Evaluation of identifying tuberculosis infection and disease in a rural institutionalized population

Abstract 

Context

Although the overall prevalence of tuberculosis (TB) in the United States is declining, correctional facilities continue to encounter a higher prevalence of this disease. Despite mandatory reporting laws for active TB, data for latent TB infection (LTBI) remains sketchy because reporting it is not required.

Purpose

Investigation of the period prevalence of LTBI in a rural Ohio regional jail compared with other populations in the region to determine the need and adequacy of the screening program.

Methods

Data collected on inmates was compared with data collected on hospital employees within the same geographic region.

Findings

Between January 2006 and July 2007, staff at the jail tested 1274 inmates for TB using the Mantoux purified protein derivative (PPD) method. Ten inmates (6 in 2006 and 4 in 2007) tested positive. All 10 cases were followed with a negative chest radiograph, leading to the diagnosis of LTBI. The overall incidence for the jail for LTBI was 0.8%, with 0% active cases. However, 85 inmates (6.7% of the population) were released before a PPD interpretation could be completed. In the comparative population, 651 hospital employees were tested for TB. Of these, 32 employees tested positive (LTBI prevalence of 4.9%). There were no cases of active TB reported.

Conclusion

The prevalence of LTBI in a rural jail (0.8%) is lower than the comparative sample population at a local hospital (4.9%). The rapid release of inmates (6.7%) indicates that TB data is incomplete and that potential cases of LTBI could have been unreported because of missed opportunity for interpretation of skin tests.

Keywords: Tuberculosis, Latent, Jail, Rural, Prevalence, LTBI