The 2007 tuberculosis scare occurred when Atlanta personal-injury lawyer^[1] Andrew "Drew" Speaker^[2] (dubbed the 'TB Guy' by major American news organizations) flew from the United States to Europe and back while infected with multi-drug-resistant tuberculosis. The Centers for Disease Control and Prevention believed at the time that Speaker was suffering from extensively drug-resistant tuberculosis (XDR-TB). The incident sparked a debate in Congress on the failure of federal customs agents to stop him.^[2] Upon Speaker's return to the United States, the CDC placed him under involuntary isolation (similar to quarantine) using a provision of the Public Health Service Act.^[3] With this action, Speaker became the first individual subjected to a CDC isolation order since 1963.^[4] Nickname: Location in Fulton and DeKalb counties in the state of Georgia Coordinates: , Country State Counties Fulton, DeKalb Government  - Mayor Shirley Franklin (D) Area  - City  132. ... This article or section is in need of attention from an expert on the subject. ... For other uses, see Europe (disambiguation). ... Multi-drug resistant tuberculosis (MDR-TB) is defined as TB that is resistant at least to isoniazid (INH) and rifampicin (RMP). ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... Extensively drug-resistant tuberculosis (XDR-TB) is defined as multi-drug resistant tuberculosis or MDR-TB that is resistant to quinolones and also to any one of kanamycin, capreomycin, or amikacin. ... Type Bicameral Houses Senate House of Representatives President of the Senate President pro tempore Dick Cheney, (R) since January 20, 2001 Robert C. Byrd, (D) since January 4, 2007 Speaker of the House Nancy Pelosi, (D) since January 4, 2007 Members 535 plus 4 Delegates and 1 Resident Commissioner Political... U.S. Customs and Border Protection (CBP), a bureau of the United States Department of Homeland Security, is charged with regulating and facilitating international trade, collecting import duties, and enforcing U.S. trade laws. ... This article does not cite any references or sources. ... Table of Contents Public Health Service Act References are to Title 42 United States Code TITLE 42 - THE PUBLIC HEALTH AND WELFARE CHAPTER 6A - PUBLIC HEALTH SERVICE Subchapter I - Administration and Miscellaneous Provisions Part A - Administration § 201 Definitions Part B - Miscellaneous Provisions §238 Gifts for Benefit of Service §238a Use...

Travel sequence

In January 2007 Speaker suffers a fall and goes to the doctor, worried he has bruised a rib. Doctors X-ray his chest and found an abnormality that requires further testing ^[5]. Andrew Speaker was first diagnosed with TB when a positive PPD test came back on March 2, 2007. His third CT scan was done on March 3, 2007 and a bronchoscopy was done on March 8, 2007. After 18 days of incubation the isolate was sent to CDC for confirmation of his susceptibility results that were done by Ga. Dept. of Human Resources. On March 28, 2007 his doctors and the health department believed it was resistant and communicated this to the CDC. On May 1, 2007 apparent MDR TB was discussed with the CDC lab by his doctors and they discussed stopping the treatment he was on. On May 9, 2007 this was confirmed. A meeting was held with Fulton County Health Officials, his doctors, his fiancée and his father and father-in-law on May 10, 2007. At this time he was told that he was not contagious and not a threat to anyone, but that he would need to go to Denver for treatment. It would take a few weeks to arrange this. However, he was cautioned not to travel. Nonetheless, he did travel, including multiple commercial jet flights, during which he potentially exposed hundreds of people on various aircraft to the disease.

On May 12, 2007, Speaker flew from the U.S. to Paris. On May 14, he flew on to Athens and, two days later, flew to the Aegean holiday island of Santorini for his wedding. (The mayor of Santorini, Amgelos Roussos, states that Speaker had not filed the necessary paperwork for the civil ceremony.^[6]) Speaker then flew to Rome for his honeymoon. is the 132nd day of the year (133rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... Transatlantic flight is any flight of an aircraft, whether fixed-wing aircraft, balloon or other device, which involves crossing the Atlantic Ocean -- with a starting point in North America or South America and ending in Europe or Africa, or vice versa. ... It has been suggested that List of visitor attractions in Paris be merged into this article or section. ... May 14 is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... Athens is the largest and the capital city of Greece, located in the Attica periphery. ... The Aegean Islands (Greek: Αιγαίον Πέλαγος, Aigaíon Pélagos; Turkish: Ege Adaları) are a group of islands in the Aegean Sea, with mainland Greece to the west and north and Turkey to the east; the island of Crete delimits the sea to the south. ... Santorini (Greek Σαντορίνη, IPA: ) is a small, circular archipelago of volcanic islands located in southern Aegean Sea, about 200 km south-east from Greeces mainland. ... Nickname: Motto: SPQR: Senatus Populusque Romanus Location of the city of Rome (yellow) within the Province of Rome (red) and region of Lazio (grey) Coordinates: Region Lazio Province Province of Rome Founded 21 April 753 BC Government  - Mayor Walter Veltroni Area  - City 1,285 km²  (580 sq mi)  - Urban 5...

Doctors say that only after Speaker left the United States did they realize he likely had XDR-TB. Speaker says that he was informed of MDR TB before leaving the country, and that while officials preferred him not to fly, they said that he was not a threat and was not required to wear a mask.^[7] "Once Speaker was in Europe, however, test results showed his strain of tuberculosis was even rarer than originally thought leading public health officials to try to persuade Speaker to turn himself in to Italian health authorities." [1] It has since been determined by the doctors at National Jewish that this diagnosis was wrong and that he did not have XDR TB. [2] The CDC informed him that there were no options for the CDC to get him home, and that he would have to arrange private transportation. Instead, he flew by commercial jet to Prague and then on to Montréal.^[8] Both Speaker and his new wife both claim that, had they been offered transport, they would have accepted it and would have waited in Rome.^[9] Speaker has also said the CDC told him to check himself into an Italian hospital and wait, and that he was not told special transportation was arranged.^[9] Extensively drug-resistant tuberculosis (XDR-TB) is defined as multi-drug resistant tuberculosis or MDR-TB that is resistant to quinolones and also to any one of kanamycin, capreomycin, or amikacin. ... Nickname: Motto: Praga Caput Rei publicae Location within the Czech Republic Coordinates: , Country Czech Republic Region Capital City of Prague Founded 9th century Government  - Mayor Pavel Bém Area  - City 496 km²  (191. ... {{Canadian City/Disable Field={{{Disable Motto Link}}}}} Motto: Concordia Salus (Salvation through harmony) Ville de Montréal, Québec, Canada Location. ...

Once in Montreal, Speaker rented a car and drove across the Canada–United States border. A United States Border Patrol agent failed to detain him at the frontier, disregarding a warning after he had passed Speaker's passport through the Treasury Enforcement Communications System (TECS)^[2] to hold the traveler, wear a protective mask when dealing with him, and call health authorities because he "did not look sick." The guard was later fired by Homeland Security.^[10] The Peace Arch border between Surrey, British Columbia and Blaine, Washington Canada and the United States of America share the longest common border in the world. ... This article or section does not cite its references or sources. ...

Flight itinerary

According to the CDC, Speaker flew on the following flights:^[11]

Air France (Compagnie Nationale Air France) is an airline based in Paris, France, a subsidiary of Air France-KLM Group and is the international flag carrier of France. ... Delta Air Lines, Inc. ... The Boeing 747-400 is the latest version of the Boeing 747 in service and the largest commercial airliner, a title it will lose to the Airbus A380 when it enters service in October 2007. ... FAA diagram of Hartsfield-Jackson Atlanta International Airport (ATL) Hartsfield-Jackson Atlanta International Airport (IATA: ATL, ICAO: KATL, FAA LID: ATL), locally known as Atlanta Airport, Hartsfield Airport, Hartsfield-Jackson, or simply Hartsfield, is located seven miles (11 km) south of the central business district of Atlanta, Georgia, United States. ... Charles de Gaulle International Airport (IATA: CDG, ICAO: LFPG) (French: ), also known as Roissy Airport (or just Roissy in French), in Paris, is one of worlds principal aviation centres, as well as Frances main international airport. ... The Airbus A320 family of short-to-medium range commercial passenger aircraft are manufactured by Airbus S.A.S.. Family members include the A318, A319, A320, and A321, as well as the ACJ business jet. ... Athens International Airport, Elefthérios Venizélos (Greek: ) (IATA: ATH, ICAO: LGAV), which began operation on 29th of March 2001, is the only civilian airport that serves the city of Athens. ... Olympic Airlines (Ολυμπιακές Αερογραμμές - OA) is the state-run flag carrier of Greece, employing about 1850 people. ... The ATR 72 is a twin-turboprop short-haul regional airliner built in France by the ATR company (Avions de Transport gional). ... Santorini (Thira) National Airport is an airport in Santorini/Thira, Greece (IATA: JTR, ICAO: LGSR). ... Mykonos Island National Airport is an airport in Mykonos, Greece (IATA: JMK, ICAO: LGMK). ... The Boeing 737 is the worlds most popular short to medium range, single aisle, narrow body airliner. ... Rome Leonardo da Vinci Fiumicino Airport (Italian: Aeroporto Leonardo da Vinci di Fiumicino) (IATA: FCO, ICAO: LIRF), also known as Rome-Fiumicino International Airport, is Italys largest airport and second-largest international air gateway, with over 30 million passengers served in 2006, located in Fiumicino, 34 km from Rome... CSA Czech Airlines (in Czech: ÄŒeské aerolinie (abbreviation: ÄŒSA) is the Czech national airline company, and former national carrier of Czechoslovakia based at RuzynÄ› International Airport, Prague. ... RuzynÄ› International Airport (IATA: PRG, ICAO: LKPR) serves Prague, Czech Republic. ... The Airbus A310 is a medium to long-range widebody airliner manufactured by Airbus S.A.S. It was Airbus second model to be introduced, and is a shortened derivative of the A300. ... Montréal-Pierre Elliott Trudeau International Airport (IATA: YUL, ICAO: CYUL) (French: Aéroport international Pierre-Elliott-Trudeau de Montréal) or Montréal-Trudeau, formerly known as Montréal-Dorval International Airport, is located in the city of Dorval, on the Island of Montreal and is 20 kilometres (12...

Tuberculosis case notes

On May 31, 2007, Speaker was moved from Grady Memorial Hospital in Atlanta to the National Jewish Medical and Research Center in Denver, Colorado, for further treatment.^[12] Image File history File links WikiNews-Logo. ... Wikinews is a free-content news source and a project of the Wikimedia Foundation. ... is the 151st day of the year (152nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... This article or section does not cite its references or sources. ... This article is about the state capital of Georgia. ... National Jewish Medical and Research Center is a research institute specializing in respiratory, immune and allergic research and treatment. ... Nickname: Location of Denver in Colorado Location of Colorado in the United States Coordinates: , Country United States State Colorado City-County Denver (coextensive) Founded [1] November 22, 1858 Incorporated November 7, 1861 Government  - Type Strong Mayor/Weak Council  - Mayor John Hickenlooper (D) Area [1]  - City & County  154. ... Official language(s) English Capital Denver Largest city Denver Largest metro area Denver-Aurora Metro Area Area  Ranked 8th  - Total 104,185 sq mi (269,837 km²)  - Width 280 miles (451 km)  - Length 380 miles (612 km)  - % water 0. ...

It was reported that Speaker's father-in-law, Robert C. Cooksey, works for the Centers for Disease Control and Prevention and is a microbiologist who has conducted research on tuberculosis, according to his CDC biography posted on the agency's Web site.^[13] However, Cooksey has never worked with the strain of tuberculosis Speaker has been diagnosed with. The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... An agar plate streaked with microorganisms Microbiology is the study of microorganisms, which are unicellular or cell-cluster microscopic organisms. ... Tuberculosis (abbreviated as TB for tubercle bacillus) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ...

Wearing a medical mask, Speaker was interviewed by Diane Sawyer on the June 1 edition of the American talk show Good Morning America on ABC and apologized to all passengers, explaining that he had not intended to endanger them.^[14] Diane Sawyer is a television journalist for the U.S. network ABC News and co-anchor of ABCs Good Morning America, along with with Robin Roberts. ... is the 152nd day of the year (153rd in leap years) in the Gregorian calendar. ... Good Morning America is a weekday morning news show that is broadcast on the ABC television network. ...

Drug-resistant tuberculosis is typically much less contagious than wild strains that have not evolved multiple drug resistance (see Extensively drug-resistant tuberculosis). According to an interview on Larry King Live, Speaker said that he had not been told that there was any risk of transmitting the disease to others, nor did the May 10 letter recommending against his travel state this, which Speaker in any case had not received before leaving May 14. His wife, with whom he lived for five months without precautions, including traditional celebration of the first few days of a honeymoon, remains uninfected. Extensively drug-resistant tuberculosis (XDR-TB) is defined as multi-drug resistant tuberculosis or MDR-TB that is resistant to quinolones and also to any one of kanamycin, capreomycin, or amikacin. ... Larry King Live is a nightly CNN interview program hosted by broadcaster and writer Larry King. ... is the 130th day of the year (131st in leap years) in the Gregorian calendar. ... May 14 is the 134th day of the year (135th in leap years) in the Gregorian calendar. ...

New Diagnosis

On July 4, 2007 the National Jewish Medical and Research Center announced, and the CDC confirmed, that Mr. Speaker's earlier diagnosis was incorrect and that he instead had MDR-TB (Multi-drug-resistant tuberculosis), a more treatable form of tuberculosis.^[15] Multi-drug resistant tuberculosis (MDR-TB) is defined as TB that is resistant at least to isoniazid (INH) and rifampicin (RMP). ...

Isolation and Law

Before a Congressional Hearing, Speaker and his father played audio recordings from CDC and Fulton County Health Officials which say he was not a danger to others. He asked such questions on five recordings repeatedly and was given the same answers even after stating on two recordings that he was going out of the country and the CDC later admitted they were aware and waited until he had already left before further actions.

Speaker was in New York when the CDC served him with an isolation order but CDC director Julie Gerberding stated that the government was legally constrained prior to that order. The federal statute granting quarantine authority allows isolation or quarantine but only for individuals coming into the country from a foreign country or territory. ^[16]

Georgia TB law should have required Speaker confined for two weeks and only allowed travel for medical appointments. ^[17] A court confinement order can isolate a patient only after the infected patient ignores medical advice. This method can be overridden by a declaration of public health emergency by the governor of Georgia.

On July 12, 2007 it was announced that seven Canadians and two Czechs will launch $1.3 million in civil lawsuits in Montreal. Eight were on the same flight as Andrew Speaker and one was a roommate of one of those on the same flight. ^[18]

References

Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 154th day of the year (155th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 153rd day of the year (154th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 162nd day of the year (163rd in leap years) in the Gregorian calendar. ... is the 152nd day of the year (153rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 159th day of the year (160th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 199th day of the year (200th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 193rd day of the year (194th in leap years) in the Gregorian calendar. ...

See also

• Progress of the SARS outbreak for a comparison to the last news-worthy international quarantining incident, 2002-2004

The following is a timeline of severe acute respiratory syndrome (SARS). ...

External links

• Interview with Andrew Speaker
• Official transcript of CDC briefing session on the Speaker case
• Official Andrew Speaker biography