TB sufferer is quarantined as US asks how he was allowed to fly

An American lawyer with a potentially fatal form of tuberculosis who travelled to Europe against the advice of his doctors and then snuck back into the US through Canada, was yesterday undergoing treatment under armed guard, amid a national outcry at his behaviour.

Andrew Speaker, 31, is in danger of becoming a latter-day "Typhoid Mary" as details emerge of the lengths he went to ignore medical advice, to the extent of refusing to remain in his hotel room in Rome when contacted by experts from the US Centres for Disease Control (CDC). He is now the first person to be quarantined on US government orders since 1963.

In a strange twist to the tale, Mr Speaker's father-in-law, Robert Cooksey, is a TB specialist at the CDC. Mr Cooksey said he was not involved in his son-in-law's decision to travel to Europe, and that the TB strain did not come from the CDC's labs, "which operate under the highest levels of biosecurity".

Mr Speaker flew from his home in Atlanta to Paris on 12 May on an Air France flight, then travelled to Greece to get married before honeymooning in Rome. He then went to Prague to catch a flight to Canada, where he rented a car to cross the US border, at which point he was intercepted but not detained.

Amid mounting hysteria over the possibility that he infected hundreds of others on his travels, there were worries about the country's ability to protect itself from potential biological pandemics. Mr Speaker is now beginning his treatment for XDR TB, an extremely drug-resistant strain of the disease, in a Denver hospital.

Questions were being asked about why he had been allowed to travel in the first place and why he was not detained upon re-entering the country from Canada, despite the fact that he was being sought by health authorities.

A customs agent who ran Mr Speaker's passport through a computer at the border and then ignored a warning that said he should detain him, as well as put on a face mask and call the authorities, has been removed from border duty. The agent says he let Mr Speaker into the US because he "looked healthy".

Congressional hearings are to be convened on Mr Speaker's case and politicians have called for a review of security. One Senator, Susan Collins of Maine, said the incident "highlights how vulnerable our security remains and raises considerable doubts about the nation's preparedness for pandemic influenza and other biological incidents".

Mr Speaker, a personal injury lawyer in Atlanta, was described yesterday as "tired, co-operative, emotional and concerned about the publicity his case was receiving". He also appeared - complete with facemask - on Good Morning America to beg forgiveness of any passengers he may have exposed to TB.

But viewers also learned of the lengths he took to flout medical advice, following his diagnosis earlier this year. He has released a transcript of tape-recorded meetings with his doctors, in which they told him that he should not travel abroad, but did not categorically instruct him not to go.

He has queried why he was not told to cancel his wedding before he left Atlanta and why the authorities waited until he was on his honeymoon in Rome to order him into isolation.

"I'm a very well-educated, successful, intelligent person," he said. "This is insane that I have an armed guard outside my door when I've co-operated with everything other than the solitary confinement in Italy thing."

Mr Speaker's case has revived memories of Typhoid Mary, a New York woman in the early 20th-century who infected scores of people with typhus fever after working as a hospital cook despite being a healthy carrier of the disease. Eventually tracked down, she was quarantined for the rest of her life.

A killer strain

XDR-TB, also known as extreme resistant tuberculosis, is virtually untreatable with existing drugs. The disease is transmitted in the same way as ordinary TB, through droplets in the air when infected people cough or sneeze. The World Health Organisation warned last year that the deadly new strain was spreading round the globe. It estimated that 2 per cent of the nine million cases of TB worldwide were the XDR strain - amounting to 180,000 cases in all.

In South Africa, 98 per cent of those infected with the strain have died. Even in the US, which has the best drugs available, a third of those infected have died.

Tuberculosis was thought to have been beaten 50 years ago with the development of antibiotics. But the emergence of drug resistance means experts fear we may now face a new untreatable plague.