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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
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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@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.

Ann Intern Med. 1999;131(8):557-563. doi:10.7326/0003-4819-131-8-199910190-00002
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Tuberculosis is a problem in correctional facilities throughout the United States. In 1996, 3.7% of all cases of tuberculosis nationwide occurred among residents of correctional facilities (1). Although in 1996 the incidence of new cases of active tuberculosis in the United States was 8.0 per 100 000 persons (1), many prison systems have reported rates of 200 per 100 000 persons and higher (210). Transmission of tuberculosis from prisons into surrounding communities has been documented (5), and correctional facilities may be important reservoirs of infection (1113). One study concluded that a prison was potentially linked to 9% of a state's tuberculosis cases during a 5-year period (5), and another study indicated that 24% of the tuberculosis cases in a county were associated with its jail (14).

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Figure 2.
Cases of active tuberculosis disease diagnosed in guards (top) and inmates (bottom) from the Memphis jail, 1 January 1995 through 31 December 1997, by quarter in which disease was diagnosed.

White bars indicate persons with isolates with DNA fingerprints matching the predominant strain in the jail, striped bars indicate those with a different DNA fingerprint, and black bars indicate culture-negative persons.

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Figure 1.
Distribution of lengths of incarceration of inmates in the Memphis jail, 1995 to 1997.
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Figure 3.
Autoradiograph of IS-6110 restriction fragment length polymorphism patterns ofMycobacterium tuberculosisisolates.

Lanes 1 and 11 are standards. Lanes 4 through 7 and 9 are from inmates whose isolates had the 11-band pattern matching that of 12 inmates and two guards. Lanes 2 and 3 are from two of three inmates with an identical 12-band pattern. Lane 8 is from an inmate whose isolate did not match those of other jail cases, and lane 10 is from a person living in the community.

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Figure 4.
Periods of incarceration, during the 2 years before diagnosis, of the 16 jail inmates (black lines) whoseMycobacterium tuberculosisisolates had the predominant DNA fingerprint and periods of employment of the two jail guards (striped lines) with the same strain.

Boxes indicate periods in the jail when persons were presumably infectious. Inmate P was not considered infectious.

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Summary for Patients

Tuberculosis Infection in a Jail

The summary below is from the full report titled “Transmission of Tuberculosis in a Jail.” It is in the 19 October 1999 issue of Annals of Internal Medicine (volume 131, pages 557-563). The authors are T.F. Jones, A.S. Craig, S.E. Valway, C.L. Woodley, and W. Schaffner.


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