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U.S. Department of Health and Human Services


The Status of TB Prevention and Control Measures in Large City and County Jails in the U.S.

Executive Summary

Three Key Recommendations

1) Improving TB prevention and control requires that jails and local public health departments increase their direct collaboration. Organizational mechanisms that are associated with increased collaboration include

  • having designated liaisons between the agencies for TB control,
  • holding regular meetings of management and line staff, and
  • having health department TB program staff perform on-site services at jails.

2) Monitoring patient management and evaluating TB control activities necessitates that jails develop electronic information systems that have easily retrievable patient information and aggregate data on key TB measures, including skin test positivity rates.

3) Effective TB prevention and control necessitates that jails and health departments actively evaluate TB screening, containment, and discharge planning practices in order to identify successes and address deficiencies.

The share of U.S. tuberculosis (TB) cases occurring among inmates in jail facilities is disproportionately high.1 Structural factors in most jails, such as overcrowding and poor ventilation, combined with inmates’ heightened risk for TB, make jails a particularly high-risk environment for the transmission of TB. At the same time, the rapid movement of inmates into and out of jails makes it difficult for many inmates to complete any TB treatment that is started in jail. As a result, effective TB prevention and control measures in jails are needed to reduce TB rates among inmates as well as in the general U.S. population.2

In 1999, the Centers for Disease Control and Prevention (CDC) initiated a study to assess the extent to which jails have implemented CDC’s 1996 recommendations for TB prevention and control in correctional facilities, to assess the extent of collaboration between jail systems and public health departments, and to identify barriers to collaboration.

The study focused on jurisdictions having large city and county jail systems—i.e., those with average daily populations of at least 1,500—and having general community TB case rates at or above the national average (6.8/100,000). Forty-six jurisdictions met these criteria. Twenty jurisdictions were randomly selected from these 46, proportional to the regional distribution. After review by the CDC Institutional Review Board, data were collected from September 2000 to September 2001 through the following methods:

  1. questionnaires mailed to jail system medical directors and health department TB control directors;
  2. on-site surveys and observation in each of the 20 jurisdictions; and
  3. abstraction of a sample of medical records of inmates with TB disease and latent TB infection (LTBI).

City and county jail systems face difficult choices regarding how to allocate scarce resources in order to implement these recommendations. However, as the jails’ partners in TB control, public health departments can help jail systems increase the effectiveness and efficiency of their TB prevention and control efforts.

1 Hutton MD, Cauthen GM, Bloch AB. Results of a 29-state survey of tuberculosis in nursing homes and correctional facilities. Public Health Reports 1993;108:305-314.

2 CDC. Prevention and control of tuberculosis in correctional facilities: recommendations of the Advisory Counci;45 (No. RR-8). 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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