title: Meningococcal disease in Los Angeles County, California, and among men in the county jails.
abstract: BACKGROUND
  From January through March 1993, there were 54 cases of meningococcal disease in Los Angeles County, California, of which 9 occurred among men incarcerated in the county's jail system, which was 40 percent above capacity at the time. Several of the 45 patients from the community had had contact with men recently released from a county jail.
  
  
  METHODS
  We interviewed patients from the community (n=42) and neighborhood controls matched with the patients for age, race, and ethnic group (n=84) about potential exposures. We collected and cultured pharyngeal swabs for Neisseria meningitidis from men entering the central jail (n=162), men leaving the central jail (n=379), members of the jail staff (n=121), and patients at a community health center (n=214). Meningococcal isolates were identified by serotyping and multilocus enzyme electrophoresis.
  
  
  RESULTS
  The presence of community-acquired meningococcal disease was strongly associated with exposure to a person who had been in or worked at one of the county jails (multivariate matched odds ratio, 18.5; 95 percent confidence interval, 3.8 to 90.8; P<0.001). Pharyngeal carriage of meningococcus was significantly more frequent among men released from jail (19 percent) or entering jail (17 percent) than among workers at the jails (3 percent) or community residents seen at the clinic (1 percent). Among men entering jail, those who had previously been incarcerated were more often carriers than those who had not (21 percent vs. 7 percent, P=0.03). Of the isolates from nine community residents with serogroup C meningococcal disease, eight were the same strain as that isolated from the eight inmates with serogroup C disease.
  
  
  CONCLUSIONS
  In this outbreak of meningococcal disease in Los Angeles County, nearly half of community residents with the disease had contact with persons who had been in a county jail. The high rates of carriage among recidivists and released inmates suggests that the men became meningococcal carriers while in jail.
authors.affiliation: Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Tappero
authors.forename: R
authors.initials: R
authors.lastname: Reporter
authors.forename: J D
authors.initials: JD
authors.lastname: Wenger
authors.forename: B A
authors.initials: BA
authors.lastname: Ward
authors.forename: M W
authors.initials: MW
authors.lastname: Reeves
authors.forename: T S
authors.initials: TS
authors.lastname: Missbach
authors.forename: B D
authors.initials: BD
authors.lastname: Plikaytis
authors.forename: L
authors.initials: L
authors.lastname: Mascola
authors.forename: A
authors.initials: A
authors.lastname: Schuchat
mesh_terms: D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D006801:Humans; D015994:Incidence; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008589:Meningococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D015999:Multivariate Analysis; D009345:Neisseria meningitidis / Q000145:classification / Q000302:isolation & purification; D010614:Pharynx / Q000382:microbiology; D011329:Prisoners; D011330:Prisons; D012307:Risk Factors