TB case prompts questions; Patient sidestepped federal safeguards


 
 

By Jeremy Manier and Judith Graham | | Thursday, June 14, 2007


DENVER In a time of widespread worry over pandemic flu and bioterrorism, the case of Andrew Speaker offered a prime chance for international health agencies to show how they would prevent the spread of a potentially deadly disease.

Speaker carried a virulent form of tuberculosis by airplane to Europe, where U.S. and European officials tried to isolate him and ensure that he could not endanger others. He was stubborn and afraid, but he was just one patient -- as opposed to the thousands or millions of people a flu pandemic could drive to panic.

Yet the global health network failed to keep Speaker from boarding a plane last week and flying from the Czech Republic to Canada. A U.S. Border Patrol agent let him cross into New York even though he saw Speaker on a public health watch list, later explaining that the man did not look sick.

Such lapses have shown the need for more effective prevention measures to experts within and outside the federal Centers for Disease Control and Prevention. CDC Director Julie Gerberding said Friday that at one crucial juncture last week, agency leaders did not know if they had the proper jurisdiction to send an agency jet to bring Speaker back from Europe.

Gerberding said the CDC needs better procedures for dealing with international travel, and perhaps stronger laws to handle uncooperative infected patients.

"In this case I think we've learned a number of things within the travel system that need to be improved," Gerberding said at a news conference. "You can believe me when I tell you we will aggressively approve any changes in statutory authority that will help us clarify what, if anything, can be done in the future to minimize this kind of problem."

Fellow passengers to be tested

The lessons for future preparedness may be more significant than the risk from Speaker's strain of tuberculosis, which is difficult to treat but still rare in the U.S. His infection does not appear highly contagious, but passengers who shared his flights likely will be tested for up to 10 weeks.

Speaker's case can be compared to a drill in which a law enforcement officer tries to sneak a plastic gun through an airport checkpoint, said Dr. James L. Cook, chief of infectious diseases at the University of Illinois at Chicago.

"One guy tested the system, and it failed," Cook said. "That's not a good sign."

Federal authorities flew Speaker this week from New York to Atlanta and finally to Denver's National Jewish Medical and Research Center, widely considered the nation's top center for treatment of tuberculosis and other respiratory diseases.

Its reputation was one reason Speaker was so desperate to return to the U.S. against the CDC's instructions, he said in an interview from the Denver hospital Friday morning on ABC's "Good Morning America." An apologetic Speaker, a 31-year-old lawyer from Atlanta, said he feared that if he stayed in Europe, "it's very real that I could have died there."

Speaker had traveled to Europe to get married in Greece, and news reports had indicated the couple had wed. But the mayor of the island of Santorini told the Associated Press on Friday that Speaker and his fiance had not brought the necessary papers. The woman's father is a tuberculosis researcher at the CDC, but officials there say Speaker's strain did not come from the agency's labs.

Gerberding said CDC officials had not known how serious Speaker's infection was until May 22, and they reached him in Italy the next day.

Military transport considered

The CDC could not surmount unexpected legal and bureaucratic hurdles fast enough to ensure that Speaker either stayed in Italy or returned home on a government jet where he would not infect other passengers, Gerberding said. She said the agency had looked into using a Department of Defense air ambulance or even a boat, but Speaker left Italy before plans could be finalized.

"It wasn't even clear to us ... whatever transportation ability we had, whether or not the Italian [health] ministry was in a position to say, 'Fine, come and get your patient, do what you need to do,'" she said.

Asked how the CDC would respond to a true pandemic given its difficulty with a single patient, Gerberding defended her agency's performance.

"One thing that you don't realize is this is one case, but there are actually many, many, many cases where we have been successful," Gerberding said.

It's possible to treat and cure even the highly drug-resistant form of tuberculosis, though the success rate with drugs alone is about 33 percent, experts said. Doctors at National Jewish said that by the end of the week Speaker will be on at least five medications and taking at least 12 pills a day or more. It appears he'll stay at the facility for at least two months. If he fails to respond to drugs, doctors may consider removing a portion of his infected lung.

Although Speaker is under a federal isolation order -- the first issued since 1963 -- there is no security guard outside his hospital room door.




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