TB carrier, officials differ on travel ban

A Georgia man infected with a potentially deadly form of drug-resistant tuberculosis told a newspaper that health authorities in Atlanta never explicitly barred him from leaving on an overseas trip that may have exposed hundreds of people in the U.S., Europe and Canada.

The man, who spoke to the Atlanta Journal-Constitution on Tuesday, said health officials only said that they “preferred� he stay home in the Atlanta area. The man then reportedly left for Europe to get married.

On Wednesday, officials from the Fulton County Health and Wellness Department and the federal Centers for Disease Control and Prevention said that they clearly and emphatically told him to stay put.

“He was told in no uncertain terms that he had a serious, contagious disease,� said Dr. Steven Katkowsky, director of the Fulton County health department. “We told him not to travel.�

The conflicting stories are the latest twist in the series of missteps and misunderstandings that have sparked an international effort to track down airline passengers, crew and others that may have had close contact with the infected man.

Dr. Martin Cetron, director of CDC’s division of global migration and quarantine, acknowledged at a news conference Wednesday that the agency was making slow progress in reaching passengers and crew aboard the man’s transatlantic flights.

The CDC released more detailed information about the man’s itinerary to help people aboard those flights identify themselves.

CDC officials said they believed the man was sitting around row 51 on Air France Flight 385 from Atlanta to Paris and in seat 12C on Czech Air Flight 0104 from Prague to Montreal. They believe about 80 people on the two flights were sitting in the high-risk areas, which include the row the man was sitting in and two rows around him.

About 450 people were aboard the Paris-bound plane and about 200 were aboard the Montreal-bound plane.

Cetron emphasized that the chances that other people were infected were low. But because the man’s disease, known as extensively drug-resistant tuberculosis, or XDR TB, is so difficult to treat, the agency indicated it could take no chances.

The CDC is isolating the man under a federal public health order -- the first issued since the isolation of a smallpox patient in 1963.

Tuberculosis is an infection of the lungs characterized by fever, weight loss, night sweats and coughing up of blood. The disease is spread primarily through prolonged close contact, in microscopic droplets released when an infected person coughs, sneezes or speaks.

The tuberculosis bacterium has developed resistance to antibiotics over the years. XDR TB is the most resistant form. It is six times more lethal than regular TB.

XDR TB is extremely rare. Since 1993, there have been just 49 cases in the United States.

The man, identified only as a Fulton County resident, was diagnosed with tuberculosis in January after a small lesion on his lungs was found after a chest X-ray was taken for other medical reasons, the CDC said.

County health officials knew by May that his tuberculosis was of a drug-resistant variety, although they didn’t know whether it was of the most serious type.

They met with the man to tell him the severity of his disease and that he should not travel out of the area, Katkowsky said.

But before the health department could deliver an official medical directive, the man left for Paris.

The man and his wife traveled from Paris to Athens, then to two Greek islands. “We headed off to Greece thinking everything’s fine,� the man told the Atlanta paper.

Only when the couple reached Rome did the CDC discover that the man was infected with XDR TB.

A member of the CDC quarantine team reached the man by cellphone May 23, officials said.

“There were ... several communications between my staff and the individual in Rome, begging and asking him to stay put and not travel while we worked on some options,� Cetron said.

The man, who declined requests for interviews Wednesday, earlier told the Atlanta paper that the CDC then counseled him to turn himself over to Italian health authorities for an indefinite period of time.

“I thought to myself, ‘You’re nuts,’ � he told the paper.

The man traveled to Prague and then flew to Montreal to avoid being detected by U.S. authorities, according to the Atlanta paper.

CDC officials finally reached the man on his cellphone near Albany, N.Y., on Friday after he had driven across the border into the U.S. He voluntarily drove himself to an isolation hospital in New York City and was then taken in a CDC plane back to Atlanta on Monday.

The man is being isolated at Grady Memorial Hospital in Atlanta. He is in stable condition and remains without the signature symptoms of tuberculosis, the CDC said. His wife has tested negative for tuberculosis, the CDC said.

“We certainly hope in the very near future that this federal isolation order will be able to be lifted,� Cetron said.

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