CDC reviews actions of father-in-law of tuberculosis patient

CDC reviews actions of father-in-law of tuberculosis patient
By Sue Mueller

The U.S. government is shifting its investigation to answer the question how Andrew Speaker, a 31-year old Georgia lawyer who was forced back from his honey-moon in Europe and now detained in a Denver hospital for treatment, acquired the deadly disease extensively drug resistant tuberculosis or XDR TB, according to the update published Saturday June 2 by the U.S. Centers for Disease Control and Prevention.

The CDC says on its website that actions of Robert C. Cooksey, a CDC TB expert who has worked for the agency for 32 years, are now under review and health officials want to see if the father-in-law of Speaker played any role in his son-in-law and daughter's travels with a form of tuberculosis which resists almost all antibiotics.

Cooksey has already denied any wrongdoing in the whole drama involving his son-in-law, claiming that Speaker's TB has nothing to do with him or the CDC. He has had no influence on the travel plans of Speaker and his daughter.

Speaker has been now under federal quarantine for extensively drug resistant tuberculosis since May 25 a day after he sneaked back to the U.S. through Montreal, Canada. The personal injury lawyer was placed as the first person in the last 40 plus years under federal quarantine.

The CDC says the Denver Health Authority Public Health Department has issued an order to continue detaining him in the National Jewish Medical and Research Center until further laboratory tests indicate that he is no longer contagious. He is currently considered infectious based on tests on specimens that were reported culture positive for extensively drug-resistant tuberculosis.

Accordingly, the federal quarantine order has been lifted; but the CDC says it will continue providing input and consultation to local authorities on the diagnosis, management and methods for preventing of spread of communicable disease.

Speaker and his wife Sarah Cooksey flew to Paris last month to get married as planned for a long time. By Mr. Speaker's account, he was told the disease he was suffering was not contagious and it would pose any risk to any other person. The health officials suggested he should not travel, but did not prohibit him from flying.

Dr. Steven Katkowsky, director of the Fulton County ( Georgia) Department of Health and Wellness, was cited as saying by healthday.com that Speaker had been told in early May not to travel to Europe.

Results of a test showing Speaker's TB infection is actually XDR-TB became only available when the couple was on the midst of their honey-moon. The U.S. health officials ordered him to report to Italy health authorities and not to return to the United States. Speaker decided that submission to such an order could result in loss of an opportunity of getting treated in the U.S., which would put him in danger, he thought. He flew to Canada where he rented a car and drove back to the U.S.

"He was told traveling is against medical advice," healthday.com cited Dr. Martin Cetron, director of the CDC's division of global migration and quarantine as saying. Cetron said once Speaker got in Europe, "He was told in no uncertain terms not to take a flight back."

Health officials are now concerned about the passengers who sit near Speaker on two long flights. One flight was Air France flight #385/Delta Airlines flight #8517, which departed on May 12 from Atlanta, Georgia to Paris, Francis. Passengers included 292 Americans. Another was Czech Air flight #0104, which departed on May 24 from Prague, Czech Republic, to Montreal, Canada. There were two Americans on board, Speaker and his wife.

In a statement posted on Saturday, the CDC says the agency has contacted 160 Americans or their relatives as of June 2, 2007. The CDC says it will continue reaching out for the remaining passengers. So far, the agency has contacted all 26 who were most likely to get infected if Speaker was infectious at all at the time. Of them, six are currently out of the U.S. and their relatives and families were contacted.

The CDC warns that the information on the extensively drug resistant tuberculosis circulated in news media is not all accurate. The following is provided by the agency to correct the misinformation.

Many recent media stories have conveyed information or impressions regarding tuberculosis that are inaccurate, including information about how the disease is transmitted, how quickly people may become infected or show symptoms, and the contagiousness of the disease.

There are some other important characteristics of tuberculosis that need to be conveyed:

Only a person with active TB disease can spread TB bacteria to others.

Persons who have spent prolonged time with someone with active TB disease should get tested for TB infection. It usually takes prolonged exposure to someone with active TB disease for someone to become infected.

After exposure, it usually takes 8 to 10 weeks before the TB test would show if someone had become infected.

A person with a positive test for TB infection (i.e., latent TB infection) is not sick, and cannot spread TB germs to others. However, some of these persons can go on to develop TB disease, especially if their immune system is weak, for example, HIVinfected persons, persons with diabetes, or persons undergoing treatment for certain forms of cancer.

The CDC also provides the following advice for those who may get infected with the XDR TB on those two long flights.

What should a person do if they were on the Air France flight #385 / Delta flight 8517 on May 12 with the XDR TB patient?

They need to go to their doctor or local health department and request a TB evaluation, as well as contact their State TB Control Office. They should be evaluated for signs and symptoms of TB disease, and get a TB skin test or the QuantiFERON�TB Gold blood test (QFT-G) to test for TB infection.

It can take 8 to 10 weeks after infection for a person�s immune system to react to the TB skin test or QFT-G. It is important to get a TB test as soon as possible because people may already have latent TB infection, but are unaware since there are no signs and symptoms. The first test is needed to determine whether a person already had latent TB infection before this recent exposure. A person with latent TB is not infectious.

If a person�s first test is negative, they will still need to get a second TB test 8 to 10 weeks following the flight date (i.e., the time of their last possible exposure to the patient) to determine if they may have been infected by the XDR TB patient. If the first test is positive, their doctor or nurse may do other tests to see if treatment is needed.

Source : foodconsumer.org