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TB Alert

By David Gilbert

Tuberculosis (TB) is the leading infectious killer in the world. Long considered conquered in the industrialized nations, TB is now making a comeback in the U.S. Prison is one danger zone for this disease which can be spread by airborne bacteria. In recent mass screenings (with the PPD test) in New York State, 1/4 of the prisoners showed positive for exposure to TB. Ordinarily only a small portion of those who test positive, about 10%, will proceed to active TB, and it is only those who are actively sick who can transmit the germs to others. While New York has been particularly hard hit, including with treatment resistant strains, TB is an emerging problem in other prison systems as well.

Prisoners need to be aware of the particular problems of containing the spread of TB in populations with significant incidence of HIV (the AIDS virus). The typical TB screening with PPD tests, while a part of a public health program, is not adequate for finding every prisoner who may have active/contagious TB for purposes of isolation and treatment. Persons with compromised immune systems 1) will often show false negatives on the PPD test and 2) can convert from latent to active/contagious TB very rapidly. In addition, some prisoners don't trust medical staff and will live with possible TB symptoms rather than report to sick call. Adequate screening for active TB requires painstaking and expensive measures.

As a practical matter, the front-line of TB protection for prison populations is adequate ventilation. Bringing in fresh air and exhausting the old, along with good circulation, greatly reduce the risk by diluting the concentration of germs. In some situations, ultra violet lights to kill the TB germs are also needed. It is impossible to know without an engineering survey just how much the windows have to be open and how adequate the ventilation is. Prisoners should try to see that such surveys are done. In the meantime, prisoners should maximize fresh air and circulation in all buildings. It is much better to put on an extra sweatshirt for the chill than to catch TB.

More information can be found in: TB Information. Write to: The National Prison Project, 1875 Connecticut Ave. NW, Suite 410, Washington, DC 20009.

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