WHO Faults Handling of TB Case

More Action to Bar Travel Was Warranted, Official Says

Top officials of the World Health Organization yesterday criticized U.S. health authorities' handling of the case of a 31-year-old Atlanta lawyer with a dangerous strain of tuberculosis who defied official requests that he not take a long airplane flight.

At the least, local health officials should have told airlines to keep Andrew Speaker from boarding a plane once they concluded he was likely to defy advice and go ahead with plans to fly to Europe to be married.

"If his physician was aware that Mr. Speaker was going to travel, then he or she should have informed the public health authorities, and the public health authorities should have informed the airline . . . or put them [Speaker and his fiancee] on a watch list," said Paul Nunn, the head of WHO's office on drug-resistant tuberculosis.

Much remains unclear about which agencies knew of Speaker's intent to defy recommendations that he not travel and what they did about it. Details may emerge today at a congressional hearing in which officials of the Centers for Disease Control and Prevention will testify. Speaker is also scheduled to testify via a video link from Denver, where he is hospitalized in seclusion while under treatment.

Georgia health department officials said yesterday they were advised by the CDC -- the federal government's chief public health agency -- that local health officials should consider asking airlines to prevent Speaker from boarding a plane.

The CDC also offered two other suggestions to Georgia health officers on May 11 in response to the state's request for advice. The U.S. Customs and Border Protection service could be notified to stop him, and health authorities in Greece, where he was to be married, could be told that he was coming their way and posed a possible health threat.

Taka Wiley, a spokeswoman for the Georgia Division of Public Health, said her department passed that advice on to the health department in Fulton County, where Speaker lived. She said she did not know whether county officials acted on any of the CDC's suggestions. The state did not pursue them, she said, and did not know that Speaker had left the country until May 17 -- five days after his flight.

Repeated efforts to reach the county health department yesterday were unsuccessful.

There is much dispute over how much of a public hazard Speaker posed and how emphatically he was told not to travel -- which would have required canceling his long-standing plans to wed on the Greek island of Santorini and then honeymoon in Italy.

Speaker was not ill when the infection was found by chance on an X-ray taken last winter. He has never had any of the classic symptoms of active tuberculosis, such as fever, weight loss or cough. He has had no readily visible TB bacteria in his sputum, but the bacteria grew out in laboratory culture.

Someone with a "smear-negative, culture-positive" case of TB is less likely to infect others than someone who has a florid case, but the person still poses a hazard, the WHO experts said.

"It is much less infectious, but it is not non-infectious," said Mario Raviglione, head of WHO's Stop TB Department. He said that about 15 percent of new TB infections are contracted from such patients.

The WHO guidelines on air travel with tuberculosis -- to which there is a link on the CDC's Web site -- state that "people with MDR [multidrug-resistant] TB must postpone air travel until advised by their physicians that they are no longer infectious, i.e., culture-negative."

The guidelines also say that public health authorities "who are aware that a person with infectious TB is planning to travel with a commercial carrier on a flight whose total duration could potentially exceed eight hours should inform the concerned airline."

Speaker said that he was told he posed little or no threat to anyone else, and that the advice he not fly was not an outright prohibition.

"They said, 'We'd prefer you not to fly,' " Speaker quoted county health authorities telling him, in an interview published this week in Newsweek. "I wasn't told that there was little risk, I was told there was no risk."