Stopping TB at the Border: What Went Wrong

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A timeline shows the movements of Andrew Speaker.

An American man infected with a drug-resistant strain of tuberculosis was able to fly to and from Europe, and then drive into the United States over the Canadian border.

The patient, Andrew Speaker, a 31-year-old lawyer from Atlanta, is now in isolation at a Denver treatment center. But in recent weeks, he traveled on airline flights despite being told by the U.S. Centers for Disease Control and Prevention not to fly commercially, and to check himself into a clinic.

European authorities were unable to detain Speaker; border guards near upstate New York didn't stop him from re-entering the United States. As NPR's Dina Temple-Raston tells John Ydstie, Homeland Security officials are looking into the security breach.

Speaker has said that the CDC doctors merely suggested to him that he not fly. But after being told to check himself into a clinic while he was in Italy, Speaker became determined to go to a specialized clinic in Denver instead.

The CDC is authorized to hold people only if they have resisted a quarantine order. At the time the agency contacted Speaker, he had not yet resisted the order.

Speaker was then put on the CDC's medical warning list. But officials in Europe and Canada say they did not receive the update in time to stop him from traveling.

When Speaker entered the United States at Champlain, N.Y., the U.S. border guard saw the medical alert when he checked Speaker's passport. But the guard has said he determined that Speaker did not pose a threat, since he did not look sick.

An internal inquiry is under way; the border guard who allowed Speaker into the country has been put on administrative leave.

Lawyer: Doctors Deemed His TB Not Contagious

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Why TB Remains a Modern and Deadly Problem

  

For now, extremely drug-resistant TB remains rare in the United States — with 49 cases confirmed over the last 15 years. But these dangerous, hard-to-cure strains are gaining a foothold around the globe.

  

Read why.

Health officials say Andrew Speaker, the 31-year-old lawyer now in isolation for a dangerous TB infection in Denver, is doing well and expected to recover.

The experience has been traumatic for Speaker. In an interview Friday on ABC's Good Morning America, he apologized for possibly infecting others with extremely drug-resistant tuberculosis.

"I don't expect those people to ever forgive me. I just hope they understand that I truly never meant to put them in harm. I hope they can find a way to forgive me," he said.

There were 435 passengers on his flight from Atlanta to Paris. The Centers for Disease Control and Prevention has been working to find the U.S. passengers on that flight.

"We believe we have contacted all of the U.S. passengers ... who were seated in the five rows of concern," CDC director Julie Gerberding said Friday.

Speaker and his wife were the only Americans on their second long flight, from Prague to Montreal on Czech Airlines. It's the job of other countries to contact their own citizens. The Americans on the Paris flight will be tested twice in the next several weeks, because TB takes time to establish itself.

Gerberding says the likelihood that Speaker infected anyone is pretty low. But there's a reason for the concern.

"The public health actions necessary to protect people in this situation are based not only on the degree of his infectiousness, but also on the fact that this is a very, very drug-resistant bacteria, and we have to be as cautious as we can," Gerberding said.

According to the World Health Organization, there have been no recorded cases of someone becoming sick with TB after merely sitting on an aircraft with an infected person. There are two cases of people on long flights becoming infected but never showing symptoms.

Dozens of Americans have been infected with the type of TB Speaker has. What makes Speaker's case worrisome is that while health officials knew of his infection, he managed to get on several planes. He had been under treatment for TB since January and had so few bacteria that they didn't show up on a simple smear of his sputum. On Good Morning America on Friday, Speaker said he didn't understand that he might infect others.

"I repeatedly asked my doctors, 'Is my family at risk? Is anybody at risk for this?' I turned up smear-negative on all my cultures. They told me I wasn't contagious, I wasn't dangerous," Speaker said.

He said that when he was in Rome, he got confusing messages from U.S. health officials about if, when and how he could fly back home. So he and his new wife decided to just go for it.

"Truly, in our minds, we were told that we were not a threat to the people around us. And we wanted to get home," he said.

Meanwhile, Gwen Huitt, his doctor at National Jewish Research and Medical Center in Denver, says he's doing very well. His chest X-ray shows no further infection in his lungs. He has no cough and no fever — two hallmarks of active TB.

"We were able to get him on an exercise bike in his room ... in preparation of the road he has ahead of him," Huitt said.

What he has ahead of him is a regimen of taking up to five drugs for two years. Some of them can have side effects that include vomiting, diarrhea and weakness.

Next week in Washington, the House Homeland Security Committee will have a hearing to investigate how Speaker evaded federal officials' efforts to control his travel.

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