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TB case shows border flaws

A man carrying a dangerous disease but bent on entering the U.S. does so with ease.

By TIMES WIRES SERVICES
Published May 31, 2007


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WASHINGTON - What if the globe-trotting tuberculosis patient had instead been carrying the next super-flu? That he could drive into the country after his name was put on the no-fly list -- and given to U.S. border guards -- illustrates just one of the gaps in the system to keep the direst of diseases from crossing borders.

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 Department of Homeland Security launched a major investigation Wednesday into how the Atlanta man was cleared on Friday by border agents who were told to stop him.

It was one in a series of missed opportunities to catch a patient seemingly determined to elude health officials during a six-country odyssey, first for his honeymoon and then -- finally convinced of the situation's seriousness -- to get back home.

The Centers for Disease Control and Prevention tracked the man to Rome and was in discussion about having Italian officials quarantine him -- only to learn he had disregarded CDC warnings not to board a plane, and fled.

"It's regretful that we weren't able to stop that," Dr. Martin Cetron, the CDC's quarantine chief, said Wednesday, explaining that the agency hesitates to invoke heavy-handed quarantine steps.

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

The man has cooperated fully since re-entering the United States on Friday, and he remains under federally ordered isolation in an Atlanta hospital, pending his requested transfer to a Denver hospital that specializes in lung disorders.

'You're nuts'

The man is under the first U.S. government-ordered quarantine since 1963.

"Is the patient himself highly infectious? Fortunately, in this case, he's probably not," CDC's director, Dr. Julie Gerberding, said. "But the other piece is this bacteria is a very deadly bacteria. We just have to err on the side of caution."

The man continues to feel well and shows no symptoms, Cetron said.

He 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 finding passengers 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.

CDC officials said they are working closely with airlines. Health officials in France said they have asked Air France-KLM for passenger lists, and the Italian Health Ministry said it 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.

Health officials said the man had been advised not to fly and knew he could expose others when he boarded the jets.

But 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 that 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.

"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.

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 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 the man told the newspaper 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.

"I thought to myself: 'You're nuts.' I wasn't going to do that (wait for the CDC to get him home). 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.

Congress sets hearing

By the time the CDC added his name to the no-fly list, he apparently already was on a plane about to land in 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 Homeland Security spokesman told the Associated Press on 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 investigating, too: The House Homeland Security Committee has scheduled a June 6 hearing.

The good news: The man apparently isn't highly contagious, judging from the lack of obvious TB in his sputum. Also reassuring is that his wife seems TB-free.

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, spokesman William Allstetter said.

Tuberculosis symptoms

Tuberculosis, caused by germs that are spread from person to person through the air, usually affects the lungs and can lead to symptoms such as chest pain and coughing up blood.

Timeline

Movement of the man infected with the XDR-TB.

May 10: Notified in Atlanta he had multidrug-resistant TB

May 12: Air France Flight 385 from Atlanta to Paris, May 12, also listed as Delta Air Lines Flight 8517.

May 14: Air France 1232 from Paris to Athens to get married.

May 16: Athens to Thira Island.

May 21: Mykonos Island to Athens flight; Athens to Rome flight; contacted in Rome by the CDC and told he has XDR-TB and not to take commercial flight.

May 24: Czech Air 727 from Rome to Prague; Czech Air Flight 104 from Prague to Montreal; drives into the United States at Champlain, N.Y.

May 25: Entered New York hospital.

May 28: Taken to Atlanta's Grady Memorial Hospital in respiratory isolation.

Fast Facts:

 

Officials seek passengers

Health officials in North America and Europe are seeking passenger lists for two trans-Atlantic flights in their efforts to find about 80 people who sat near a man infected with a dangerous form of tuberculosis:

May 12: Air France Flight 385 from Atlanta to Paris, also listed as Delta Air Lines Flight 8517.

May 24: Czech Air Flight 104 from Prague to Montreal

 

[Last modified May 30, 2007, 23:26:58]


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