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Man With Rare TB Easily Eluded Safeguards

By David Brown
Washington Post Staff Writer
Thursday, May 31, 2007

The Atlanta man with extensively drug-resistant tuberculosis who sparked an international health alarm by flying to Europe and back for his wedding twice ignored requests to stay put and not travel, officials said yesterday.

He apparently also shortened his honeymoon -- which included stays in both Greece and Italy -- and returned home early in order to avoid the complicated procedure being put together to get him back to the United States in a way that would not expose other people to his dangerous microbe.

Those were among the details that emerged yesterday about a bizarre cat-and-mouse game that reveals both how seriously public health officials take the threat of transcontinental spread of infectious disease and how easily the safeguards can be eluded.

"There is some indication of deceitfulness on the part of the individual," said Russ Knocke, spokesman for the Department of Homeland Security, which was in the process of putting the patient's name on a "no-fly list" last Thursday when it learned he was already on a plane headed for Montreal.

Knocke also said last night that investigators were looking into how the man and his wife got through U.S. customs in Champlain, N.Y., when all border crossings had been given his name and told to hold him if he appeared.

The man, now back in Georgia and undergoing treatment, provided a different version of events to an Atlanta newspaper, saying he was never explicitly told he could not travel. He could not be reached yesterday. His name and identity have not been revealed; he is said to be in his 30s.

Extensively drug-resistant tuberculosis (XDR-TB) is neither more contagious nor more virulent than ordinary TB. Once acquired, however, it is very difficult to cure.

Authorities in the United States and several European countries are tracking down about 50 people who sat near the man on his Atlanta-to-Paris flight on May 12, and 30 people on his Prague-to-Montreal return May 24. They will be offered testing to see if they are infected.

This chronology emerged yesterday:

Early this year, the man fell, hurt his ribs and got an X-ray, which revealed an abnormality in the upper lobe of his right lung suggesting tuberculosis. He had no symptoms then and has reportedly felt well throughout the entire episode.

In early March he underwent a procedure to get a sample of sputum from his lungs, and by the end of the month, lab cultures revealed he had TB.

Further study of the bacterium showed on May 10 that it was "multidrug-resistant" -- it could not be killed by the two most commonly used drugs. TB patients are generally treated with at least three different antimicrobial medicines.

That same day, Eric Benning, the head of the communicable disease branch of the Fulton County health department, met with the patient and his personal physician. Benning said yesterday that he had told the man "it was our recommendation that he not travel because of the potential exposure of other people, but also for his benefit."

Benning said the man mentioned his plans to go to Europe and said he felt well but was willing to take precautions. Benning said he advised the man to wear a mask when in public, confined spaces.

"I didn't ask him specifically if he was going to travel. He said I had not provided him with any compelling reason not to travel," Benning recalled. An article in the Atlanta Journal-Constitution yesterday quoted the man as saying that local health officials told him they "preferred" he not travel.

On May 22, while the man was still in Europe, tests in Atlanta revealed his TB bacterium was resistant to two classes of backup drugs, qualifying it as "extensively drug-resistant."

The next day, a quarantine officer at the Centers for Disease Control and Prevention reached the man in Rome by cellular phone, told him not to travel, and said arrangements for travel and treatment were being made, said Martin Cetron, CDC's head of global migration and quarantine.

Cetron also dispatched a former CDC employee working with Italy's health ministry to visit the man at his hotel and reiterate that message. But by then he was gone.

Although his original plans were to return June 5, he flew from Rome to Prague on May 24 and from Prague to Montreal the same day.

The no-fly list is primarily intended to prevent potential terrorists from boarding flights bound for the United States, but people who pose health risks can be included.

The department does not get real-time passenger data for flights ending in Canada, Knocke said, making it "very difficult for us to know who might be traveling there." It is unknown if the TB patient specifically chose to return via Canada for that reason.

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