Corrections_Today_January_February_2019

Advertisement

Tuberculosis in Correctional Facilities: Keeping inmates, employees and visitors healthy

Photo by CDC/Dr. George Kubica

Most Americans consider tuberculosis (TB) to be a disease of the past - or at least one that isn’t a problem in this country. However, recent research shows that, though completely preventable, TB incidence has been declining at the sluggish rate of only 1.65%, a rate too slow to reach TB elimination this century. 1 This goal might be further out of reach for populations in certain high-risk settings, such as corrections facilities.

BY THE NUMBERS

The rate of TB in American corrections facilities is up to 8x higher in higher than civilian populations 4

An estimated 1. 3 MILLION people die from TB each year worldwide 2

13 MILLION people in the U.S. carry latent TB infection 3

8 x

TB is caused by the bacterial complex Mycobacterium tuberculosis , which can spread via cough or sneeze by someone with an active infection. In the general population, 10% of individuals infected will develop active TB disease in their lifetime. Those who do not develop TB disease but remain infected will have a condition called latent TB infection (LTBI). While most people with LTBI will stay healthy, certain health and environmental factors heighten the risk that a latent infection will convert into the full-blown disease. As a population, those who have been or are currently incarcerated have higher rates of risk factors independently associated with TB. 5 In the US, these factors include:

Co-infection with HIV 5.6% of cases

Substance/excessive alcohol use (within 12 months prior to diagnosis): 18.1%

Homelessness* (within 12 months prior to diagnosis): 4.9%

TB can spread quickly in overcrowded settings—a reality of many correctional facilities—where a single infectious outbreak increases the rate of disease for inmates, employees, and visitors alike. TB outbreaks in correctional facilities not only affect inmates, but staff and surrounding communities, due to:

High turnover rate for inmates with short sentences

Lack of access to health care for formerly incarcerated individuals

86 % are reactivation of LTBI 5

14% of TB cases are from recent transmission 3

The best way to prevent TB is to identify LTBI and treat it before it poses a threat. Correctional facilities are susceptible to both new transmission and reactivation of LTBI.

As a result, prevention of tuberculosis has long been a public health priority in the US, and early intervention to screen for and treat LTBI are now considered routine primary health services for high-risk populations. National guidelines from the US Preventive Services Task Force (USPSTF) now recommend LTBI testing for all persons who live or work in congregate settings, including correctional facilities. 6 “In correctional facilities, as in other high-risk settings, a strong infection-control plan requires administrative measures and risk assessments that are focused on early detection and treatment of LTBI,” says Dr. Masae Kawamura, Senior Director of Medical and Scientific Affairs at QIAGEN. “Strong TB infection control requires the cooperation of a facility’s entire community— employees, residents and visitors— to know they are at risk, know their TB status and to take action when TB is suspected. One step that management can take is to use the most effective and accurate tools to detect TB infection, while it’s latent, enabling the targeting of new shorter and safer preventive treatment regimens to those needing it most.”

1. Keshavjee, S. et al. (2015). Stopping the body count: a comprehensive approach to move towards zero tuberculosis deaths. The Lancet. Dec. 5, 2015. https://doi.org/10.1016/S0140-6736(15)00320-7 2. Tuberculosis Data and Statistics (2018, June 5). Retrieved from https://www.cdc.gov/tb/statistics/default.htm 3. CDC Latent Tuberculosis infection. www.cdc.gov/tb/publications/ltbi/intro.htm 4. McDaniel C. J. et al. (2017). Tuberculosis trends in California correctional facilities, 1993-2013. Int J Tuberc Lung Dis. 2017;21(8):922-929 5. Tuberculosis in the United States, 2016 (2017). Retrieved from: https://www.cdc.gov/tb/statistics/reports/2016/pdfs/2016_Surveillance_FullReport.pdf 6. Bibbins-Domingo, K. (2016) Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. Sep 6, 2016.

24