2007 tuberculosis scare
Encyclopedia
The 2007 tuberculosis scare occurred when Atlanta
personal-injury lawyer
Andrew "Drew" Speaker flew from Atlanta, Georgia to Paris, France and then returned on a flight from Prague, Czech Republic to Montreal, Canada, when he crossed over the border and back into the United States while infected with multi-drug-resistant tuberculosis
. The Centers for Disease Control and Prevention
believed at the time that Speaker was suffering from extensively drug-resistant tuberculosis
(XDR-TB). The incident sparked a debate in Congress
on the failure of federal customs agents
to stop him. Upon Speaker's return to the United States, the CDC placed him under involuntary isolation (similar to quarantine
) using a provision of the Public Health Service Act
. With this action, Speaker became the first individual subjected to a CDC isolation order since 1963.
On March 28, 2007 his doctors and the health department believed the TB strain Speaker had was a resistant one and communicated this to the CDC. On May 1 the apparent MDR TB infection was discussed with the CDC lab by his doctors and they discussed discontinuing the treatment he was on at that time. On May 9 the suspicion of MDR TB was confirmed. A meeting was held with Fulton County
Health Officials, his doctors, his fiancée and his father and father-in-law on May 10, 2007. At this time he was told that he was not contagious and not a threat to anyone but that he would need to go to Denver for treatment. It would take a few weeks to arrange this. He was advised, or according to some accounts strongly recommended, not to travel.
to Paris
. On May 14, he flew on to Athens
and, two days later, flew to the Aegean
holiday island of Santorini
for his wedding (Santorini's Mayor Angelos Roussos, states that Speaker lacked the necessary paperwork for the civil ceremony.). Speaker then flew to Rome
for his honeymoon.
Doctors say that only after Speaker left the United States did they realize he likely had XDR-TB
. Speaker says that he was informed of MDR TB before leaving the country, and that while officials preferred him not to fly, they said that he was not a threat and was not required to wear a mask. Once Speaker was in Europe, however, test results showed his strain of tuberculosis was even rarer than originally thought, leading public health officials to try to persuade Speaker to turn himself in to Italian health authorities.http://www.cnn.com/2007/POLITICS/06/07/tb.borders/index.html http://abcnews.go.com/GMA/story?id=3344625&page=1 The CDC informed him that there were no options for the CDC to get him home, and that he would have to arrange private transportation. Speaker instead flew by commercial jet to Prague
and then on to Montréal
. Both Speaker and his new wife claimed that, had they been offered transport, they would have accepted it and would have waited in Rome. Speaker has also said that the CDC told him they were going to send officials to put him in Italian quarantine for up to two years, and that he was not told special transportation was arranged.
Once in Montréal, Speaker rented a car and drove across the Canada – United States border. A Customs and Border Protection Officer failed to detain him at the frontier, disregarding a warning after he had passed Speaker's passport through the Treasury Enforcement Communications System (TECS) to hold the traveler, wear a protective mask when dealing with him, and call health authorities because he "did not look sick".
in Atlanta to the National Jewish Medical and Research Center
in Denver
, Colorado
, for further treatment.
It was reported that Speaker's father-in-law, Robert C. Cooksey, works for the Centers for Disease Control and Prevention
and is a microbiologist
who has conducted research on tuberculosis
, according to his CDC biography posted on the agency's Web site. However, Cooksey has never worked with the strain of tuberculosis Speaker has been diagnosed with.
Wearing a medical mask, Speaker was interviewed by Diane Sawyer
on the June 1 edition of the American talk show Good Morning America
on ABC and apologized to all passengers, explaining that he had not intended to endanger them.
Drug-resistant tuberculosis is typically much less contagious than wild strains that have not evolved multiple drug resistance (see extensively drug-resistant tuberculosis
). According to an interview on Larry King Live
, Speaker said that he had not been told that there was any risk of transmitting the disease to others, nor did the May 10 letter recommending against his travel state this, which Speaker in any case had not received before leaving May 14. His wife, with whom he lived for five months without precautions, remained uninfected.
(MDR-TB), a more treatable form of tuberculosis.
Speaker was in New York when the CDC served him with an isolation order but CDC director Julie Gerberding stated that the government was legally constrained prior to that order. The federal statute granting quarantine authority allows isolation or quarantine but only for individuals coming into the country from a foreign country or territory.
Georgia TB law may have required Speaker to be confined for two weeks and only allowed travel for medical appointments. A court confinement order can isolate a patient only after the infected patient ignores medical advice. This method can be overridden by a declaration of public health emergency by the governor of Georgia.
On July 12, 2007 it was announced that seven Canadians and two Czechs will launch $1.3 million in civil lawsuits in Montreal. Eight were on the same flight as Andrew Speaker and one was a roommate of one of those on the same flight.
Atlanta, Georgia
Atlanta is the capital and most populous city in the U.S. state of Georgia. According to the 2010 census, Atlanta's population is 420,003. Atlanta is the cultural and economic center of the Atlanta metropolitan area, which is home to 5,268,860 people and is the ninth largest metropolitan area in...
personal-injury lawyer
Personal injury lawyer
A personal injury lawyer is a lawyer who provides legal representation to those who claim to have been injured, physically or psychologically, as a result of the negligence or wrongdoing of another person, company, government agency, or other entity....
Andrew "Drew" Speaker flew from Atlanta, Georgia to Paris, France and then returned on a flight from Prague, Czech Republic to Montreal, Canada, when he crossed over the border and back into the United States while infected with multi-drug-resistant tuberculosis
Multi-drug-resistant tuberculosis
Multi-drug-resistant tuberculosis is defined as TB that is resistant at least to isoniazid and rifampicin , the two most powerful first-line anti-TB drugs...
. The Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
believed at the time that Speaker was suffering from extensively drug-resistant tuberculosis
Extensively drug-resistant tuberculosis
Extensively drug-resistant tuberculosis is a form of TB caused by bacteria that are resistant to the most effective anti-TB drugs. Some contend that XDR-TB strains have emerged from the mismanagement of multidrug-resistant TB and once created, can spread from one person to another...
(XDR-TB). The incident sparked a debate in Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
on the failure of federal customs agents
U.S. Customs and Border Protection
U.S. Customs and Border Protection is a federal law enforcement agency of the United States Department of Homeland Security charged with regulating and facilitating international trade, collecting import duties, and enforcing U.S. regulations, including trade, customs and immigration. CBP is the...
to stop him. Upon Speaker's return to the United States, the CDC placed him under involuntary isolation (similar to quarantine
Quarantine
Quarantine is compulsory isolation, typically to contain the spread of something considered dangerous, often but not always disease. The word comes from the Italian quarantena, meaning forty-day period....
) using a provision of the Public Health Service Act
Public Health Service Act
The Public Health Service Act is a United States federal law enacted in 1944. The full act is captured under Title 42 of the United States Code "The Public Health and Welfare", Chapter 6A "Public Health Service"....
. With this action, Speaker became the first individual subjected to a CDC isolation order since 1963.
Background
In January 2007, Speaker suffered a fall and went to the doctor, concerned that he had bruised a rib. Doctors X-rayed his chest and found an abnormality that required further testing. Andrew Speaker was suspected of having TB when a positive PPD test came back on March 2, 2007. His third CT scan was done on March 3 and a bronchoscopy was done on March 8. After 18 days of incubation the isolate was sent to CDC for confirmation of his susceptibility results that were done by the Georgia Department of Human Resources (DHR).On March 28, 2007 his doctors and the health department believed the TB strain Speaker had was a resistant one and communicated this to the CDC. On May 1 the apparent MDR TB infection was discussed with the CDC lab by his doctors and they discussed discontinuing the treatment he was on at that time. On May 9 the suspicion of MDR TB was confirmed. A meeting was held with Fulton County
Fulton County, Georgia
Fulton County is a county located in the U.S. state of Georgia. Its county seat is Atlanta, the state capital since 1868 and the principal county of the Atlanta metropolitan area...
Health Officials, his doctors, his fiancée and his father and father-in-law on May 10, 2007. At this time he was told that he was not contagious and not a threat to anyone but that he would need to go to Denver for treatment. It would take a few weeks to arrange this. He was advised, or according to some accounts strongly recommended, not to travel.
Travel Sequence
On May 12, 2007, Speaker flew from the U.S.Transatlantic flight
Transatlantic flight is the flight of an aircraft across the Atlantic Ocean. A transatlantic flight may proceed east-to-west, originating in Europe or Africa and terminating in North America or South America, or it may go in the reverse direction, west-to-east...
to Paris
Paris
Paris is the capital and largest city in France, situated on the river Seine, in northern France, at the heart of the Île-de-France region...
. On May 14, he flew on to Athens
Athens
Athens , is the capital and largest city of Greece. Athens dominates the Attica region and is one of the world's oldest cities, as its recorded history spans around 3,400 years. Classical Athens was a powerful city-state...
and, two days later, flew to the Aegean
Aegean Islands
The Aegean Islands are the group of islands in the Aegean Sea, with mainland Greece to the west and north and Turkey to the east; the island of Crete delimits the sea to the south, those of Rhodes, Karpathos and Kasos to the southeast...
holiday island of Santorini
Santorini
Santorini , officially Thira , is an island located in the southern Aegean Sea, about southeast from Greece's mainland. It is the largest island of a small, circular archipelago which bears the same name and is the remnant of a volcanic caldera...
for his wedding (Santorini's Mayor Angelos Roussos, states that Speaker lacked the necessary paperwork for the civil ceremony.). Speaker then flew to Rome
Rome
Rome is the capital of Italy and the country's largest and most populated city and comune, with over 2.7 million residents in . The city is located in the central-western portion of the Italian Peninsula, on the Tiber River within the Lazio region of Italy.Rome's history spans two and a half...
for his honeymoon.
Doctors say that only after Speaker left the United States did they realize he likely had XDR-TB
Extensively drug-resistant tuberculosis
Extensively drug-resistant tuberculosis is a form of TB caused by bacteria that are resistant to the most effective anti-TB drugs. Some contend that XDR-TB strains have emerged from the mismanagement of multidrug-resistant TB and once created, can spread from one person to another...
. Speaker says that he was informed of MDR TB before leaving the country, and that while officials preferred him not to fly, they said that he was not a threat and was not required to wear a mask. Once Speaker was in Europe, however, test results showed his strain of tuberculosis was even rarer than originally thought, leading public health officials to try to persuade Speaker to turn himself in to Italian health authorities.http://www.cnn.com/2007/POLITICS/06/07/tb.borders/index.html http://abcnews.go.com/GMA/story?id=3344625&page=1 The CDC informed him that there were no options for the CDC to get him home, and that he would have to arrange private transportation. Speaker instead flew by commercial jet to Prague
Prague
Prague is the capital and largest city of the Czech Republic. Situated in the north-west of the country on the Vltava river, the city is home to about 1.3 million people, while its metropolitan area is estimated to have a population of over 2.3 million...
and then on to Montréal
Montreal
Montreal is a city in Canada. It is the largest city in the province of Quebec, the second-largest city in Canada and the seventh largest in North America...
. Both Speaker and his new wife claimed that, had they been offered transport, they would have accepted it and would have waited in Rome. Speaker has also said that the CDC told him they were going to send officials to put him in Italian quarantine for up to two years, and that he was not told special transportation was arranged.
Once in Montréal, Speaker rented a car and drove across the Canada – United States border. A Customs and Border Protection Officer failed to detain him at the frontier, disregarding a warning after he had passed Speaker's passport through the Treasury Enforcement Communications System (TECS) to hold the traveler, wear a protective mask when dealing with him, and call health authorities because he "did not look sick".
Flight itinerary
According to the CDC, Speaker flew on the following flights:| Airlines | Flight# | Aircraft | Date | Departing | Scheduled Departure | Calculated Scheduled Duration !! Arriving !! Number of Passengers !! Patient Seat Row Number | |||
|---|---|---|---|---|---|---|---|---|---|
| Air France Air France Air France , stylised as AIRFRANCE, is the French flag carrier headquartered in Tremblay-en-France, , and is one of the world's largest airlines. It is a subsidiary of the Air France-KLM Group and a founding member of the SkyTeam global airline alliance... / Delta Delta Air Lines Delta Air Lines, Inc. is a major airline based in the United States and headquartered in Atlanta, Georgia. The airline operates an extensive domestic and international network serving all continents except Antarctica. Delta and its subsidiaries operate over 4,000 flights every day... |
385 / 8517 | Boeing 747-400 Boeing 747-400 The Boeing 747-400 is a major development and the best-selling model of the Boeing 747 family of jet airliners. While retaining the four-engine wide-body layout of its predecessors, the 747-400 embodies numerous technological and structural changes to produce a more efficient airframe... |
2007-05-12 | Atlanta, Georgia Hartsfield-Jackson Atlanta International Airport Hartsfield–Jackson Atlanta International Airport , known locally as Atlanta Airport, Hartsfield Airport, and Hartsfield–Jackson, is located seven miles south of the central business district of Atlanta, Georgia, United States... |
8:45 PM Local | 8 Hr 27 Min | Paris, France Charles de Gaulle International Airport Paris-Charles de Gaulle Airport , also known as Roissy Airport , in the Paris area, is one of the world's principal aviation centres, as well as France's largest airport. It is named after Charles de Gaulle , leader of the Free French Forces and founder of the French Fifth Republic... |
433 | 30 |
| Air France | 1232 | Airbus A320 Airbus A320 The Airbus A320 family is a family of short- to medium-range, narrow-body, commercial passenger jet airliners manufactured by Airbus Industrie.Airbus was originally a consortium of European aerospace companies, and is now fully owned by EADS. Airbus's name has been Airbus SAS since 2001... |
2007-05-14 | Paris, France | 7:35 AM Local | 3 Hr 11 Min | Athens, Greece | not more than 172 | unknown |
| Olympic Air Olympic Airlines Olympic Airlines was the flag carrier airline of Greece, with its head office in Athens. It operated services to 37 domestic destinations and to 32 destinations world-wide. Its main base was at Athens International Airport, with hubs at Thessaloniki International Airport, "Macedonia" and Rhodes... |
560 | ATR 72-202 ATR 72 The ATR 72 is a twin-engine turboprop short-haul regional airliner built by the French-Italian aircraft manufacturer ATR. ATR and Airbus are both built in Toulouse, and share resources and technology... |
2007-05-16 | Athens, Greece | 7:25 PM Local | 0 Hr 40 Min | Thira Island, Greece Santorini (Thira) National Airport Santorini National Airport is an airport in Santorini/Thira, Greece , located north of the village of Kamari. The airport serves both as a military and as a civil airport. With its relatively small apron, the airport is only able to serve up to 6 civilian planes at the same time. The tower... |
not more than 74 | unknown |
| Olympic Air | 655 | ATR 72-202 | 2007-05-21 | Mykonos Island, Greece Mykonos Island National Airport -External links:* Mykonos Airport: *... |
1:45 PM Local | 0 Hr 40 Min | Athens, Greece | not more than 74 | unknown |
| Olympic Air | 239 | Boeing 737-400 Boeing 737 The Boeing 737 is a short- to medium-range, twin-engine narrow-body jet airliner. Originally developed as a shorter, lower-cost twin-engine airliner derived from Boeing's 707 and 727, the 737 has developed into a family of nine passenger models with a capacity of 85 to 215 passengers... |
2007-05-21 | Athens, Greece | 5:30 PM Local | 2 Hr 05 Min | Rome, Italy | not more than 168 | unknown |
| Czech Airlines Czech Airlines Czech Airlines j.s.c. , trading as Czech Airlines , is the national airline of the Czech Republic and temporary in Slovakia with its head office on the grounds of Ruzyně Airport in Ruzyně, Prague... |
727 | Boeing 737-400 | 2007-05-24 | Rome, Italy | 8:50 AM Local | 1 Hr 55 Min | Prague, Czech Republic Ruzyne International Airport -Ruzyně today:Most flights depart Ruzyně Airport from the North Terminals . The South Terminals handle a few irregular flights, as well as VIP flights, special flights and small aircraft.... |
not more than 168 | unknown |
| Czech Airlines | 0104 | Airbus A310 Airbus A310 The Airbus A310 is a medium- to long-range twin-engine widebody jet airliner. Launched in July 1978, it was the second aircraft created by Airbus Industrie,a consortium of European aerospace companies, Airbus is now fully owned by EADS and since 2001 has been known as Airbus SAS. the consortium of... |
2007-05-24 | Prague, Czech Republic | 12:25 PM Local | 8 Hr 25 Min | Montreal, Canada Montréal-Pierre Elliott Trudeau International Airport Montréal-Pierre Elliott Trudeau International Airport or Montréal-Trudeau, formerly known as Montréal-Dorval International Airport, is located on the Island of Montreal, from Montreal's downtown core. The airport terminals are located entirely in Dorval, while the Air Canada headquarters complex... |
191 | 12 |
Tuberculosis case notes
On May 31, 2007, Speaker was moved from Grady Memorial HospitalGrady Memorial Hospital
Grady Memorial Hospital, frequently referred to as Grady Hospital or simply Grady, is the largest hospital in the state of Georgia and the public hospital for the city of Atlanta. It is the 5th largest public hospital in the United States, as well as one the busiest Level I trauma centers in the...
in Atlanta to the National Jewish Medical and Research Center
National Jewish Medical and Research Center
National Jewish Health is a research institute located in Denver, Colorado specializing in respiratory, immune and allergic research and treatment. It was founded in 1899 to treat tuberculosis, and is today considered one of the world's best medical research and treatment centers...
in Denver
Denver, Colorado
The City and County of Denver is the capital and the most populous city of the U.S. state of Colorado. Denver is a consolidated city-county, located in the South Platte River Valley on the western edge of the High Plains just east of the Front Range of the Rocky Mountains...
, Colorado
Colorado
Colorado is a U.S. state that encompasses much of the Rocky Mountains as well as the northeastern portion of the Colorado Plateau and the western edge of the Great Plains...
, for further treatment.
It was reported that Speaker's father-in-law, Robert C. Cooksey, works for the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
and is a microbiologist
Microbiology
Microbiology is the study of microorganisms, which are defined as any microscopic organism that comprises either a single cell , cell clusters or no cell at all . This includes eukaryotes, such as fungi and protists, and prokaryotes...
who has conducted research on tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, according to his CDC biography posted on the agency's Web site. However, Cooksey has never worked with the strain of tuberculosis Speaker has been diagnosed with.
Wearing a medical mask, Speaker was interviewed by Diane Sawyer
Diane Sawyer
Lila Diane Sawyer is the current anchor of ABC News' flagship program, ABC World News. Previously, Sawyer had been co-anchor of ABC Newss morning news program, Good Morning America ....
on the June 1 edition of the American talk show Good Morning America
Good Morning America
Good Morning America is an American morning news and talk show that is broadcast on the ABC television network; it debuted on November 3, 1975. The weekday program airs for two hours; a third hour aired between 2007 and 2008 exclusively on ABC News Now...
on ABC and apologized to all passengers, explaining that he had not intended to endanger them.
Drug-resistant tuberculosis is typically much less contagious than wild strains that have not evolved multiple drug resistance (see extensively drug-resistant tuberculosis
Extensively drug-resistant tuberculosis
Extensively drug-resistant tuberculosis is a form of TB caused by bacteria that are resistant to the most effective anti-TB drugs. Some contend that XDR-TB strains have emerged from the mismanagement of multidrug-resistant TB and once created, can spread from one person to another...
). According to an interview on Larry King Live
Larry King Live
Larry King Live is an American talk show hosted by Larry King on CNN from 1985 to 2010. It was CNN's most watched and longest-running program, with over one million viewers nightly....
, Speaker said that he had not been told that there was any risk of transmitting the disease to others, nor did the May 10 letter recommending against his travel state this, which Speaker in any case had not received before leaving May 14. His wife, with whom he lived for five months without precautions, remained uninfected.
New diagnosis
On July 4, 2007 the National Jewish Medical and Research Center announced, and the CDC confirmed, that Mr. Speaker's earlier diagnosis was incorrect and that he instead had multi-drug-resistant tuberculosisMulti-drug-resistant tuberculosis
Multi-drug-resistant tuberculosis is defined as TB that is resistant at least to isoniazid and rifampicin , the two most powerful first-line anti-TB drugs...
(MDR-TB), a more treatable form of tuberculosis.
Isolation and law
Before a Congressional hearing, Speaker and his father played audio recordings from CDC and Fulton County health officials which say he was not a danger to others. He asked such questions on five recordings repeatedly and was given the same answers even after stating on two recordings that he was going out of the country and the CDC later admitted they were aware and waited until he had already left before taking further actions.Speaker was in New York when the CDC served him with an isolation order but CDC director Julie Gerberding stated that the government was legally constrained prior to that order. The federal statute granting quarantine authority allows isolation or quarantine but only for individuals coming into the country from a foreign country or territory.
Georgia TB law may have required Speaker to be confined for two weeks and only allowed travel for medical appointments. A court confinement order can isolate a patient only after the infected patient ignores medical advice. This method can be overridden by a declaration of public health emergency by the governor of Georgia.
On July 12, 2007 it was announced that seven Canadians and two Czechs will launch $1.3 million in civil lawsuits in Montreal. Eight were on the same flight as Andrew Speaker and one was a roommate of one of those on the same flight.
See also
- Progress of the SARS outbreakProgress of the SARS outbreak-November 2002:On November 16, 2002, an outbreak of what is believed to be severe acute respiratory syndrome , began in the Guangdong province of China, which borders on Hong Kong. The first case of infection was speculated to be a farmer in Foshan County...
for a comparison to the last news-worthy international quarantining incident, 2002-2004