title: An outbreak of syphilis in Alabama prisons: correctional health policy and communicable disease control.
abstract: OBJECTIVE
  After syphilis outbreaks were reported at 3 Alabama State men's prisons in early 1999, we conducted an investigation to evaluate risk factors for syphilis infection and describe patterns of syphilis transmission.
  
  
  METHODS
  We reviewed medical, patient interview, and prison transfer records and documented sexual networks. Presumptive source cases were identified. Odds of exposure to unscreened jail populations and transfer from other prisons were calculated for case patients at 1 prison.
  
  
  RESULTS
  Thirty-nine case patients with early syphilis were identified from 3 prisons. Recent jail exposure (odds ratio [OR] = 8.0, 95% confidence interval [CI] = 0.3, 158.7, P = .14) and prison transfer (OR = 32.0, 95% CI = 1.6, 1668.1, P < .01) were associated with being a source case patient.
  
  
  CONCLUSIONS
  Probable sources of syphilis introduction into and transmission within prisons included mixing of prisoners with unscreened jail populations, transfer of infected inmates between prisons, and multiple concurrent sexual partnerships. Reducing sexual transmission of disease in correctional settings is a public health priority and will require innovative prevention strategies.
authors.affiliation: Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), Medical Examiner Program, National Center for Environmental Health, Atlanta, Ga., USA. msw6@cdc.gov
authors.forename: M I
authors.initials: MI
authors.lastname: Wolfe
authors.forename: F
authors.initials: F
authors.lastname: Xu
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.forename: M
authors.initials: M
authors.lastname: O'Cain
authors.forename: J A
authors.initials: JA
authors.lastname: Schillinger
authors.forename: M E
authors.initials: ME
authors.lastname: St Louis
authors.forename: L
authors.initials: L
authors.lastname: Finelli
mesh_terms: D015492:AIDS Serodiagnosis; D000328:Adult; D000407:Alabama / Q000453:epidemiology; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006292:Health Priorities; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016134:Organizational Policy; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons / Q000458:organization & administration* / Q000706:statistics & numerical data; D015980:Public Health Practice; D044469:Racial Groups / Q000145:classification; D012307:Risk Factors; D021841:Safe Sex / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D012747:Sexual Partners; D013587:Syphilis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D013588:Syphilis Serodiagnosis