California prison system overhauls TB prevention
Outbreaks prompt tighter controls in HIV units
The California Department of Corrections (DOC) has taken several steps to help curb the spread of TB and other infectious diseases, experts say.
For one thing, the department recently staged a conference, held in three locations across the state, on the topic of infectious diseases. Held in conjunction with the Francis J. Curry Model TB Center and the state AIDS Training Network, the conference was prompted partly by two outbreaks of TB last year, both of which occurred on HIV-dedicated wards.
The conference agenda included talks on the connection between TB and HIV and on ways to prevent TB among health care and correctional officer staff, says Gisela Schecter, MD, conference speaker. Schecter is a consultant for the Francis Curry TB Center in San Francisco and an assistant professor of internal medicine and infectious disease at Stanford University School of Medicine.
Annual screening for latent TB
As a more long-term TB-fighting strategy, four years ago the state DOC implemented a policy that mandates the annual screening of all inmates in the system for latent TB infection. Blind surveys among the prison system’s 100,000-plus inmates have found rates of HIV positivity stand at about 2%; says Schecter; tuberculin skin-test reactivity rates are much higher, at 22%.
"The first year, the screenings turned up a lot of conversions and many active cases," Schecter notes. In 1995, for example, almost 100 cases of active TB were identified.
But every year since, there has been a decline in the number of active cases. Plus, the rate of new infections has been dropping as well. "That’s been very gratifying," she adds.
The two outbreaks that took place last year were similar, even though they happened in separate prisons. "They were similar in the way they spread quickly and in how many people were involved — about 15 in each," says Schecter. In both instances, infection was transmitted beyond the prison walls, spreading into the surrounding community through visiting family members of an inmate in one case and parolees who’d recently been released in the other case.
The outbreaks’ size and their similarity prompted department officials to devise a new and tighter algorithm for dedicated HIV units, she says. Now, anyone admitted to an HIV ward submits a sputum sample and has a chest radiograph. In addition, inmates are strongly urged to take isoniazid prophylaxis when indicated, and delays in getting back test results have been shortened substantially.
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