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Jails, prisons test to prevent outbreak of tuberculosis

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  • Jails, prisons test to prevent outbreak of tuberculosis

    Article published Monday, September 25, 2006

    Jails, prisons test to prevent outbreak of tuberculosis
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    The short, thin needle slides under the inmate's skin. The solution injected within raises the skin like a mosquito bite.

    <CENTER></CENTER>The tuberculosis test at the Lucas County jail is almost as fast as the click of a pen. Yet it's one of the most important tests done at the jail and at prisons and detention centers across the country.

    <CENTER></CENTER>That's because tuberculosis, or TB, is a disease caused by bacteria spread through the air from one person to another when an infected person coughs or sneezes. Some drug-resistant strains that have arrived in the United States from overseas recently have health officials concerned. In a closed, often overcrowded environment like a jail or prison, that can be disastrous.

    <CENTER></CENTER>"[TB] is so contagious. It's airborne. It's very, very easily transmitted. It is a big concern," said Valerie Sylvester, director of medical services at the county jail.

    <CENTER></CENTER>Tuberculosis cases among the total U.S. population have fallen for decades to about four cases per 100,000 people. Although less than 1 percent of the U.S. population was in prisons and jails in mid-2003, 3.2 percent of all TB cases nationwide occurred among inmates in correctional facilities, according to the federal Centers for Disease Control and Prevention.

    <CENTER></CENTER>Tuberculosis is believed to be the leading cause of death among prisoners worldwide. Earlier this summer, the CDC issued a report that contained recommendations on prevention and control of the disease specifically aimed at correctional and detention facilities.

    <CENTER></CENTER>Area and state correction and detention officials said they take preventative measures regarding TB seriously, maintaining inmate medical records and offering treatment for the disease.

    <CENTER></CENTER>"All infectious diseases are a high level of concern in our correctional facility. We do not want one person to negatively affect another's health," said Annette Chambers, chief of the bureau of medical services for the Ohio Department of Rehabilitation and Correction, which operates prisons across the state, including the Toledo Correctional Institution.

    <CENTER></CENTER>Several factors contribute to the high rate of TB in prisons, according to the CDC report. The facilities often place inmates in close living quarters or may be overcrowded, making it easier for TB to be spread. Jails and prisons also may have inadequate ventilation systems that fail to remove the airborne TB threat and may actually help spread it, the report states.

    <CENTER></CENTER>In addition, individuals being incarcerated have often not received standard public health intervention or nonemergency medical care before incarceration. The CDC report states that controlling TB can be difficult in these facilities because of the number of people from diverse backgrounds and communities, including those from other countries, housed in close proximity for varying periods.

    <CENTER></CENTER>But there are some measures facilities can take to prevent and control the disease. They include identifying inmates through early and follow-up screening; treating the disease; using airborne precautions, such as respiratory protection; planning for inmate release and working with local or state health departments. The CDC also recommends that employees in the facilities be tested.

    <CENTER></CENTER>Employees at the county jail, the Corrections Center of Northwest Ohio in Stryker, and state prisons in Michigan and Ohio, including Toledo Correctional Institution, are tested annually, especially if they have inmate contact.
    Every six months

    <CENTER></CENTER>Employees at the two prison reception centers in Michigan are tested every six months because they are at a higher risk. They come into contact with inmates often transferred from other facilities, such as small county jails that generally don't test for tuberculosis, said Dr. George Pramstaller, chief medical officer for the Michigan Department of Corrections.

    <CENTER></CENTER>Inmates are tested and screened for symptoms - such as weight loss, night sweats, and fever - anywhere from the day they walk into the lockup up to seven days later. They are asked questions during intake to help the medical staff determine if they may have TB or other infectious diseases. Oftentimes, the inmate may not know if he or she has the disease.

    <CENTER></CENTER>But the risk is very real.

    <CENTER></CENTER>A high school student in California, for example, was symptomatic for more than a year before tuberculosis was diagnosed. Subsequently, 12 TB cases among other students were linked to the original source student. The CDC reported that 23 percent of a total 1,263 students who were tested had positive tuberculin skin tests.

    <CENTER></CENTER>If an inmate's skin test is positive, a chest X-ray often is ordered. Most of the time, no additional testing or isolation is required. If isolation is needed, inmates are housed in negative pressure or negative air flow cells. These cells filter the air, have separate ventilation systems, and are checked to ensure they are working properly, correction and detention officials said.

    <CENTER></CENTER>The Lucas County jail and some Michigan and Ohio prisons, including Toledo Correctional, have such cells. Inmates at jails that do not have a proper isolation cell would be transferred to a prison with the cells or - such as those at CCNO - taken to a hospital, officials said. Five to 10 Ohio prison inmates are isolated each year, Ms. Chambers said.

    <CENTER></CENTER>Inmates entering Ohio prisons are tested and screened the first day or two at one of the state's reception centers and then tested annually on the same day. There have been two active TB cases since 2003. No other inmates were infected in either case, Ms. Chambers said.

    <CENTER></CENTER>She said 42,965 inmates were tested last October. Of them, 132 had been exposed to the disease. There were no active TB cases. A year earlier, 159 out of 42,569 inmates tested positive who previously had not done so. There were no active TB cases upon further testing, Ms. Chambers said.

    <CENTER></CENTER>Dr. Pramstaller said Michigan tests prisoners around their birthday. If they refuse, they are quarantined for 90 days and monitored for signs or symptoms of TB. If they display none, they are returned to the general prison population.

    <CENTER></CENTER>The chief medical officer said the first active TB case in a Michigan prison this year was diagnosed about a week ago. He recalled there were two cases last year and less than a handful of cases in prior years. The Michigan prison system takes in more than 14,000 individuals a year, he said.

    <CENTER></CENTER>Dr. Pramstaller said of the diagnosed cases, the inmates either entered the prison with the disease or were exposed to it at a county jail. While he believes county jails are checking for the disease more than before, it can be difficult to do so.

    <CENTER></CENTER>Full-time health care staff isn't often available, he said, and inmates can quickly move in and out of a facility. They could be released by the time their test results are known.

    <CENTER></CENTER>Lucas County tests only those inmates who are held there more than seven days.

    <CENTER></CENTER>A test taken when an inmate is brought into the county jail "is useless if it's not followed up with the reading. Most of our population doesn't stay long enough to do that," Ms. Sylvester said.
    200 tests a month

    <CENTER></CENTER>She said it's not terribly expensive to conduct the tests: a 50-test vial recently cost about $92. The jail averages about four vials, or 200 tests, a month, she said.

    <CENTER></CENTER>Ms. Sylvester said once every two or three months a follow-up chest X-ray test is needed. Once every two or three years, testing beyond the X-ray is necessary, she said.

    <CENTER></CENTER>The 26-year employee recalled one active TB case during her tenure. Luckily, she said, no other inmates in his cell area tested positive.

    <CENTER></CENTER>Correctional Medical Services in St. Louis, which contracts with CCNO to provide medical care at the regional jail near Stryker Ohio, is not aware of any TB cases there during the last five years, spokesman Amanda Brown said.

    <CENTER></CENTER>Active TB cases can be headaches for correction and detention officials. Local and state health departments are notified, and officials have to contact everyone - including those outside the lockup - who may have been exposed.

    <CENTER></CENTER>"Everyone had to be tested," Ms. Sylvester recalled of the active case at the county jail. "Tracking them all down is almost impossible."

    <CENTER></CENTER>Contact Christina Hall at: or 419-724-6007.