same articles now.  I know for sure that the previous travel in Asia was mentioned on the NBC nightly news the same evening, but they didn't provide more than that.



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dangergirl


Kate Spade

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what a complete mess, i think he's been so irresponsible and stupid - ok so he was stuck in a foreign country and he's got TB, but how could he justify probably giving it to loads of other people?! grrrr

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tina242


Kate Spade

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pollyjean23 wrote:

Check this;

The man infected with potentially fatal tuberculosis is a lawyer from Atlanta, Georgia, whose father-in-law works at the Centers for Disease Control. Andrew Speaker, 31, is now receiving treatment in Denver, Colorado, as health officials track down people he may have infected. His father-in-law, Robert C. Cooksey, is a microbiologist who has conducted research on tuberculosis for CDC

From cnn.com


You've got to be kidding me...just when I was thinking well...he didn't know the extent of his disease, that's a bit weird. bleh



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