THURSDAY, May 31, 2007 (HealthDay News) -- The Georgia man infected with a dangerous form of tuberculosis who became the first American quarantined since 1963 arrived for treatment Thursday at a Denver hospital that specializes in infectious diseases.
The 31-year-old man was identified Thursday as Andrew Speaker, an Atlanta personal injury lawyer, whose father-in-law is a long-term U.S. government microbiologist specializing in the spread of TB.
Speaker entered Denver's National Jewish Medical Center at approximately 7:45 a.m. Mountain time, saying he felt fine, according to a hospital statement. He was flown to Denver from Atlanta accompanied by federal marshals after being quarantined at Grady Memorial Hospital in Atlanta for two days.
Speaker had taken two trans-Atlantic flights earlier this month for his wedding and honeymoon, possibly infecting fellow passengers in the process with what has been diagnosed as "extensively drug-resistant" TB, also called XDR-TB. This form of the disease resists many drugs used to treat the infection.
Speaker's father-in-law, Robert C. Cooksey, a research microbiologist with the U.S. Centers for Disease Control and Prevention's division of tuberculosis elimination, issued a terse statement Thursday afternoon through the CDC, asking for his family's privacy and denying that he knew of his new son-in-law's travel plans.
"As part of my job, I am regularly tested for TB. I do not have TB, nor have I ever had TB. My son-in-law's TB did not originate from myself or the CDC's labs, which operate under the highest levels of biosecurity," said Cooksey, who has worked at the CDC for 32 years.
He added, "First and foremost, I am concerned about the health and well-being of my son-in-law and family, as well as the passengers on the affected flights."
Doctors at the Denver hospital held a Thursday afternoon press conference after initially evaluating Speaker.
"He is smear-negative," Dr. Gwen Huitt, an attending physician on the infectious disease unit, told reporters. "He is considered low communicably."
The patient is not showing any symptoms, she said, adding, "It is possible that the patient has had the disease for two years, and the organism woke up in the past few months."
But, she added, left untreated, he would have become worse and more contagious.
The hospital is testing other antibiotics and developing a drug regimen that could include as many as five antibiotics, Huitt said.
Meanwhile, a leading tuberculosis expert believes U.S. health officials were right to quarantine Speaker upon his return to the United States from Europe, where he had traveled with his fiancee to get married.
But a second TB expert said the CDC's decision to isolate him in the Atlanta hospital was unwarranted, contending that he was "minimally infectious."
Speaker has disputed federal and local health officials' claims that he traveled abroad in violation of their wishes. He said that while officials told him they preferred that he postpone his long-planned wedding in Greece and honeymoon, they did not prohibit him from flying. He has also said that he knew he had tuberculosis but did not think he posed a health risk, according to published reports.
On May 12, he flew from Atlanta to Paris on Air France Flight 385, continued on to Prague, then took a return flight aboard Czech Air Flight 0104 to Montreal, Canada, on May 24, before driving back into the United States at Champlain, N.Y.
On Tuesday, CDC officials issued the first federal isolation order since 1963 to quarantine Speaker.
The agency has advised passengers who were on both flights to get tested for tuberculosis, although they are thought to be at low risk of infection from the disease, agency officials said Wednesday.
"We believe that the patient's degree of infectiveness is limited," Dr. Martin Cetron, the CDC's director of the Division of Global Migration and Quarantine, said during an afternoon teleconference. Tests show Speaker was carrying a relatively low level of the tuberculosis bacteria, he said.
Cetron noted that on the flight from Atlanta to Paris, some 40 to 50 passengers who sat near the man were those most likely at risk. Speaker probably sat in row 51. The same is true for the 30 passengers who sat near him on the flight from Prague to Montreal. On that flight, he sat in seat 12C.
However, Cetron said that the CDC and other health agencies in the United States and abroad would notify all passengers on both planes as well as passengers who flew with the patient on several shorter flights to and from Greece and Italy.
Dr. Tawanda Gumbo, an assistant professor of internal medicine at the University of Texas Southwestern Medical Center at Dallas and an infectious disease expert who specializes in TB and XDR-TB, believes that isolating the patient was the right thing to do.
"The best we can do right now is to make sure it doesn't spread. We don't want it to spread," Gumbo said, noting that tuberculosis can be very contagious. "You don't have to do anything, just breathe," he added.
But Philip Alcabes, an epidemiologist and professor at New York City's Hunter College School of Health Sciences, said that Speaker posed no public safety threat and that quarantine was "a maximum penalty for a minor medical problem."
"Pulling the trigger on a quarantine should be reserved for serious medical emergencies that pose a genuine health hazard to the general population," Alcabes said. "Doing so for this event only serves to trivialize the real quarantine call-to-action when it is finally needed. The man in question is obviously minimally infectious, as his wife has not been infected."
"Transmission in an airplane is very unlikely, owing to the intrinsic difficulty of transmitting TB and to the relatively high rate of filtration of airplane cabin air," Alcabes added.
"The CDC is making much of the fact that the man's TB strain is drug resistant," Alcabes said. "That is of some clinical relevance but of no public health importance. Drug-resistant strains are no more infectious than other strains. This TB is no more likely to be transmitted in this way than garden-variety TB would. Transmission is not impossible, but highly unlikely."
Dr. Julie Gerberding, director of the CDC, said Wednesday that her agency was working closely with airlines to locate passengers who may have been exposed.
More information
For more information on extensively drug-resistant tuberculosis, visit the U.S. Centers for Disease Control and Prevention.
