- The Washington Times - Thursday, October 18, 2007

A Mexican national infected with a highly contagious form of tuberculosis crossed the U.S. border 76 times and took multiple domestic flights in the past year, according to Customs and Border Protection interviews and documents obtained by The Washington Times.

VIDEO: Discussing the TB case

The Customs and Border Protection (CBP) agency was warned by health officials on April 16 that the frequent traveler was infected, but it took Homeland Security officials more than six weeks to issue a May 31 alert to warn its own border inspectors, according to Homeland Security sources who spoke on the condition of anonymity for fear of retribution. Homeland Security took a further week to tell its own Transportation Security Agency.

Multi-drug-resistant tuberculosis (MDR-TB) is a highly contagious illness and also resistant to the two most commonly used drugs to treat TB. It is 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 story set off alarms that the system had failed to identify the contagious passenger, which led to congressional hearings in June.

A physician with the Centers for Disease Control and Prevention (CDC) said that his agency usually only notifies airlines of possibly infected passengers if the flight is eight hours or longer. But other doctors say the disease can be transmitted within minutes — especially in people with lowered immunity — and recommend that anyone coming in contact with this form of TB seek medical attention.

World Health Organization guidelines, which were rewritten in 2006 and adopted by the CDC, state that “physicians should inform all MDR-TB patients that they must not travel by air — under any circumstances or on a flight of any duration until they are proven” not to have the disease.

“You can argue that even one single cough would transmit TB, which is, in fact, what is probably happening,” said Dr. Mario Raviglione, director of the WHO’s Stop TB department, in a conference call with reporters in June. “It was seen that at least eight hours were required for someone to infect someone else. It does not mean that you cannot get infected in the first one minute, but it means statistically speaking that it’s much less likely to get infected until your hours of contact increase.”

Christopher White, Transportation Security Administration spokesman, said TSA was notified on the morning of June 7 by Homeland Security officials “that a person infected with MDR-TB may be attempting to use the U.S. transportation system.”

“TSA leadership quickly convened, and the individual was added to our no-board list” in a matter of four hours, Mr. White said.

In that time, the infected man, identified as Amado Isidro Armendariz Amaya, made at least one more trip across the U.S. border, on May 21, where he applied for an I-94 visa to extend his stay in the U.S.

Roger Maier, spokesman with El Paso CBP says the delay for issuing a “be on the lookout” (BOLO) alert to stop the man at the border was caused by the traveler’s use of an alias.

Attempts to identify the subject failed “because information provided to Mexican health officials is not accurate” when an alias is used, Mr. Maier said in an e-mail. “Efforts to obtain solid data … were achieved on May 31.”

Other documents reveal that the Mexican government had known for more than five years of the condition of Mr. Armendariz, a businessman from Juarez, a city in the Mexican state of Chihuahua across the Rio Grande from El Paso, Texas. The officials who spoke on that condition of anonymity said, “Information sharing is still at an all-time low, if not nonexistent, in issues such as these.”

“For the first five years, he self-medicated and was noncompliant [with] Mexican State Health Department treatments. … His father and sister both died of TB in Chihuahua,” an internal DHS e-mail states.

Homeland Security employees were told in June that they would be fired if the situation with Mr. Armendariz went public. At the same time, DHS officials were preparing to testify before Congress regarding the Speaker case, which had been front-page news across the nation.

The congressional investigation found that the CDC lacks a reliable means of preventing someone infected with a biological agent from entering or leaving the U.S. Congressional committees have taken up a bill to amend the Foreign Assistance Act of 1961 to provide more assistance in preventing, treating and controlling tuberculosis.

Meanwhile in El Paso, Luis Garcia, director of CBP field operations, fired off a June 1 message to his employees to be on the lookout for Mr. Armendariz: “In response to this possible health and safety threat, the El Paso Field Office is working with CDC and the State Health Department to provide tuberculosis testing for any officer and/or employee at the El Paso Port of Entry who may choose to take the test.”

The Juarez businessman was identified as “a frequent border crosser” who “frequently travels by air into the United States,” according to the alert issued by the Customs and Border Protection El Paso Field Office Operations Center that included a photo of Mr. Armendariz.

“Subject has a very dangerous and contagious strain of TB,” the alert said. “He is a public health threat to others and should be masked and placed in isolation immediately.”

The alert also recommended that CBP officers wear masks and rubber gloves “when conducting a personal search” and isolate him among detainees.

The foreign national “flew in the U.S. on Delta Airlines to Atlanta and Salt Lake City, he flew on US Air/Am West to Phoenix. No specific dates were provided just that these flights were in Nov. 2006, Jan. 2007 and May 2007,” according to documents obtained by The Washington Times.

Both airlines were asked whether and when they were informed by Homeland Security or CDC officials that the infected foreign national had been a passenger on recent flights or of the possible contamination risks to fellow passengers.

US Airways and Delta Air Lines both declined to answer, citing passenger privacy issues.

“These events are of grave concern regarding the inability of CBP El Paso managers, along with those working with CDC to adequately address the important U.S. homeland security mission against bioterrorism as well,” said another DHS official familiar with the incident. “How can we realistically expect them to protect us and the rest of these United States?”

Dr. Martin Cetron, director of the CDC’s Division of Global Migration and Quarantine, said that people with active infectious tuberculosis should not travel, but studies have shown that transmission is more likely on long-haul flights of eight hours or more.

“To my understanding, all the right effective steps were taken to protect the individual who was infected as well as the public,” Dr. Cetron said. “One of the things at the top of my list on this talk is how do we maintain current and accurate information in order to manage infectious disease threats on a global scale from the local, state, national and international jurisdictions in order to protect privacy and prevent the transfer of the illness.”

An MDR-TB patient who is not complying with health regulations may be required to undergo supervised treatment for 18 to 24 months to ensure that the complete medical regimen is followed, said Dr. Greg Ciottone, assistant professor of medicine at Harvard University.

“Yes, any person who had close or continued contact with him needs to go in and get tested,” Dr. Ciottone said. “If anyone comes in contact with MDR-TB in our hospital, they get tested. MDR-TB is active until you are under full treatment and your tests come back” negative.

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