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Man knew he had TB before flying to Europe

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ATLANTA, Georgia (CNN) -- A man infected with the extensively drug-resistant form of TB known as XDR TB knew he was not supposed to travel overseas but did so anyway, director of the Centers for Disease Control and Prevention Dr. Julie Gerberding told CNN's "American Morning" on Wednesday.

The man, who is quarantined at an Atlanta, Georgia, hospital, told the Atlanta Journal Constitution that Fulton County health officials had said they "preferred" he not travel, but knew about his plans for an overseas wedding and honeymoon.

CNN is trying to contact the man and his family.

The man and Gerberding both said it wasn't until he was in Europe that his diagnosis of XDR TB was confirmed by lab tests. ( TB patient quarantined after traveling )

He was then contacted while on his honeymoon in Italy last week by CDC officials and asked to turn himself over to Italian health authorities, he told the newspaper. (Patient disputes what CDC told him )

Gerberding said health officials "usually rely on a covenant of trust to assume that a person with tuberculosis just isn't going to go into a situation where they would transmit disease to someone else."

"The patient really was told that he shouldn't fly," she added.

"The patient himself was not highly infectious" but there still was a small risk he could transmit the disease to someone else, Gerberding told CNN.

It is the first time in 40 years the federal government has issued a quarantine order for an individual. Gerberding acknowledged that "we kind of had to make up a plan as we went along."

The CDC director announced Tuesday that federal health officials are looking for people who may have been seated near the man during the two trans-Atlantic flights. (XDR TB leaves doctors with few treatment options)

He departed Atlanta on May 12 aboard Air France Flight 385 and arrived in Paris the next day, she said at the news conference. He returned last Thursday to North America aboard Czech Airlines Flight 0104 from Prague, Czech Republic, to Montreal, Canada, then drove into the United States.

Those most at risk would have been seated within two rows of the man, Gerberding said.

Newer-model planes use HEPA filters that are able to trap the long, rod-shaped tuberculosis bacilli, according to the CDC.

The man told the newspaper he was aware he was placed on a no-fly list in the United States after his recent diagnosis with XDR TB, which is why he decided to fly into Canada.

He told the newspaper that he asked the CDC whether they would provide a jet for him to return home, and was told there was no money for it.

But Gerberding told CNN, "I don't think that that's an accurate description of what actually happened involving the CDC."

"We were doing everything we could to try to find a way to get him home," she said. "In fact, the irony is that when we were no longer able to reach him, we were even preparing to send the CDC plane to Europe to bring him home at government expense."

She noted that it was Memorial Day weekend and because of the holiday, "it took some time to get all the pieces together."

The man told the newspaper that a CDC staff member told him to turn himself into Italian health authorities where he would be put in isolation and given medical treatment. He said he sneaked back into the country because he feared "an unsuccessful treatment in Italy would have doomed him," the newspaper reported.

The man is in isolation at Atlanta's Grady Memorial Hospital and "is required to stay in isolation until the responsible public health officials deem that he is no longer infectious to others," according to Gerberding.

An armed guard stands outside his room.

The diagnosis

XDR TB was recently defined as a subtype of multiple-drug resistant tuberculosis.

People with XDR TB are resistant to first- and second-line drugs; their treatment options are limited and the disease often proves fatal.

It can take between six and 16 weeks for a final diagnosis of XDR TB.

Health officials determined the man had a multiple-drug resistant form of TB on May 11, a day before he left for Paris, Dr. Stuart Brown, director of Georgia's Division of Public Health, told CNN.

He had met with county health officials and his doctors that same day to discuss his risk, Brown said.

"The Fulton County folks gave him a verbal warning of the danger and the prohibition against travel on May 11," Brown said, noting that the patient's reaction set off some alarm bells.

"They were so concerned by his interaction in this discussion that they went back and hand-delivered a letter reiterating that he remain isolated and not travel," Brown said, adding that at that time, "a plan of treatment was put together."

However, when they arrived to deliver the letter later that day, he had already left, Brown said.

On May 17, the CDC was called in to test for XDR TB and the tests came back positive on either May 21 or 22, he said.

The man told the Atlanta Journal-Constitution that he planned to undergo an 18-month "cutting-edge treatment" at a Denver, Colorado, hospital after his honeymoon, something he said his private doctor and government health officials were aware of.

The man returned via Canada and entered the United States by driving through the border crossing at Champlain, New York.

Customs and Border Protection spokesman Kevin Corsaro said the man did not appear sick to border agents.

CBP said it has not changed its screening or security precautions as a result of the case.

Once he returned to the United States, the man was contacted by health officials, who required that he go to an isolation hospital in New York City for evaluation, said Dr. Martin Cetron, the CDC's chief of quarantine.

"He drove himself there voluntarily."

A spokesman for New York's Bellevue Hospital confirmed that the man was treated at the medical facility for 72 hours.

He was kept under quarantine at the hospital and did not travel on any form of public transportation while in New York, the city's health department said,

"We have no information to suggest anyone in New York City is at any risk associated with this case," the department said in a news release.

Asked if he preferred to stay in New York or return to his family in Atlanta for treatment, the man chose the latter option, said Cetron. At that point, the CDC used one of its planes to fly the patient to Atlanta on Monday, an unusual use of agency resources, Gerberding acknowledged.

XDR TB

Between 1993 and 2006, 49 people were diagnosed with XDR TB in the United States, said Dr. Ken Castro, director of the division of TB Elimination at CDC.

But the disease is more common elsewhere, he said. "When they looked, they found it in every single continent of the world," he said.

WHO estimates that there were almost half a million cases of multiple-drug-resistant tuberculosis worldwide in 2004.

People with TB of the lungs, the site most commonly affected, can spread the disease by coughing, sneezing or even talking.

"A person needs only to breathe in a small number of these germs to become infected (although only a small proportion of people will become infected with TB disease)," the WHO said on its Web site.

"The risk of becoming infected increases the longer the time that a previously uninfected person spends in the same room as the infectious case," it added.

Cure is possible for up to 30 percent of cases, it said.

No one at the disease agency recalls the agency issuing a quarantine order since 1963, when a possible case of exposure to smallpox emerged, she said.

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