On travellers with TB

From today's Washington Times - maybe pertinent to discussion during Jeffrey's presentation?

TB data shared too late to stop traveler
GAO finds border open to Mexican
Audrey Hudson and Sara A. Carter
Friday, November 14, 2008

Homeland Security Secretary Michael Chertoff was urged by senators to provide an "after-action report" in the case of a Mexican man who traveled while sick with tuberculosis. (Associated Press)

A Mexican man with a highly contagious form of tuberculosis was able to repeatedly enter the United States and board dozens of domestic flights because U.S. agencies failed to conduct adequate border inspections and share information, according to the Government Accountability Office (GAO).

The Centers for Disease Control and Prevention (CDC), the Department of Homeland Security and the Department of Health and Human Services (HHS) failed to share appropriate data, conduct adequate border inspections and employ quarantine measures for highly contagious diseases, according to a GAO report released Thursday titled "Public Health and Border Security."

The Washington Times disclosed in October 2007 documents revealing that Amado Isidro Armendariz Amaya of Juarez crossed the U.S. border 76 times and took multiple domestic flights throughout the year. At least 20 of those border crossings took place after April 16, 2007, when U.S. officials first identified him as a threat to public health.

Customs and Border Protection (CBP) did not notify the Transportation Security Administration (TSA) until two months after it identified Mr. Amaya as a carrier.

Even if the TSA had been notified earlier, the report said, the agency "had policies and procedures in place for nominating individuals with suspected ties to terrorism to the No Fly list, [but] it did not have a comparable way to prevent someone from flying because of public health concerns."

The GAO report also addressed the case of Andrew Speaker. The 31-year-old Atlanta lawyer who had received a diagnosis of a drug-resistant form of TB slipped into the U.S. from Europe via a flight to Canada. His story set off alarms that the system had failed to identify the contagious passenger, which led to congressional hearings in June 2007.

"Absent procedures for coordinating with CDC, state and local health officials responding to the incident involving the U.S. citizen were uncertain how to request federal assistance, causing the initial delay in the federal response. Finally, CBP had deficiencies in its traveler inspection process, which led to further delays in locating the individuals and deterring their travel," the report said.

Sen. Joe Lieberman, Connecticut independent and chairman of the Senate Homeland Security and Governmental Affairs Committee, along with ranking member Sen. Susan Collins, Maine Republican, held a hearing based on The Times' report and requested the GAO investigation.

"GAO tells us what we have long known and urgently sought to improve and that is basic communications among federal government agencies is essential to protect Americans from potential terrorists, natural disasters and outbreaks of disease," Mr. Lieberman said.

"Our border security and aviation controls must be stronger if we are to prevent repeats of these types of border breaches," Mr. Lieberman said.

The government investigation also revealed that "CDC had not developed procedures for informing state and local health officials about the process for coordinating with CDC to determine whether federal isolation and quarantine authorities should be used to deter the travel of an individual with TB."

Several sources in Homeland Security, speaking on the condition of anonymity for fear of retribution, told the Times that CBP issued its first alert to be on the lookout on May 31, more than six weeks after CBP was warned.

Mr. Amaya entered the U.S. on May 21 to extend his I-94 travel visa.

Homeland Security waited an additional week after May 31 to tell the TSA, which then added Mr. Amaya to its "no-fly" list.

Despite having knowledge of Mr. Amaya, none of the agencies present at the investigative hearings in June on Mr. Speaker's case revealed to Congress that another infected man was traveling in the U.S. and crossed the southwestern border numerous times.

Multidrug-resistant tuberculosis (MDR-TB) is a highly contagious illness caused by a germ that is resistant to the two most commonly used drugs to treat TB.

"Both [Homeland Security] and HHS have since taken steps to improve their ability to identify and intercept TB patients who are determined to pose a public health risk, but I urge both departments to accept and adopt all of GAO's recommendations," Mr. Lieberman said.

The GAO says government agencies are now using public health screening and border inspection tools to identify travelers who pose as public health threats who are placed on a new "do not board" list.

"Information sharing is essential to stop health threats before they cross our borders, and I am pleased the departments have made considerable improvements since our committee first identified significant lapses in this area," Miss Collins said.

"To prevent individuals who pose public health threats from entering the country, the Department of Homeland Security and Department of Health and Human Services must increase their cooperation and coordination, whether the threats stem from naturally occurring outbreaks or terrorist plots," Miss Collins said.

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