TOPICS > Health

Tuberculosis Patient Raises Concerns About Health Risks

May 31, 2007 at 6:20 PM EDT

JUDY WOODRUFF: Doctors at Denver’s National Jewish Medical and Research Center today began treating the man who has captured international attention for traveling with a dangerous form of tuberculosis. The patient was identified today as 31-year-old Andrew Speaker, an attorney from Atlanta.

The story also took on a surprising twist: It turns out his father-in-law is a CDC microbiologist specializing in the spread of TB and other bacteria. Meanwhile, health officials in North America and Europe worked to track down dozens of people who may have been exposed to Speaker while he traveled overseas for his wedding and honeymoon. So far there have been no confirmed reports that his illness spread to other passengers.

Speaker flew from Atlanta to Paris on May 12th aboard Air France Flight 385. Then he flew on four shorter flights while in Europe: Paris to Athens on May 14th; Athens to Thira Island two days later; Mykonos Island to Athens; and Athens to Rome on May 21st.

Before he left the U.S., Fulton County, Georgia, officials said they had told Speaker that he had tested positive for TB. Dr. Martin Cetron directs the Center for Disease Control’s Division of Global Migration and Quarantine.

DR. MARTIN CETRON, Centers for Disease Control: You know, there’s a difference of opinion about whether anybody condoned his travel. I think it’s very clear from the conversations we’ve had with the health department that they clearly told him not to travel.

JUDY WOODRUFF: When he was in Rome last week, Speaker was notified by CDC authorities that further test results indicated he had the worst form of TB, called extensively drug-resistant, or XDR-TB. They told him to report to Italian health officials and not to fly on any commercial airlines.

DR. MARTIN CETRON: There were clear, several communications between my staff and the individual in Rome begging and asking him to stay put and not travel while we worked on some options.

JUDY WOODRUFF: Despite that warning, Speaker took a Czech Air flight on May 24th from Rome to Prague. Then he proceeded to Montreal and drove across the Canadian border to the U.S.

After being contacted by CDC officials, he voluntarily went to Bellevue Hospital in New York, where he was held for 72 hours. The CDC then flew him to Atlanta and Grady Memorial Hospital on May 28th. Speaker is the first person to be quarantined by the federal government since 1963.

This week, CDC Director Julie Gerberding said the risk is greatest for those exposed on long flights.

JULIE GERBERDING, Director, Centers for Disease Control and Prevention: We have no suspicion that this patient was highly infectious. In fact, the medical evidence would suggest that his potential for transmission would be on the low side, but we know it isn’t zero.

Understanding Tuberculosis risks

JUDY WOODRUFF: Speaker was sent to Denver's National Jewish Medical because it specializes in treating respiratory illnesses.

This afternoon, speaker's father-in-law said in a statement that he was not the source of the tuberculosis infection, and he said that his son-in-law did not contract the infection from his work at the CDC laboratories.

For more on this case and the questions it's raising, we turn to Dr. William Schaffner of the Vanderbilt University School of Medicine. He's the chairman of the Department of Preventive Medicine and a professor of infectious diseases.

Dr. Schaffner, there are a number of puzzling, if not outright contradictory, aspects to this story, but let me just begin by asking, how contagious is this extensively resistant strain of TB?

DR. WILLIAM SCHAFFNER, Vanderbilt University School of Medicine: Well, Judy, it's good to be with you. And this sort of strain of tuberculosis depends upon actually the individual who's infected. As Dr. Gerberding said, we think the patient involved in this instance -- fortunately -- is at the lower range of infectiousness, whereas other patients, depending upon their disease in the lung, might be capable of spreading it to many people. So it's very patient-dependent.

JUDY WOODRUFF: So for those people who sat near him on those long flights, transatlantic flights, how much danger are they in, were they in?

DR. WILLIAM SCHAFFNER: My crystal ball at this distance tells me that they're actually at very, very low risk. And that's fortunate. But that will be determined. Again, the risk we can't say is zero, so they should all appear, go to their health department and physicians, get themselves tested for TB now, and they'll be retested in 10 or 12 weeks. I think they'll all breathe a sigh of relief.

"Clearly told him not to travel."

JUDY WOODRUFF: Now, we just heard officials say that they clearly told him not to travel. He, on the other hand, Andrew Speaker, says they simply said they preferred he not travel. Whichever it was, should the health officials have done more, do you believe?

DR. WILLIAM SCHAFFNER: Well, what we need to do, once the dust has settled, is review all the bidding and see exactly what was done. We can't tell that now. Clearly, he ought not to have traveled, and clearly the health officials should have told him that in no uncertain terms.

JUDY WOODRUFF: And so to say that they should have done something in particular, you're saying we don't know what that would have been? I mean, to go to the lengths, say, of preventing his leaving the country?

DR. WILLIAM SCHAFFNER: Well, there's a bit of he said, she said about all this, because he's reported as saying, "Well, they told me they preferred me not to travel." And he's an attorney. He knows that "prefer" means, "Well, I can do it if I want." And so we ought to see what happens to all of that.

He was clearly a potential risk, and they could have gone to a judge, if necessary, and asked for a restraining order of sorts that would have kept him in. They would have had to make a good argument that he was a public health risk for the judge to interdict his movement.

Locating international health risks

JUDY WOODRUFF: Now, Mr. Speaker says he'd been treated for this TB since January. He knew that it was resistant to two types of drugs. He knew that, when he came back from this trip overseas, he was going to have to get some sort of special treatment. But I guess my question is, does it make sense that it took from January until May to determine that he had this more serious strain of tuberculosis?

DR. WILLIAM SCHAFFNER: Yes, Judy, I'm afraid it does make sense, because, in a sense, we're prisoners of somewhat modified late-19th-century technology. It just takes a long time for the TB bacteria to grow, and then it has to be re-grown in the sensitivity tests. So it just takes a long time for that final result to come through.

JUDY WOODRUFF: Well, then you have the situation in Rome. He and his wife, Mr. Speaker and his wife, were in Rome. CDC officials locate him. They tell him not to get on a plane, any commercial flight. He decides to make a run for it. Is there something more than should have been done at that point? And I guess my question is, what does this say about our ability to force people not to expose whatever they have to others?

DR. WILLIAM SCHAFFNER: You know, remember, this is an intelligent person. At that point, the instructions must have been crystal clear, and he clearly turned himself into a rascal at that point and did what was unconscionable. He did an end-run around the system.

As Dr. Gerberding said, we have a covenant with our patients, and most of them comply. We would not have expected to show up at his doorstep with an armed guard at that point; we would have expected him to comply.

An "era of emerging infections"

JUDY WOODRUFF: What does all of this say to you, Dr. Schaffner, about this episode and the implications of it? What does it say about our ability to locate someone who's been identified as having a serious infection or a virulent form of a disease?

DR. WILLIAM SCHAFFNER: I think there are several important lessons, some good ones, and some that are not so good. The first thing is that we realize that we live in the world. We try to do the best public health at home, but that also means we have to collaborate with our colleagues abroad.

In this era of emerging infections, re-emerging infections, resistant infections, pandemics, and bioterrorism threats, it's no time to cut back the CDC's budget, as has been done. That, in our family, we would call that "D-U-M," dumb, and that's not good policy.

I think we do need to review some of our procedures. Perhaps we need to make some of them a bit more stringent, in terms of communicating to our patients about the restrictions that are necessary in these perilous times.

JUDY WOODRUFF: Well, one thing this episode has done, it's caused us all to take a closer look at all of these issues. Dr. William Schaffner, we thank you very much for joining us.

DR. WILLIAM SCHAFFNER: Judy, always good to be with you.

JUDY WOODRUFF: Appreciate it.