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ARTICLE

Transmission of Tuberculosis in a Jail

Timothy F. Jones, MD; Allen S. Craig, MD; Sarah E. Valway, DMD, MPH; Charles L. Woodley, PhD; and William Schaffner, MD

19 October 1999 | Volume 131 Issue 8 | Pages 557-563

Background: Outbreaks of tuberculosis are uncommonly recognized in jails. In 1996, an increase in active tuberculosis cases was noted among inmates of a large urban jail.

Objectives: To determine the source and extent of a tuberculosis outbreak in an urban jail and to recommend control measures.

Design: Retrospective cohort study.

Setting: Urban jail.

Patients: Inmates and guards with tuberculosis.

Intervention: Outbreak evaluation and control.

Measurements: Medical records of inmates and guards with tuberculosis were reviewed, and inmates were interviewed. DNA fingerprinting was performed on Mycobacterium tuberculosis isolates.

Results: From 1 January 1995 through 31 December 1997, active tuberculosis was diagnosed in 38 inmates and 5 guards from the jail. Nineteen (79%) of the 24 culture-positive inmates had isolates with DNA fingerprints matching those of other inmates. Isolates from both culture-positive guards matched the predominant inmate strain; only 6 (14%) of 43 isolates from infected persons in the community had this pattern. The median length of incarceration of all inmates in the jail was 1 day; the median length of continuous incarceration before diagnosis of tuberculosis in inmates was 138 days. Inmates with tuberculosis had been incarcerated a median of 15 times. Forty-three percent of persons in this city with tuberculosis diagnosed from January 1995 through July 1997 had been incarcerated in the jail at some time before diagnosis.

Conclusions: Traditional and molecular epidemiologic investigations suggest that tuberculosis was transmitted among inmates and guards in an urban jail. Aggressive measures to screen for active tuberculosis upon incarceration are important for preventing spread of disease in jails and to the surrounding community.

Author and Article Information

From the Centers for Disease Control and Prevention, Atlanta, Georgia; and the Tennessee Department of Health and Vanderbilt University School of Medicine, Nashville, Tennessee.

Presented in part at the 36th Annual Meeting of the Infectious Diseases Society of America, Denver, Colorado, 12 to 15 November 1998.

Acknowledgments: The authors thank Donna Hurst and William L. Moore, MD, of the Tennessee Department of Health; David Crowder and Gail Grant at the Centers for Disease Control and Prevention; Yvonne Madlock, Martha Woloshyn, RN, Linda Hamer, RN, Harold Brown, Francis Fountain, MD, and the staffs of the Memphis/Shelby County Health Department, Correctional Medical Services, Inc., the Memphis/Shelby County Criminal Justice Center, and the Shelby County Correctional Center for assistance with the investigation; Dr. James Musser, Baylor College of Medicine, for genetic polymorphism testing; and Kenneth G. Castro, MD, and Laura J. Fehrs, MD, Centers for Disease Control and Prevention, for their thoughtful review of the manuscript.

Requests for Reprints: Timothy F. Jones, MD, Tennessee Department of Health, CEDS, Cordell Hull Building, 4th Floor, 425 5th Avenue North, Nashville, TN 37247-5281. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

Current Author Addresses: Drs. Jones and Craig: Tennessee Department of Health, CEDS, Cordell Hull Building, 4th Floor, 425 5th Avenue North, Nashville, TN 37247-5281.

Dr. Valway: Division of Tuberculosis Elimination, National Center for HIV/STD/TB Prevention, Centers for Disease Control and Prevention, Mailstop E-10, 1600 Clifton Road, NE, Atlanta, GA 30333.

Dr. Woodley: Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-08, 1600 Clifton Road, NE, Atlanta, GA 30333.

Dr. Schaffner: Departments of Medicine and Preventive Medicine, A1124 Medical Center North, Vanderbilt University School of Medicine, Nashville, TN 37232-2637.

Related articles in Annals:

Summaries for Patients
Tuberculosis Infection in a Jail

Annals 1999 131: 557. [Full Text]  

Editorials
On Target: A Tuberculosis Control Strategy Whose Time Has Come
Lee B. Reichman

Annals 1999 131: 617-618. [Full Text]  

Letters
Transmission of Tuberculosis in a Jail
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Annals 2000 132: 843. [Full Text]  

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