The resurgence of tuberculosis (TB) in the late 1980's and early 1990's in the general population and in correctional facilities is closely associated with the AIDS epidemic and particularly affects minorities and intravenous drug users who are disproportionately represented among correctional inmates.
Not only do inmate populations contain a large number of persons at high risk for TB and HIV but also correctional facilities themselves may be high-risk settings for TB transmission because of their crowding and poor ventilation. One of the most ominous developments in TB resurgence has been the appearance of multidrug resistant TB (MDR-TB). In response to the increasing occurrence of TB in prisons and jails, the National Institute of Justice and the Centers for Disease Control (CDC) and Prevention sponsored a survey of TB and TB control. Questionnaires were mailed in 1992 to 88 correctional systems in Federal, State, city, and county jurisdictions, and telephone followup was conducted to attain a 100-percent response rate for Federal and State prison systems and 84 percent for city and city jail systems. In addition, site visits were made to correctional systems in New York and Georgia. Survey results provided basic clinical information on TB and the increase in MDR-TB, as well as information on correctional system policies and procedures with respect to TB control, TB screening and diagnosis, the management and treatment of inmates with TB, discharge issues, and training and education. Specifically, survey respondents reported 1,177 inmates under treatment for TB (805 in Federal and State prison systems and 372 in city and county jail systems); 85 percent of cases involved men. The point prevalence rate for TB was 121 cases per 100,000 inmates. Survey results also indicated that 53,000 inmates were infected with TB (48,000 in Federal and State prison systems and 5,000 in city and county jail systems). The infection rate was 10 percent among men and 11 percent among women. Forty-three cases of TB were reported among correctional staff. In general, TB control policies of most correctional systems appeared to follow CDC recommendations. Areas where compliance with CDC guidelines was less widespread included screening, testing, and treatment duration. An appendix contains an order form for CDC materials. Endnotes and tables