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January

• Testing: Patient's chest X-ray and CT scan are abnormal.

March 8

• Testing: Diagnostic bronchoscopy.

March 26

• Testing: Bronchoscopy specimen culture positive for Mycobacterium tuberculosis at hospital lab; patient notified of diagnosis by private medical doctor (PMD).

April 5

• Testing: Patient starts self-administered first-line 4-drug TB therapy.

April 10

• Testing: Repeat culture of specimen confirmed for Mycobacterium tuberculosis at hospital lab.
• Testing: Georgia Public Health Laboratory receives isolate for Mycobacterium tuberculosis susceptibility testing and reincubation.

April 25

• Testing: Patient reports to the Fulton County Health Department.
• Testing: Patient advises health department physician of overseas travel (not itinerary).
• Testing: Physician asks for expedited susceptibility testing of isolate culture.

April 26

• Testing: Georgia Public Health Laboratory finds sufficient growth to begin susceptibility testing.

April 27

• Testing: CDC receives patient sample for susceptibility testing.

April 30

• Testing: Georgia Public Health Laboratory preliminary susceptibility test indicates MDR TB.

May 10

• Testing: Georgia Public Health Laboratory susceptibility test indicating multidrug-resistant tuberculosis (MDR TB) reported to Fulton County Health Department.
• Testing: Private family meeting held at private doctor's office with Fulton County Health Department represented. Patient verbally advised not to travel.
• Testing: Fulton County Health Department begins review of legal remedies to restrict patient movement.

May 10-11

• Locate XDR/MDR TB Patient: Georgia Department of Public Health asks CDC for options that could be used to restrict travel in a person with untreated MDR TB. CDC responds with options.

May 11-13

• Locate XDR/MDR TB Patient: Fulton County Health Department attempts to hand deliver written advisory to patient. Patient cannot be located.

May 11

• Locate XDR/MDR TB Patient: Patient changes flight departure from May 14 to May 12 (unknown to health authorities).

May 12

• Locate XDR/MDR TB Patient: Patient departs U.S. on Air France #385 (unknown to health authorities).

May 18

• Locate XDR/MDR TB Patient: Georgia Department of Public Health notifies CDC that patient with MDR TB traveled internationally; CDC initiates effort to locate patient and travel itinerary. This is the initial step in CDC's contact tracing efforts.

May 18-25

• Locate XDR/MDR TB Patient: CDC contacts family, acquaintances to find patient.

May 22

• Testing: CDC lab's preliminary tests indicate extensively drug-resistant tuberculosis (XDR TB).
• Locate XDR/MDR TB Patient: Based on CDC request, U.S. Customs and Border Protection (CBP) flags patient for nationwide border lookout.

May 22-23

• Locate XDR/MDR TB Patient: CDC speaks to patient in Rome to discuss diagnosis and options for isolation and evaluation, safe return to U.S., and treatment.

May 23

• Locate XDR/MDR TB Patient: CDC contacts colleague working with Italian Ministry of Health (MOH) to discuss temporary isolation and treatment options for patient in Rome.

May 24

• Locate XDR/MDR TB Patient: CDC discusses transportation options on how to bring the patient back to the U.S. from Europe.

May 24

• Locate XDR/MDR TB Patient: Patient location unknown. Patient leaves Rome on newly booked flight to Montreal, Canada on Czech Air #104 (unknown to health authorities).
• Locate XDR/MDR TB Patient: CDC requests Transportation Security Administration (TSA) issue order to prevent patient from boarding U.S. bound flights.

May 24

• Investigate Spread of Infection: CDC notifies Italian Ministry of Health authorities and World Health Organization (WHO) in Geneva.

May 25

• Investigate Spread of Infection: U.S. Department of Health and Human Services (DHHS) provides formal International Health Regulation (IHR) notification.
• Locate XDR/MDR TB Patient: Customs and Border Protection (CBP) validates U.S. re-entry of patient in New York (NY) by automobile; notifies CDC.
• Locate XDR/MDR TB Patient: CDC contacts patient in New York.
• Isolate XDR/MDR TB Patient: Patient is isolated in New York City (NYC) hospital under provisional federal isolation order.

May 25-27

• Testing: CDCs requests patient evaluation and lab tests in New York City.

May 25 - ongoing

• Investigate Spread of Infection: CDC collaborates with international, federal, state, and local health authorities on airline passenger contact tracing. As of July 17, 99% of U.S. passengers contacted by CDC.

May 26-27

• Isolate XDR/MDR TB Patient: CDC team interviews patient in New York City.

May 26

• Investigate Spread of Infection: From interview, CDC obtains patient itinerary and requests passenger info for contact tracing.
• Isolate XDR/MDR TB Patient: CDC starts discussion on bringing the patient from NYC to Atlanta.

May 28

• Isolate XDR/MDR TB Patient: CDC flies patient to Atlanta; upon arrival, serves federal isolation order.

May 29 - ongoing

• Investigate Spread of Infection: CDC engages news media to notify passengers of possible exposure and direct them to CDC hotline.
• Investigate Spread of Infection: CDC contacts those self-identified passengers who call CDC hotline.

May 29-30

• Isolate XDR/MDR TB Patient: CDC discusses options for safe travel of patient to TB treatment facility in Denver.

May 31

• Isolate XDR/MDR TB Patient: CDC escorts patient to TB treatment facility in Denver by air ambulance under federal isolation order.
• Isolate XDR/MDR TB Patient: Denver County issues isolation order.

• Investigate Spread of Infection: CDC receives passenger contact info from multiple sources for contact tracing to facilitate testing.

June 2

• Isolate XDR/MDR TB Patient: CDC rescinds federal isolation order.

July 3

• Testing: Susceptibility testing of Mycobacterium tuberculosis organisms cultured from multiple induced sputum specimens from the patient is reported to be MDR TB.