Tuberculosis, or TB, is a word that can evoke fear and apprehension in inmates, medical staff, correctional officers, attorneys and even judges. But TB is as old as the Pyramids. According to the medical journals, TB has even been found in the spines of mummies. 

Many people think tuberculosis has been eradicated much like smallpox, however, it has not. March 24th signifies World TB Day, the date commemorating Robert Koch's discovery of the TB bacillus. Medications have been developed to cure tuberculosis, and are very effective once the disease is identified. However, as disease rates decline, so do concerns³. 

The airborne transmission of TB in a correctional setting presents a public health problem for everyone: employees, inmates and the communities into which inmates are released. March 24th is a date that should be important to people who work in corrections as well as governmental organizations. It is a day to look within your own correctional facilities and TB programs and see how they support worldwide TB control efforts. The facts listed below will help you to understand more: 

*Around the nation, there are an estimated 10 to 15 million Americans infected with the TB bacteria, with the potential to develop active TB disease in the future. 
* CDC estimates that about 10 percent of infected individuals with healthy immune systems will develop TB disease at some point in their lives¹. 
* Persons recently infected with TB and those who have HIV/AIDS or other conditions that harm the immune system are at greater risk of progressing to active TB disease at some point in their lives and 
* Persons with HIV and TB infection are up to 800 times more likely to develop active TB Disease². 

Persons at increased risk of developing active disease once infected with tuberculosis, other than the HIV-infected, include people with diabetes, substance abusers, persons <10% below ideal body weight, such as alcoholics, non-injection drug users, etc., and persons born in countries where TB is prevalent. If your correctional facility has people like this as part of its identified population of inmates, then you need a good TB program in your facility and a good working relationship with your local health department.

In Florida from 1993 until 2001, cases in county jails and prisons made up only a small part of the total overall cases in the state. But, as you look at the numbers, along with the percentages of cases, it takes on a whole new meaning because conditions associated with TB (e.g., poverty, drug use, HIV infection) are more common in the incarcerated population than in the general population. Tuberculosis infection rates are also substantially higher among inmates.

The following table represents the totals over a three-year period: 

Table 1

However, if you look at the period of the past five years, you see a different picture:

Table 2

              1998     1999      2000    2001   2002*
Jails:          35          36          45        47       26
DOC:          24           9            18        11       13 
State:     1,294      1,274    1,163   1,139   1,086

County Jails: 2.70% of TOTAL CASES in 1998
County Jails: 3.86% of TOTAL CASES in 2000
County Jails: 4.2% of TOTAL CASES in 2001
County Jails: 2.4% of TOTAL CASES in 2002

                                           (*Provisional Data)


While disease rates declined, cases per population in corrections rose. As we learn more and more about how tuberculosis affects people, we learn to understand the importance of effective TB control programs for correctional facilities. The opportunity exists to recognize this disease 'within the walls' and to work with some otherwise non-compliant clients, such as homeless persons and substance abusers. 

Florida has developed several ways to work with their correctional facilities. 

* The Bureau of TB and Refugee Health has developed a link on their website specifically for those interested in corrections. You can access it here.

* The Florida Corrections TB Program brings persons interested in corrections together with people working in the field of tuberculosis, as well as other people working with diseases that impact TB, such as HIV, Hepatitis and STDs. Its meetings are held semi-annually around the state and are very informative. 

* The development of a TB Contact Investigations in Corrections course has been helpful in identifying difficulties within corrections with identification to outside providers. 

TB is an important public health issue in correctional facilities. Despite widespread efforts to reduce transmission within these facilities, TB outbreaks continue. Every person who has TB disease was once a contact to someone with active tuberculosis. Working together, we can raise the awareness and continue to combat this major health problem. 

For more information on tuberculosis, visit the Bureau of TB and Refugee Health's website at www.doh.state.fl.us/disease_ctrl/tb, or contact your local health department's TB control program. 

References
¹ Centers for Disease Control and Prevention (CDC), Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection, MMWR, Vol. 49/No RR-6, June 9, 2000.
² Core Curriculum on Tuberculosis, What the Clinician Should Know, U.S. Department of Health & Human Services, Centers for Disease Control and Prevention, 4th Edition, 2000
³ Quote by Lee Reichman, M.D., Director for New Jersey Model TB Center, 1991 

About the Author 
Ellen Murray is a Registered Nurse Consultant for Corrections in the Florida Department of Health's Bureau of TB & Refugee Health. She currently works with county jails and county health departments to establish better communication regarding tuberculosis reporting, as well as assisting county jails with the development of site-specific TB plans with their own community. She is also the Contract Manager for the Florida Department of Corrections' TB Program. To contact Ms. Murray, call (850) 245-4316 or e-mail her at Ellen_Murray@doh.state.fl.us.