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Overcrowding Leads to Pneumonia

On September 8, 1994, the New England Journal of Medicine published the report of an investigation conducted by the U. S. Centers for Disease Control and Prevention into the outbreak of a deadly form of pneumonia in the Harris County (Houston) jail in Texas in 1989. The outbreak was caused by a bacteria known as streptococcus pneumoniae which causes pneumonia or more serious blood infections. This outbreak was the first in what has become a series of pneumonia infections in crowded places, including prisons, jails, military bases, day care centers and nursing homes.

Dr. Robert Breiman, whose team investigated the Harris County jail outbreak, said "We think this was a sentinel in the reemergence of that disease." The study concluded that the bacteria was fostered by the cramped, airless conditions that gave each jail prisoners less than 34 square feet of living space. The 13 story jail was designed to hold 3,500 prisoners but at the time of the outbreak held 6,700, with half sleeping on the floor on mattresses. The outbreak affected 46 prisoners in one month, killing two. Investigators discovered that no prisoners with more than 80 square feet of living space were affected. They also discovered that the jail ventilation system delivered 6 cubic feet of outside air per person per minute. The recommended level is 20 cubic feet per person per minute. Likewise, current engineering standards suggest giving prisoners at least 50 square feet of living space.

The report concluded that the outbreak was caused by overcrowding, poor air circulation and the susceptibility of the prisoners to actually being infected by the bacteria due to health problems caused by AIDS and drug abuse. "My gut feeling is the thing that played the greatest role was overcrowding, but it was a combination of all three," said Dr. Breiman.

Harris county has opened a new jail since the outbreak occurred. The old jail, where the outbreak occurred, now holds 3,750 prisoners. A new ventilation system has been designed but not installed yet.

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