Lawyer with Dangerous Form of TB May Have Infected Others

By Anastacia Mott Austin

Andrew Speaker, 31, an Atlanta lawyer, was diagnosed with a rare, antibiotic-resistant form of tuberculosis called XDR (extensively drug resistant) tuberculosis shortly before flying to Greece for his wedding on May 12. His doctors were aware of his plans to travel, he says, but because TB bacterium are slow-growing it can take up to several weeks to determine whether a patient has a drug-resistant form of the disease.

Speaker was already in Rome for his honeymoon when CDC officials contacted him in Italy and told him that his disease was the dangerous strain of TB and it would be dangerous to others for him to fly. Officials had determined that his TB is the XDR strain, which resists not only the first-line antibiotics typically used, isoniazid and rifampin, but also several second-line drugs.

Speaker told the press that the CDC had informed him that he could not fly commercial airlines because of the potential communicability of his strain of TB, and would have to remain in Italy until he was completely treated.

However, Speaker told reporters that he feared for his health and wished to return to the United States for treatment, even though he knew he was on a no-fly list to the States. So he booked a flight to Montreal and from there rented a car to drive to New York, where he checked into a hospital and contacted the CDC. The CDC flew Speaker on their own plane back home to Atlanta, where he remains hospitalized. He is scheduled to be moved to a hospital in Denver that specializes in treating TB.

In the meantime, U.S. and international authorities are seeking out fellow passengers who shared flights with Speaker, especially those seated near him. Officials estimate that with the number of flights involved, more than 80 people could potentially be affected.

Ironically, Speaker's father-in-law, Dr. Robert Cooksey, is one of the leading TB researchers at the CDC in Atlanta.

CDC Director Julie Gerberding told reporters, "We have no suspicion that this patient was highly infectious. In fact, medical evidence would suggest his potential for transmission is on the low side, but we know it isn’t zero." Gerberding then added, "Because this organism is so potentially serious and could cause such serious harm to people, especially those who have other medical conditions that would reduce their immunity, we felt it was our responsibility to err on the side of abundant caution." The CDC told a press conference that this form of TB is often fatal and has been a rising threat to public health in other countries.

Though he has been placed under federal isolation orders, Speaker has apparently not broken any laws, as he was not directed by law to remain in the United States before his trip abroad. However, the CDC’s Gerberding told reporters if the federal authorities had been aware of his travel plans, they might have become involved. Said Gerberding, "We were surprised that the patient had left the country," adding to reporters that there is a "covenant of trust" in which health officials assume that potentially infectious patients will heed their advice to not expose others.

XDR-TB is transmitted from person to person in the same manner as regular TB, by infectious fluids passing into the air through coughing or sneezing. Some health experts fear that the drug-resistant strain is just as infectious as any other type of TB. The XDR strain has been caused by incomplete antibiotic treatment turning TB bacteria into so- called super-bugs. People whose immune systems are already compromised are especially vulnerable.

The spread of any type of TB is dependent upon the amount of exposure time. Inadequate ventilation and crowded conditions can increase the risks of infection.

The isolation of Speaker is the first U.S. federally-ordered quarantine since 1963, when a patient had been exposed to the smallpox virus.

Speaker appears to be unfazed as to the possible ramifications of his actions. "I’m a well-educated, successful, intelligent person," he told The Atlantic Journal-Constitution. "This is insane to me, that I have an armed guard outside my door, when I’ve cooperated with everything…other than the whole solitary-confinement-in-Italy thing."