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Archive for Thursday, May 31, 2007

TB traveler’s movement bodes poorly for containing disease

May 31, 2007

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— The government is investigating how a globe-trotting tuberculosis patient drove back into the country after his name was put on the no-fly list and given to U.S. border guards - a major gap in the nation's system to keep the direst of diseases from crossing borders.

Dr. Ken Castro, CDC director of the Division of Tuberculosis Elimination, left, and Dr. Martin Cetron, CDC director of the Division of Global Migration and Quarantine, give an update on a tuberculosis patient being held in quarantine at an Atlanta hospital. The two spoke Wednesday at the Centers for Disease Control and Prevention headquarters in Atlanta.

Dr. Ken Castro, CDC director of the Division of Tuberculosis Elimination, left, and Dr. Martin Cetron, CDC director of the Division of Global Migration and Quarantine, give an update on a tuberculosis patient being held in quarantine at an Atlanta hospital. The two spoke Wednesday at the Centers for Disease Control and Prevention headquarters in Atlanta.

That the Atlanta man and his wife were cleared by border agents told to stop them is one in a series of missed opportunities to catch a patient seemingly determined to elude health officials.

And worried infection specialists say it shows how vulnerable the nation is, from outdated quarantine laws and the speed of international flight, to killer germs carried by travelers. What if, they ask, the now-quarantined man had carried not hard-to-spread tuberculosis but something very contagious like the next super-flu?

"It's regretful that we weren't able to stop that," Dr. Martin Cetron of the Centers for Disease Control and Prevention said of how the man fled when U.S. health officials tracked him down in Rome and told him not to get on an airplane.

Should the CDC have asked Italian health authorities to put the man in isolation there? That was under discussion when the CDC learned the man had fled, Cetron said.

"We need to rely on people to do the right thing," Cetron said, saying the CDC hesitates to invoke its quarantine powers. "Can we improve our systems? Absolutely. There will be many lessons learned from this."

Patient stays a step ahead

The man has a rare but exceptionally dangerous form of TB, a type that international health authorities are desperate to curb because it is untreatable by most medications. The CDC was a step, or more, behind the man on his six-country odyssey. His name didn't get on the no-fly list until he apparently already was en route to Canada, Cetron said.

But the CDC did get word to U.S. Customs and Border Patrol before the man and his wife crossed into the country at Champlain, N.Y., a Department of Homeland Security spokesman said Wednesday.

Customs "is reviewing the facts involved with the decision to admit the individuals into the country without isolation," said DHS spokesman Russ Knocke.

Both Homeland Security's inspector general and internal affairs officials are investigating, reflecting the seriousness of the case, Knocke said.

Congress is probing, too.

The House Homeland Security Committee has scheduled a June 6 hearing.

Sen. Charles Schumer, D-N.Y., said the case "shows that something is wrong with the training and supervision of our border agents. ... I shudder to think that this individual could have been a terrorist."

Outdated quarantine laws

Border security isn't the only issue. While the man now is cooperating with CDC investigators, he remains in federally ordered isolation, in a guarded room in an Atlanta hospital. His identity is being withheld to protect his privacy.

But the nation's quarantine laws are so outdated that if the TB traveler challenged that order, "he would probably win in court," warned Lawrence Gostin, a public health law expert at Georgetown University who has advised the CDC's ongoing effort to update those laws.

"There is a hole" in the nation's disease-security system, Gostin added. "The person's instinct to get back to the United States in this case is understandable. But that's exactly what the law's there for, to prevent a person from endangering other people. ... We need to update the entire process."

Adding to the complexity is the tracking down of roughly 80 passengers who were close enough to the man on two trans-Atlantic flights to potentially have been exposed to TB, plus 27 crew members. The CDC has pushed for years for faster access to electronic lists of air passengers to trace their whereabouts in disease emergencies, and hopes to have new regulations to ease that access in place later this year.

Determined traveler

Where was he missed?

The saga begins in mid-May, when Fulton County, Ga., health department officials say they told the man he had a drug-resistant form of TB and should not travel. The man contacted his hometown newspaper to contradict that, saying he was never told to cancel his May 12 flight for his wedding and honeymoon.

The CDC caught up with him by cell phone in Rome a week and a half later, telling him that updated test results showed he had the worst form of TB, called "extensively drug-resistant" or XDR-TB. Cetron said a CDC official told him not to get on an airplane, that U.S. officials were working on how to get him home, but in the meantime he could seek medical care through the U.S. embassy or Italian hospitals.

The man told the Atlanta Journal-Constitution that he interpreted that conversation as being stuck in Italy, and decided to sneak home, flying from Prague to Montreal and then driving to New York, because he feared he would die without treatment in the U.S.

"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.

Still, the man didn't violate any laws and faces no charges, CDC said.

Comments

Newell_Post 6 years, 10 months ago

The guy was diagnosed and told not to fly before he left the US. If he had acted responsibly, getting back to the US for treatment wouldn't have been an issue since he never would have left the US. As noted above he's a smart guy (lawyer) and his wife's father is a CDC disease expert. He just behaved in a reckless and incredibly selfish manner. Even if he wasn't highly contagious, he could have contacted transplant patients or others with compromised immune systems.

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Marion Lynn 6 years, 10 months ago

Well, the guy did act out of self preservation as he has been quoted as saying that he was afraid that he would die without the treatment available in the USA.

A tough call.

Were I in his shoes, I might well have done the same thing.

Thanks.

Marion.

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Dorothy Hoyt-Reed 6 years, 10 months ago

His bride has tested negative for the disease, so he can't be too contagious. My husband and I share our germs with each other all the time.

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Newell_Post 6 years, 10 months ago

Send THIS guy to Guantanamo. He's worse than some of the other people there. (And he might give the others TB.)

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Godot 6 years, 10 months ago

from GMA, on ABCnews.com:

"In a strange twist, Speaker's father-in-law, Bob Cooksey, is a CDC microbiologist specializing in the spread of TB and other bacteria. He said only that he gave Speaker "fatherly advice" when he learned the young man had contracted the disease."

Is this a piece in the puzzle of how he acquired the disease?

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Godot 6 years, 10 months ago

He washed out of the Naval Academy. No wonder.

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pelliott 6 years, 10 months ago

What a pig among the monkeys.

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ljreader 6 years, 10 months ago

suprised he isn't an immigration attorney. or a member of ACLU.

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Flap Doodle 6 years, 10 months ago

The guy has been id'd on msnbc as a personal injury lawyer. Imagine.

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ljreader 6 years, 10 months ago

Yep- I've been worried about this for years- When people entered the US through Ellis Island, (rather than stacked like cordwood in a minivan, or allowed to wander amongst us for eternity after overstaying visas)- they were checked for contagious disease. What is frightening, is that so many are working in food service and around our food supply. Good reason to prepare our own meals at home, and hope that washing our veggies, etc will be effective.. _______- What is required of LEGAL immigrants: Persons applying to enter the U.S. with immigrant or refugee visas must complete a questionnaire about any symptoms of TB they may have and obtain a chest radiograph. If positive, the person submits sputum specimens for examination for TB bacteria. Persons identified as having infectious TB are not granted entry to the United States, until they have been treated.


No such checks when entering the US in the trunk of a car or through a tunnel.


Patients with drug-resistant TB, including XDR, can take up to two years to be cured -- for a cost of up to $250,000, according to Dr. Robert Benjamin, medical director for the Alameda County TB control program. They remain contagious for a longer period, and worldwide 25 percent to 33 percent of them die. Of the 128 cases of drug-resistant TB reported in the United States in 2004, 97 were in foreign-born patients, the CDC said.

_((((Of course, this can also be contracted from travel.)))))

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75x55 6 years, 10 months ago

Yes indeed - how about updating those quarantine laws and screening of those entering this country?

Perhaps we can include the millions of illegals that trudge across the borders to "do the work that Americans won't do", since we seemed to have no great issue with doing it at Ellis Island for decades....

Unless, of course, those illegals don't have any medical problems or potential to act as carriers of various diseases.....

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Linda Endicott 6 years, 10 months ago

"What if, they ask, the now-quarantined man had carried not hard-to-spread tuberculosis but something very contagious like the next super-flu?"

If TB is so hard to spread (as this sentence suggests), then why are they so worried?

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minko224 6 years, 10 months ago

It's against the law for someone with aids to knowingly give the disease to another, shouldn't this guy be charged with something because he knowingly put alot of people at risk?

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ljreader 6 years, 10 months ago

Scarier, whoever this man contracted the disease from is still out there spreading it around.

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