High Rates of TB Found in Prisons, Nursing Homes

Tuberculosis rates among inmates in prisons and jails nationwide have risen to twice the level in the general population, according to unpublished statistics currently being analyzed by the federal Centers for Disease Control.

Dr. Dixie Snider, director of the centers’ Division of Tuberculosis Control, said in an interview that preliminary data from a survey of 29 states suggests equally disproportionately high rates among people living in nursing homes.

Snider and other health officials traced the high rates to several factors, including easy transmission of airborne bacteria in communal living quarters, as well as high tuberculosis rates among recent immigrants and among people infected with the AIDS virus.

“One of the concerns is that there are a large number of people who go through corrections facilities each year,” Snider said. “If there’s not a mechanism in place to detect when people are infected and give preventive treatment, we can increase the tuberculosis problem in the community.”

In nursing homes, Snider said, the high infection rate could affect visitors as well as residents.

“Not that I want to alarm people, but there have also been instances of outbreaks in nursing homes,” Snider added. “Some family members are very devoted and stay many hours. . . . Those folks are at risk. I think for those reasons, the general public has a vested interest.”

Tuberculosis is a chronic bacterial infection that usually attacks the lungs. It is most often spread by coughing and sneezing. In the past, it was usually fatal. Now, most cases can be successfully treated with antibiotics that stop the bacteria from spreading.

Nevertheless, the disease is on the rise in the United States, according to the most recent CDC statistics. Between 1985 and 1986, the number of cases reported nationwide rose by 2.6% to 22,768--the first significant increase since 1953.

Public health officials trace much of that rise to lowered immunity in people infected with the AIDS virus. They also attribute it to the influx of immigrants from Central America and the Asian-Pacific islands where tuberculosis is more common.

Two-Year Survey

The CDC findings come from a two-year survey of tuberculosis rates in institutions nationwide. Twenty-nine states, not including California, agreed to supply the agency with disease-rate and census data in 1984 and 1985.

According to Snider, a preliminary analysis indicates that the rate in prisons and in nursing homes is about twice what would be expected in the general population. The prison statistics were adjusted to take into account the fact that prisons house disproportionately high numbers of younger people and men from low-income groups, in which tuberculosis is more common.

Snider declined to make available specific figures but said: “I think our epidemiologists feel comfortable in saying . . . that regardless of the specific number, there is more tuberculosis in prisons than in the general population.”

CDC officials will report their findings in detail in October to the National Commission on Correctional Health Care, a nonprofit group that develops standards for jails and prisons. The agency and the commission are also drawing up new tuberculosis control guidelines.

Currently, tuberculosis screening practices differ from facility to facility depending upon state and local rules. In California, the state Department of Corrections routinely tests all people entering its prisons, said department spokeswoman Christine May.

County Inmates Screened

Dr. John Clark, chief physician for the Los Angeles County Sheriff’s Department, said that all county inmates are also screened. That screening turned up 235 cases of active, or infectious, tuberculosis in 1987, a number Clark said represents a clear increase over past years. All who test positive are held in the infirmary and treated until they are no longer infectious.

Stanley Morita, assistant chief of the tuberculosis control unit in the state Department of Health Services, said the department is drawing up a proposal for more extensive tuberculosis surveillance in state prisons in light of an outbreak at Folsom Prison in January.

Asked about the nursing home findings, industry officials said the tentative conclusions are not surprising in light of the proximity in which residents live.

“The feeling of the people I talked to was that it is unlikely that it is a problem evenly spread across the country,” said Linda Keegan, a spokeswoman for the American Health Care Assn., the nation’s largest nursing home lobbying group. “It’s more likely a variable situation where you have many nursing homes with no cases whatsoever, then you have some with several cases.”