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Old 06-04-2007, 04:37 PM
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Default U.S. waited more than a week on TB case

It took a week and a half for U.S. health officials to notify their counterparts in Europe that an American honeymooner was traveling there with a dangerous strain of tuberculosis, agencies involved in the case told The Associated Press.
The Centers for Disease Control and Prevention was first told that Andrew Speaker was traveling in Europe on May 18, nearly a week after the infected patient and his fiancee flew to Europe for a wedding in Greece.
The World Health Organization and Italian health authorities say they were not notified about Speaker until May 24, the day Speaker and his wife flew back to North America. The Greek Health Ministry was not informed until May 25, officials said.
A CDC spokesman said the delay was easy to explain — it took the agency several days to pin down the patient's exact location. "We didn't know where he was," said spokesman Tom Skinner.
Speaker's TB was caught early by chance in January when he had a chest X-ray for a rib injury.
During a meeting with Fulton County health officials on May 10, Speaker said he was advised that he was not contagious or a danger to anyone. Officials told him they would prefer he didn't fly, but no one ordered him not to, he said. His father, Ted Speaker, has said that he recorded the meeting, but has not responded to requests from The Associated Press to listen to it.
Speaker and his fiancee left Atlanta on May 12 — two days earlier than scheduled — to get to Greece for their wedding. Fulton County officials said they learned he was there on May 14, when Speaker e-mailed his doctor to say he was in Greece.
County health authorities were working with their legal department to get a court order to stop Speaker from traveling when they got the news, said April Majors, a spokeswoman for the Fulton County Department of Health & Wellness.
The county didn't tell the state about Speaker's whereabouts until May 17. It isn't clear what happened in those three days, or why it took so long for the county to pass on the information. Majors did not offer an explanation.
On May 18, CDC scientist Robert Cooksey, Speaker's father-in-law, became involved when top CDC officials learned of his relationship with the patient, Skinner said. With Cooksey's help, the CDC reached Speaker in Rome on May 23, Speaker has said.
That's when he learned tests showed he had not just multidrug-resistant TB, but an extremely drug-resistant strain known as XDR. The CDC got those test results on May 22, Skinner said.
Despite warnings from federal health officials not to board another long flight, he flew home for treatment, fearing he wouldn't survive if he didn't reach the U.S., he said.
In the time it took word to reach European officials, Speaker had flown from Atlanta to Paris; Paris to Athens; Athens to Thira Island; Mykonos Island to Athens; and Athens to Rome.
On May 24, he and his fiancee flew to Prague and then on to Montreal.
In an interview with ABC's "Good Morning America," Speaker's mother-in-law said he never would have gone to Europe if he thought he was contagious.
"He would have been the first one not to go," said Betsy Cooksey, the mother of Speaker's new wife, Sarah.
International health officials said they believe the CDC notified them within a day of finding out about the case. What they were upset by was Speaker's statement that he needed to come home for lifesaving health care.
Some of the leading research in TB is being done by Italians, said Dr. Mario Raviglione, director of the WHO's tuberculosis department.
"This is a developed country," Raviglione said. "I'm pretty sure they would have been able to do the right thing" and provide Speaker with the proper treatment, he said.
Doctors are hopeful Speaker's tuberculosis can be cured since it is not widespread, he is otherwise healthy and young. He is receiving treatment at National Jewish Medical and Research Center in Denver.
Speaker's strain has so far resisted at least 10 of 14 drugs available for treating TB, according to tests performed in Georgia, doctors said. Surgery to remove infected lung tissue that is about the size of a tennis ball is one option for Speaker. The infection's relatively small size increases the chances of success of any surgery.
On Monday, a hospital spokesman said that Speaker may soon be allowed brief trips outside of his hospital room if a third test of his sputum, a mixture of saliva and phlegm, is negative for TB bacteria.
Two previous tests already were negative. If the third is also negative, Speaker would be considered "relatively noncontagious," said hospital spokesman William Allstetter.
Drug-resistant TB patients who do venture outside are kept far from patients and anyone else in the community so they pose no risk of infecting others.
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