title: A Qualitative Inquiry About Pruno, an Illicit Alcoholic Beverage Linked to Botulism Outbreaks in United States Prisons.
abstract: OBJECTIVE
  Since 2011, 3 outbreaks of botulism in US prisons have been attributed to pruno, which is an alcoholic beverage made by inmates. Following 1 outbreak, we conducted a qualitative inquiry to understand pruno brewing and its social context to inform outbreak prevention measures.
  
  
  METHODS
  We interviewed staff, inmates, and parolees from 1 prison about pruno production methods, the social aspects of pruno, and strategies for communicating the association between botulism and pruno.
  
  
  RESULTS
  Twenty-seven inmates and parolees and 13 staff completed interviews. Pruno is fermented from water, fruit, sugar, and miscellaneous ingredients. Knowledge of pruno making was widespread among inmates; staff were familiar with only the most common ingredients and supplies inmates described. Staff and inmates described inconsistent consequences for pruno possession and suggested using graphic health messages from organizations external to the prison to communicate the risk of botulism from pruno.
  
  
  CONCLUSIONS
  Pruno making was frequent in this prison. Improved staff recognition of pruno ingredients and supplies might improve detection of brewing activities in this and other prisons. Consistent consequences and clear messages about the association between pruno and botulism might prevent outbreaks.
authors.affiliation: Maroya Spalding Walters, Nandini Sreenivasan, Mark Shew, Daniel Wheeler, and Agam Rao are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Maroya Spalding Walters and Nandini Sreenivasan are also with the Epidemic Intelligence Service, CDC. Bobbie Person is with the Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases. Julia Hall and Karyn Leniek are with the Utah Department of Health, Salt Lake City. Linda Bogdanow is with the Salt Lake County Health Department, Salt Lake City.
authors.forename: Maroya Spalding
authors.initials: MS
authors.lastname: Walters
authors.affiliation: Maroya Spalding Walters, Nandini Sreenivasan, Mark Shew, Daniel Wheeler, and Agam Rao are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Maroya Spalding Walters and Nandini Sreenivasan are also with the Epidemic Intelligence Service, CDC. Bobbie Person is with the Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases. Julia Hall and Karyn Leniek are with the Utah Department of Health, Salt Lake City. Linda Bogdanow is with the Salt Lake County Health Department, Salt Lake City.
authors.forename: Nandini
authors.initials: N
authors.lastname: Sreenivasan
authors.affiliation: Maroya Spalding Walters, Nandini Sreenivasan, Mark Shew, Daniel Wheeler, and Agam Rao are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Maroya Spalding Walters and Nandini Sreenivasan are also with the Epidemic Intelligence Service, CDC. Bobbie Person is with the Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases. Julia Hall and Karyn Leniek are with the Utah Department of Health, Salt Lake City. Linda Bogdanow is with the Salt Lake County Health Department, Salt Lake City.
authors.forename: Bobbie
authors.initials: B
authors.lastname: Person
authors.affiliation: Maroya Spalding Walters, Nandini Sreenivasan, Mark Shew, Daniel Wheeler, and Agam Rao are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Maroya Spalding Walters and Nandini Sreenivasan are also with the Epidemic Intelligence Service, CDC. Bobbie Person is with the Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases. Julia Hall and Karyn Leniek are with the Utah Department of Health, Salt Lake City. Linda Bogdanow is with the Salt Lake County Health Department, Salt Lake City.
authors.forename: Mark
authors.initials: M
authors.lastname: Shew
authors.affiliation: Maroya Spalding Walters, Nandini Sreenivasan, Mark Shew, Daniel Wheeler, and Agam Rao are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Maroya Spalding Walters and Nandini Sreenivasan are also with the Epidemic Intelligence Service, CDC. Bobbie Person is with the Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases. Julia Hall and Karyn Leniek are with the Utah Department of Health, Salt Lake City. Linda Bogdanow is with the Salt Lake County Health Department, Salt Lake City.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wheeler
authors.affiliation: Maroya Spalding Walters, Nandini Sreenivasan, Mark Shew, Daniel Wheeler, and Agam Rao are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Maroya Spalding Walters and Nandini Sreenivasan are also with the Epidemic Intelligence Service, CDC. Bobbie Person is with the Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases. Julia Hall and Karyn Leniek are with the Utah Department of Health, Salt Lake City. Linda Bogdanow is with the Salt Lake County Health Department, Salt Lake City.
authors.forename: Julia
authors.initials: J
authors.lastname: Hall
authors.affiliation: Maroya Spalding Walters, Nandini Sreenivasan, Mark Shew, Daniel Wheeler, and Agam Rao are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Maroya Spalding Walters and Nandini Sreenivasan are also with the Epidemic Intelligence Service, CDC. Bobbie Person is with the Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases. Julia Hall and Karyn Leniek are with the Utah Department of Health, Salt Lake City. Linda Bogdanow is with the Salt Lake County Health Department, Salt Lake City.
authors.forename: Linda
authors.initials: L
authors.lastname: Bogdanow
authors.affiliation: Maroya Spalding Walters, Nandini Sreenivasan, Mark Shew, Daniel Wheeler, and Agam Rao are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Maroya Spalding Walters and Nandini Sreenivasan are also with the Epidemic Intelligence Service, CDC. Bobbie Person is with the Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases. Julia Hall and Karyn Leniek are with the Utah Department of Health, Salt Lake City. Linda Bogdanow is with the Salt Lake County Health Department, Salt Lake City.
authors.forename: Karyn
authors.initials: K
authors.lastname: Leniek
authors.affiliation: Maroya Spalding Walters, Nandini Sreenivasan, Mark Shew, Daniel Wheeler, and Agam Rao are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Maroya Spalding Walters and Nandini Sreenivasan are also with the Epidemic Intelligence Service, CDC. Bobbie Person is with the Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases. Julia Hall and Karyn Leniek are with the Utah Department of Health, Salt Lake City. Linda Bogdanow is with the Salt Lake County Health Department, Salt Lake City.
authors.forename: Agam
authors.initials: A
authors.lastname: Rao
mesh_terms: D000328:Adult; D000434:Alcoholic Beverages / Q000382:microbiology*; D001906:Botulism / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011329:Prisoners; D011330:Prisons; D036301:Qualitative Research; D014481:United States; D014589:Utah