The Status of TB Prevention and Control Measures
in Large City and County Jails in the U.S.
|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
- 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:
- questionnaires mailed to jail system medical directors and
health department TB control directors;
- on-site surveys and observation in each of the 20 jurisdictions;
- 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 - http://www.cdc.gov/tb
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CDC/Division of Tuberculosis Elimination
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