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Congress orders probe of TB case
Question of the Day
Capitol Hill lawmakers yesterday called for an investigation into why federal officials knowingly allowed a Mexican national infected with a highly contagious form of tuberculosis to repeatedly board planes and cross U.S. borders.
Sen. Joe Lieberman, Connecticut independent and Homeland Security and Governmental Affairs Committee chairman, says he is “disturbed by the apparent poor coordination between [the Centers for Disease Control and Prevention] and the Department of Homeland Security that allowed a Mexican citizen known to be infected with a highly drug-resistant form of TB to cross the Southern border 76 times and board an airplane without detection.”
The Washington Times reported yesterday that Customs and Border Protection (CBP) officials were warned on April 16 that Amado Isidro Armendariz Amaya was infected, but it took Homeland Security several weeks to warn the inspectors on the border and the Transportation Security Administration.
According to a DHS official on the condition of anonymity, Mr. Armendariz, a businessman from the Mexican border city of Juarez, took at least 11 flights involving at least one U.S. destination.
The CDC yesterday defended its decision not to order testing of the hundreds of airline passengers who may have come in contact with Mr. Armendariz between August 2006 and June 2007. Officials have not released information on which flights he boarded or how long the flights lasted.
CDC spokesman Tom Skinner said the World Health Organization guidelines don’t require testing for passengers “regarding the 11 flights” because the trips were shorter than eight hours, the suggested minimum for infection with multi-drug-resistant tuberculosis (MDR-TB).
Under the Tuberculosis and Air Travel Prevention and Control 2006 guidelines, flights of eight hours or more would require notification or testing of passengers. In the U.S., however, eight-hour flights are rare — it takes less than six hours to fly direct from Washington to Los Angeles.
The guidelines were based on limited studies conducted in the 1990s that focused on approximately 2,000 passengers that may have come in contact with persons with varying forms of tuberculosis. The study findings published in the New England Journal of Medicine found that tuberculosis could be transmitted on board aircraft but contended that risk of infection was based upon time in flight and proximity to the person infected.
Mr. Armendariz carried the same dangerous strain of tuberculosis that concerned health officials when Andrew Speaker, a 31-year-old Atlanta lawyer, slipped into the U.S. from Europe via a flight to Canada. The incident set off alarms that the system had failed to identify the contagious passenger, which led to congressional hearings in June.
“Clearly, the federal government has not learned its lesson from the Speaker case, and I intend to find out why,” Mr. Lieberman said.
According to the CDC, Mr. Speaker was on seven domestic and international flights, two of which lasted longer than eight hours.
Dr. Greg Ciottone, a Harvard physician and director of the Operational Medicine Institute, said the reports used by the World Health Organization and CDC are incomplete and even the studies’ authors point out that the “data is not perfect.”
Dr. Ciottone, who is editor and chief of Disaster Medicine, said that testing the passengers who flew with the infected Mexican national would be “a worthwhile action to take.”
“The problem we face now is the length of time since the event,” said Dr. Ciottone, in reference to the time that physicians can accurately determine whether passengers who are possibly infected can be linked to Mr. Armendariz. “I think testing these individuals would still yield some data that we may be able to gleam some useful information from.”
In addition to the delay in issuing a warning to border inspectors, a week passed before Homeland Security on June 7 informed its own Transportation Security Administration and added Mr. Armendariz to the no-fly list. Internal DHS e-mails note that Mr. Armendariz applied for an I-94 extension in El Paso on May 21, after the highest levels at CBP were notified but before inspectors knew.
By David Keene
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