December 13, 1993

Tuberculosis in a Correctional Facility

Author Affiliations

From the Division of Field Epidemiology, Epidemiology Program Office (Drs Pelletier and Sosin), Division of Bacterial Diseases, National Center for Infectious Diseases (Drs Jones and Woodley), and Division of Tuberculosis Elimination, National Center for Prevention Services (Dr Bloch), Centers for Disease Control and Prevention, Atlanta, Ga; Bureau of Communicable Disease Control, New York State Department of Health, Albany (Dr DiFerdinando); and the Bureau of Infectious Disease Control, Nassau County Department of Health, Mineola, NY (Dr Greenberg).

Arch Intern Med. 1993;153(23):2692-2695. doi:10.1001/archinte.1993.00410230112013

Background:  After the identification of five suspected cases of tuberculosis (TB) in a Nassau County (New York) jail during a 3-week period, an epidemiologic investigation was begun to document the number of cases of TB infection and disease associated with the jail, the characteristics of current or former inmates with TB disease, and the factors contributing to TB transmission in the jail.

Methods:  The county TB register was matched against the inmate files of the jail. Medical records from hospitals, the health department, and the jail were then reviewed. All inmates in the jail were skin tested during a mass screening.

Results:  From January 1, 1988, through March 16, 1990, of 205 TB cases in the county, 49 (24%) were associated with the jail. Forty of the cases occurred among current or former inmates, one in a corrections officer, and eight among community contacts of inmates. The 40 inmates with TB were predominantly nonwhite (75%), unmarried (80%) men (90%), with a median age of 32 years. Twenty-three (58%) had a history of injecting drug use, and 14 (35%) were known to be seropositive for the human immunodeficiency virus. Thirty (75%) of the inmates had culture-confirmed pulmonary TB. Five (29%) of 17 Mycobacterium tuberculosis isolates had the same phage type and DNA fingerprint, which was consistent with transmission of infection within the jail. The mass screening revealed that 374 (20%) of 1855 inmates were tuberculin positive.

Conclusions:  Without an effective program of TB control, jails can act as reservoirs of disease for inmates and staff, and for the community into which the inmates are released.(Arch Intern Med. 1993;153:2692-2695)