- The Washington Times - Monday, July 10, 2006

Tuberculosis is “particularly problematic” in U.S. correctional and detention facilities, say federal health officials, who have updated guidelines for preventing the spread of TB in jails and prisons.

“Effective TB prevention and control measures in correctional facilities are needed to reduce TB rates among inmates and the general U.S. population,” say authors of a report published in the current issue of the federal Centers for Disease Control and Prevention’s (CDC) Morbidity & Mortality Weekly Report.

“Inmates with undiagnosed TB disease place other inmates and correctional staff at risk for TB, and when released, these persons also can infect persons living in surrounding communities,” the researchers said.

In the report, G. Scott Earnest and other CDC epidemiologists point out that the number of U.S. prison inmates quadrupled from 500,000 in 1980 to about 2 million in 2003.

“A disproportionately high percentage of TB cases” occur among prison inmates, they said. In 2003, 0.7 percent of the total U.S. population was confined in jails and prisons, yet 3.2 percent of all TB cases nationwide that year “occurred among residents of correctional facilities.”

The researchers said the TB rates of inmates in prisons in California and New York are 10 to 15 times greater than the general populations of those states. Studies show the prevalence of LTBI — or latent TB infection, which is asymptomatic — “to be as high as 25 percent” in prisons, they said. Like TB disease, LTBI can be detected by screening and can be treated.

The authors say the key reasons that prison inmates are at higher risk for the airborne infection are their diverse backgrounds, overcrowded facilities and poor ventilation.

In addition, they say, “disparate numbers of incarcerated persons are at high risk for TB,” because they have HIV, use injection drugs and have “low socioeconomic status” so may not have had access to proper medical care.

In the United States, TB tends to be concentrated among immigrants. “Detained immigrants are arriving largely from countries with a high prevalence of TB” — including Mexico, the Philippines and Vietnam — “and therefore present unique challenges in the elimination of TB in the United States,” the authors said.

They note that testing and treating undocumented aliens can be difficult and that these people sometimes are resistant to “first-line anti-TB drugs because of interrupted treatment received in their countries of origin.”

The good news, the researchers said, is that illegals who wind up in American prisons “have an opportunity to receive TB screening and begin treatment for TB disease.”

The CDC’s recommendations for prevention and control of TB in jails and prisons is the first update since 1996.

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