CDC report on TB traveler urges more coordination

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WASHINGTON, Nov 2 (Reuters) Breaches in security that allowed a US tuberculosis patient to defy health officials and fly to Europe and back in May can be at least partly fixed with faster communication and better training, according to a federal government report.

A report from the US Centers for Disease Control and Prevention on its handling of the matter shows a need for more coordination between airlines and federal agencies in such emergencies, including quick transmission of passenger information.

A copy of the ''After Action Report'' obtained by Reuters on Thursday shows a lack of clear standard operating procedures allowed Atlanta lawyer Andrew Speaker to fly to Greece and Italy for his wedding and honeymoon against direct advice from authorities and then sneak back into the United States.

The report is part of a standard review process that the CDC makes after an incident.

Speaker, who was forcibly isolated and treated for what turned out to be multi-drug resistant tuberculosis, made last-minute changes to his itinerary after learning that state, local and federal health officials did not want him to travel.

He was the first person isolated under such a federal order since 1963.

CDC and health officials in several countries were forced to track down 246 airline passengers who sat close to Speaker for more than eight hours on transatlantic flights, test them twice for TB and then determine if the seven who tested positive both times could have been infected by Speaker. None were.

Hearings in Congress focused on the breaches in security that allowed Speaker to fly out of Atlanta, travel around Europe, fly back to Canada and then talk his way across the U.S. border despite an alert that should have stopped him.

The report calls for airlines to develop better ways to track and contact passengers quickly and give CDC information.

''In this case, there were delays in finding his itinerary and locating the patient abroad. Airlines were cooperative but unable to provide information without itinerary information,'' the report reads.

EMBEDDING STAFF It also suggests embedding CDC staff at the Department of Homeland Security, which oversees Customs and Border Patrol, to advise on how best to act in such situations.

CDC staff at airports often speak informally to their colleagues at other agencies but routing these communications to central offices will ensure that everyone who needs to know about a situation finds out fast, said Dr Martin Cetron, director of CDC's Division of Global Migration and Quarantine.

The CDC was already making many of the changes, Cetron added.

He said the agency would have a 3 million dollars mobile isolation unit ready by spring, to use on aircraft. One reason Speaker gave for fleeing Rome in May was that he believed the CDC would not have transported him back to the United States and he feared he would not get good treatment in Italy.

The report, which has been circulating among congressional staffers, says local officials also need to be told of new, flexible CDC powers to stop people from traveling. Local officials in Georgia said they could not legally act until Speaker had already disobeyed their orders.

Better and faster tests for TB are also needed. Speaker did not learn that he had anything but ordinary TB for weeks because testing is so slow.

Cetron noted that the CDC has only half the number of staff needed to properly watch travelers at ports of entry as recommended by the Institute of Medicine. A 2005 report from the Institute said CDC needed 1 inspector for every 750,000 travelers.

''I think there is this idea out there that somehow we will be erecting impenetrable fortresses at ports of entry that, rendered well, will leave us impervious to infectious diseases. That's just not going to happen,'' Cetron said in a telephone interview.

Reuters SZ DB0909

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