RESUMEN
OBJECTIVE: This study evaluated adherence to tuberculosis control guidelines, published by the Centers for Disease Control and Prevention in 1996, in a large urban jail. Jails are a critical locale because of high risk for tuberculosis transmission in a congregate setting. METHODS: Symptom screening at intake into the facility was systematically observed. Medical records were reviewed to measure timing of tuberculin skin testing (TST) and chest radiograph (CXR) screening. Isolation records were examined for airborne infectious isolation practices. Contact investigation practices were evaluated for ease of data retrieval and adherence to CDC guidelines. RESULTS: A TB symptom screening question was asked correctly during 28/97 of intake health interviews. Median time from intake to TST was 3 days for men and 2 days for women. Median time from referral to CXR was 2 days for men and 7 days for women. Delays were noted in diagnostic testing of 51 detainees isolated for suspected TB. Contact investigations lacked comprehensive procedures, data collection forms, and databases for managing information. CONCLUSION: Findings were used to refine protocols for TB control. This evaluation illustrated the need for ongoing assessment of adherence to TB control protocols in short-term correctional settings to prevent the spread of TB.
Asunto(s)
Control de Enfermedades Transmisibles/métodos , Adhesión a Directriz/estadística & datos numéricos , Tamizaje Masivo/métodos , Prisiones , Tuberculosis Pulmonar/prevención & control , Adulto , Baltimore , Centers for Disease Control and Prevention, U.S. , Control de Enfermedades Transmisibles/normas , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Distribución por Sexo , Factores de Tiempo , Prueba de Tuberculina , Tuberculosis Pulmonar/diagnóstico , Estados Unidos , Población UrbanaRESUMEN
To assess the circumstances of recent transmission of tuberculosis (TB) (progression to active disease <2 years after infection), we obtained DNA fingerprints for 1172 (99%) of 1179 Mycobacterium tuberculosis isolates collected from Maryland TB patients from 1996 to 2000. We also reviewed medical records and interviewed patients with genetically matching M. tuberculosis strains to identify epidemiologic links (cluster investigation). Traditional settings for transmission were defined as households or close relatives and friends; all other settings were considered nontraditional. Of 436 clustered patients, 115 had recently acquired TB. Cluster investigations were significantly more likely than contact investigations to identify patients who recently acquired TB in nontraditional settings (33/42 vs. 23/72, respectively; p<0.001). Transmission from a foreign-born person to a U.S.-born person was rare and occurred mainly in public settings. The time from symptom onset to diagnosis was twice as long for transmitters as for nontransmitters (16.8 vs. 8.5 weeks, respectively; p<0.01). Molecular epidemiologic studies showed that reducing diagnostic delays can prevent TB transmission in nontraditional settings, which elude contact investigations.