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After statements by Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention, about her agency's role in detecting the extremely drug-resistant form of the disease and then notifying Mr. Speaker about it, he told the committee, ''A few of things you were told are simply not accurate.'' ''They were all discussing this, because of the fact that there was resistance,'' Mr. Speaker said, ''and talking about getting me out to Denver.'' Senator Tom Harkin, Democrat of Iowa and chairman of the subcommittee, said he suspected ''some bureaucratic mismanagement'' in how several government agencies handled Mr. Speaker's case, and announced that he would hold another hearing, but did not set a time

That chilling forecast is based in part on analyses by the organization that show that, on average, a patient infected with drug-resistant tuberculosis in 2004 was resistant to more drugs than a similar patient with that diagnosis in 1994, Dr. Paul Nunn, a TB expert for the organization, said Tuesday. About 420,000, or 5 percent, of the estimated 8.8 million new cases of tuberculosis in the world are resistant to many standard anti-tuberculosis drugs, Dr. Mario Raviglione, who directs the WHO's tuberculosis department, said in an interview. 'It is possible that in some settings drug-resistant tuberculosis could completely replace standard tuberculosis,' Raviglione said

Speaker suffers from the extensively drug resistant kind of tuberculosis, which is quite rare, with only 49 cases reported in the United States since 1993. TB itself is common, infecting one-third of the world's population, with more than 8 million people getting sick from it every year. Even with billions of airplane passengers every year, the plane is an unlikely place for TB transmission. There have been several small studies that have followed exposure to active TB on planes. From 1992 to 1994, the Centers for Disease Control and Prevention followed six passengers and a crew member who had TB in their sputum and exhibited active symptoms. Of the 2,600 contacts of these TB patients (two were deliberately flying without alerting the airline, the other five didn't know they had TB), only a few people showed subsequent transmission of TB and none got sick

That chilling forecast is based in part on the organization's analyses showing that on average, a patient infected with drug-resistant tuberculosis in 2004 was resistant to more drugs than a similar patient with that diagnosis in 1994, Dr. Paul P. Nunn, a TB expert for the organization, said at a news conference. Health officials say that Mr. Speaker's was not an isolated case because the extremely resistant form has been reported in 37 countries. With the growth of international travel, health officials say that TB anywhere is TB everywhere. About 420,000, or 5 percent, of the estimated 8.8 million new cases of tuberculosis in the world are now resistant to many standard antituberculosis drugs, Dr. Mario C. Raviglione, who directs the W.H.O.'s tuberculosis department, said in an interview. About 30,000 of the 420,000 cases are extremely drug-resistant, meaning they are resistant to first-line and a number of second-line drugs. Dr. Raviglione said the organization had begun to undertake statistical modeling studies to estimate how prevalent drug-resistant tuberculosis might become. Outcomes from such studies depend on a number of variables and none have been published. ''It is possible that in some settings drug-resistant tuberculosis could completely replace standard tuberculosis,'' Dr. Raviglione said

At that point, [Robert Cooksey] said on television, [Andrew]'s smear tests showed no tuberculosis bacteria 'and so, by the guidelines, he was not considered infectious' to others. But guidelines issued by the World Health Organization say that 'patients with multiple drug resistant tuberculosis should not travel until' no tuberculosis bacteria grow on culture tests performed in a laboratory

At that point, [Robert Cooksey] said on television, Andrew's smear tests showed no tuberculosis bacteria 'and so, by the guidelines, he was not considered infectious' to others. But guidelines issued by the World Health Organization say that 'patients with multiple drug resistant tuberculosis should not travel until' no tuberculosis bacteria grow on culture tests performed in a laboratory. The Fulton County health officials said they 'preferred' that Andrew Speaker not travel but did not cite a specific reason. Ted Speaker said he asked a health official whether he was 'just saying this to cover yourself' and that the official replied, 'Yes.' [Julie Gerberding] also said that several times 'he helped us facilitate communication with his son-in-law and the wife,' Sarah. Cooksey's 'assistance was actually extremely helpful' in getting the CDC in cellphone contact with Andrew Speaker in Europe, Gerberding said, 'to help us determine how to help him get into a safer health care environment.'

In several studies, transmission of TB has been demonstrated only in flights much longer than the ones Speaker took. In the early 1990s, six passengers and one crew member who had active TB (two knew they had TB but didn't inform the airline; the others found out after the flight) were studied by the CDC, and their 2,600 contacts were followed. Only a few cases of TB conversion were found from close contact - on flights longer than eight hours. These patients (as opposed to Speaker) were all highly symptomatic and had TB in their sputum, and yet no one got sick from the exposure. Although Speaker is the first TB patient to be quarantined in 44 years, according to the Centers for Disease Control and Prevention, he doesn't pose a significant risk to others. Consider that there have been fewer than 50 cases of this extremely resistant TB in the United States over the past 14 years. Catching any TB requires very close contact. The risk is 20 percent for close contact with someone sick with active TB. But the risk is probably much less than 1 percent for passengers on any of Speaker's flights because he wasn't coughing, had no fever and was receiving some treatment. There has not yet been a single case of active tuberculosis resulting from exposure on a plane

Yesterday Dr. [Robert Cooksey] did not directly address the question of what he would have done under the same circumstances. ''I wasn't in that situation,'' Dr. Cooksey said on the ABC program ''Good Morning America,'' ''but I probably would have done the very same thing.'' The Fulton County health officials said they ''preferred'' that Andrew Speaker not travel but did not cite a specific reason. Ted Speaker said that he asked a health official whether he was ''just saying this to cover yourself'' and that the official replied, ''Yes.'' Dr. [Julie L. Gerberding] also said that at several times ''he helped us facilitate communication with his son-in-law and the wife,'' Sarah. Dr. Cooksey's ''assistance was actually extremely helpful in getting us in cellphone'' contact with Andrew Speaker in Europe, Dr. Gerberding said, ''to help us determine how to help him get into a safer health care environment.''

The premise: On an island off the north coast of Australia, as surfer Charley Williams begins to cough, he is unaware that several dead seagulls and a dead dog lie near him. They are infected with a new form of flu virus, later determined to be an H3N7 mutated variant named 'Riptide.' Fellow surfer Ames Smith leaves the island and boards a plane to Los Angeles. While on board, he develops a high fever, coughs up blood and dies. The plane and its passengers are quarantined by the Centers for Disease Control and Prevention. A passenger escapes and spreads the virus. Five days later, as several more passengers escape, L.A. has 154 dead and 1,400 sickening. Schools and shops are closed, paper masks are everywhere, mass graves are dug. The city is placed under quarantine. The anti-viral drug 'Tana-Flu' is found to be largely ineffective, and a more useful newer drug, 'CoToxil,' is in short supply. As Riptide spreads, the governor declares martial law and brings in the National Guard. The CDC finally determines that antibodies against tuberculosis bacteria prevent this virus from attaching to the lung, so the blood of TB survivors can be used as a vaccine. The world is saved

When asked why the health organization could not move more quickly and catch up with Mr. Speaker before he took more flights, Dr. [Julie L. Gerberding] said in the press conference that much of the previous week's activity had been spent debating issues concerning the laws and regulations that govern isolation and quarantine in the United States and internationally. The World Health Organization regulations, she said, are ''wonderful statements of principles'' that do not provide ''operational details of things like who should pay to move a patient, or who should care for a patient.'' She said, ''I think a central question that we will be grappling with is, whose patient is it?'' Though their accounts differ, the county health authorities and Mr. Speaker agree that the officials did not try to forcibly restrict Mr. Speaker's movement. Dr. [Steven R. Katkowsky], the county official, said that the law presented ''kind of a Catch-22'' when it comes to restricting the activities of tuberculosis patients against their will. ''A patient has to be noncompliant before you can intervene,'' he said. ''There's no precedent for a court stepping in before a patient has proven himself to be non-compliant.'' It would have been an extraordinary step that, while not unheard of in tuberculosis cases, would evoke a centuries-old struggle to balance public health and individual liberty. The term ''quarantine'' comes from the Italian phrase ''quaranta giorni,'' or ''40 days,'' the amount of time Venetians isolated those coming into port in the plague years of the 14th century, said Robert Klitzman, a co-founder of the Columbia University Center for Bioethics and an associate professor of clinical psychiatry at the university's College of Physicians and Surgeons