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Officials Admit Errors in TB Case

Officials, Patient at Odds Over Travel Warnings
By
WebMD Health News
Reviewed by Louise Chang, MD

June 6, 2007 -- Federal officials acknowledged mistakes Wednesday in their handling of an Atlanta man who traveled to and from Europe last month while infected with a highly drug-resistant form of tuberculosis.

Meanwhile, Andrew Speaker, the patient at the center of the incident, continued to contradict officials by maintaining they never told him his travel could endanger other people.

Officials said they should have acted more quickly to notify American border police and European health authorities once it became apparent Speaker had flown out of the United States.

But they were also quick to point out that their efforts were hampered by Speaker, who they say defied the advice of doctors and health officials when he flew to Europe for his wedding and when he flew back to North America.

That move in theory put hundreds of people who flew with Speaker at potential risk for contracting extensively drug-resistant tuberculosis, also known as XDR TB.

Could Have Moved Faster

Julie Gerberding, MD, director of the CDC, told members of a Senate committee that her agency could have acted faster between May 18, when they first became aware Speaker had drug-resistant TB, and May 24 when he was placed on a no-fly list and Italian health authorities were notified of their concerns.

“I think we can do that faster, I think we should have done it faster, and I think we’ll be able to accelerate this next time. In retrospect that was a mistake, and I wish we had done it differently.”

Lawmakers questioned why days elapsed between officials' receiving of Speaker's positive test results and notification of European authorities.

“It seems to me that this time frame should have been collapsed to just a few hours,” said Sen. Tom Harkin (D-Iowa), who chairs the appropriations subcommittee with jurisdiction over CDC.

But officials, doctors, and Speaker continued to give different accounts of what happened at a May 10 meeting between them.

Early Flight

Health officials have acknowledged that they were aware at the meeting that Speaker, a 31-year-old attorney from Atlanta, intended to fly to Greece four days later. Local officials approached a county prosecutor in Fulton County, Ga., to inquire about the steps that would be needed to bar Speaker from flying, said Steven Katkowsky, MD, the district health director of the Fulton County health department.

But Speaker abruptly moved up his travel date by two days. By the time a court order was drawn up, the patient had already left the country, Katkowsky said.

“The plan that we knew was for Mr. Speaker to travel outside the United States on May 14,” he said.

No Benefit of the Doubt

Though officials knew Speaker carried a drug-resistant TB strain, tests confirming he had an extensively drug-resistant -- and more dangerous -- form were not completed until May 22, they said.

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