All 26 Americans Who Sat Nearest TB Patient Found

By David Brown
Washington Post Staff Writer
Saturday, June 2, 2007

Public health authorities have found all 26 Americans who sat near a man infected with untreated "extensively drug-resistant" tuberculosis on a transatlantic flight last month and will be able to test them for exposure to the often-fatal organism, federal officials said yesterday.

The man's good health and the small amount of TB bacteria in his lungs make it unlikely that he infected anyone on the round-trip flights to Europe, which he took against medical advice. However, it will take at least two months to rule that out -- or to discover that he did infect someone.

In the interim, the exposed people who are under surveillance should not think that they -- unlike the TB-infected traveler -- can infect anyone, the director of the Centers for Disease Control and Prevention, Julie L. Gerberding, said yesterday.

"Some of the passengers are afraid they're a hazard to other people now. We want to assure them that is absolutely not the case," she said.

There were 435 passengers on an Atlanta-to-Paris flight that the infected man and his fiancee took on May 12. (The couple were going to Europe to be married on a Greek island and then honeymoon in Italy.) Of that total, 310 were U.S. citizens or residents.

Health authorities, however, are most interested in people sitting in the man's row and in two rows in front of and behind him -- a zone where studies have shown passengers are at greatest risk in such situations. There were 26 Americans in that zone. On the return trip, a Prague-to-Montreal flight on May 24, the couple were the only Americans in the potential exposure zone.

How many countries had citizens among the approximately 50 people in the exposure zone on the outgoing flight, and the 30 exposed on the return flight, is unknown. Gerberding said she did not know how many of those people have been found, although she said that Canada had located all 28 of its citizens who sat in the zone.

People who sat farther away from the patient, Atlanta lawyer Andrew Speaker, 31, may be worried and may choose to be tested, Gerberding said. The CDC has had contact with at least 70 American passengers. About 40 came forward on their own as details of the cat-and-mouse game between Speaker and health authorities trickled out this week.

The exposed passengers will undergo skin testing for TB now, and again in eight to 10 weeks.

The test involves injecting a small amount of noninfectious material into the skin. If a person with a normal immune system has been infected with the TB bacterium at any time, the area of the injection becomes slightly swollen and red.

If a passenger has that reaction in the next few days, the infection almost certainly occurred before last month. If there is no reaction at first but one shows up two months from now, physicians will conclude the person was infected on one of the flights with Speaker's extensively drug-resistant (XDR) strain.

Exactly how people in that situation would be treated was not available yesterday.

Speaker's initial diagnosis in March triggered routine skin testing of a list of contacts he later provided to the health department in Atlanta's Fulton County. The list presumably included family, members of his household, and fellow employees who spent a lot of time with him at the law firm.

None of those tests has suggested recent TB infection, said Steven Katkowsky, the head of the local health department.

Speaker is at Denver's National Jewish Medical and Research Center, a hospital known for treating respiratory diseases, including tuberculosis.

In an interview on ABC's "Good Morning America" yesterday, Speaker said, "I'm very sorry for any grief or pain that I caused anyone." He said he did not believe he was endangering anyone by taking the flights.

Speaker's father-in-law, Robert C. Cooksey, is a microbiologist at the CDC who works in the Division of Tuberculosis Elimination -- a startling coincidence that Gerberding would not comment on yesterday.

What, if anything, Cooksey said to Speaker about the advisability of traveling with untreated XDR-TB is not known. Nobody has answered the phone at his house in Roswell, Ga., in two days.

On May 23, a CDC quarantine officer in Atlanta reached Speaker by phone in Rome and informed him that a recently completed test had shown his infection to be extensively drug-resistant -- the most dangerous category -- and asked him not to fly.

Gerberding yesterday said that at the time of that conversation, "I can assure you that we were engaged in exploring all conventional options, as well as some unconventional options . . . that would have allowed the patient to return to the United States in a way that did not pose a risk to other people."

Those options included a private air ambulance, a CDC airplane, U.S. military aircraft or a ship. However, it is not known how completely or emphatically those efforts were made known to Speaker, who said later he feared being forced to seek treatment in Italy.

The lawyer and his wife left Rome on May 23 or 24 and flew to Prague, then on to Montreal. (The Rome-Prague flight and other flights the couple made in Europe were less than eight hours, thus posing no significant risk to others.) By the time the couple arrived in Montreal, their names were on a list warning U.S. border guards to stop them. They were identified by computer scan of their passports, but a border guard in Champlain, N.Y., disregarded the computerized instructions to detain them and let the couple enter the country.

The guard has been reassigned to administrative duty, Department of Homeland Security officials said.

Sen. Charles E. Schumer (D-N.Y.) yesterday encouraged DHS to conduct "an exhaustive, top-to-bottom review of the incident." He suggested that border guards might need further training on how to deal with people who have potentially hazardous health conditions.

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