Tuberculosis case detection in a state prison system.
OBJECTIVE
This study was designed to describe the epidemiology of tuberculosis ((TB) among inmates in the Georgia state prison system; to evaluate the effectiveness of the TB case detection methods used; to evaluate the use of contact tracing for inmate TB cases; and to determine rates of completion of therapy.


METHODS
Using a standardized form, the authors abstracted data from reports to the Centers for Disease Control and Prevention, prison hospital medical charts, and county health department records for all patients with TB treated in the Georgia Department of Corrections prison system from 1991 through 1995.


RESULTS
A total of 142 cases of tuberculosis were treated in the prison during five-year period. Approximately two-thirds were detected by active case finding,either at the county jail prior to transfer to the prison system (31%) or at the prison intake evaluation (37%). Routine screening procedures at entry, following Centers for Disease Control and Prevention guidelines, had a sensitivity of 96%. Contact investigations were carried out in county jails or in the community for only 25% of cases detected at entry to prison. For those released from prison still on treatment, 38% were lost to follow-up before completion of therapy.


CONCLUSIONS
The Georgia prison system is doing an effective job of TB case detection and treatment among incarcerated inmates. Closer cooperation between the prison system and local health departments is needed to improve contact tracing and completion of therapy for this high risk population. Some cases detected at entry to prison appear to have been missed in the county jails
Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. nbock@emory.edu
N N
NN
Brock
M
M
Reeves
M
M
LaMarre
B
B
DeVoe
D000328:Adult; D019090:Case Management; D016358:Contact Tracing; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011329:Prisoners; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*