Document 0019
 DOCN  M9480019
 TI    Outbreak of multi-drug-resistant tuberculosis in a New York State
       prison, 1991.
 DT    9410
 AU    Valway SE; Richards SB; Kovacovich J; Greifinger RB; Crawford JT; Dooley
       SW; Division of Tuberculosis Elimination, Centers for Disease Control;
       and Prevention, Atlanta, GA 30333.
 SO    Am J Epidemiol. 1994 Jul 15;140(2):113-22. Unique Identifier : AIDSLINE
       MED/94295535
 AB    In the summer of 1991, four inmates from prison A in Upstate New York
       died of multi-drug-resistant tuberculosis. To determine the extent of
       resistant tuberculosis at prison A and transmission patterns, the
       authors interviewed staff and reviewed medical records and inmate
       movement histories. Contact investigation results were examined to
       determine tuberculin skin test conversions and to estimate risk of
       infection and disease for inmates who were seropositive for human
       immunodeficiency virus (HIV). Eight HIV-positive inmates and one
       HIV-negative guard, who was immunocompromised with cancer, had
       multi-drug-resistant tuberculosis. Eight died, a median of 28 days after
       the first culture-positive specimen was collected. All isolates had
       identical seven-drug resistance and DNA fingerprint patterns. Of exposed
       inmates, 92 out of 306 (30%) had skin test conversions. HIV infection
       was not associated with becoming infected with drug-resistant
       tuberculosis (active disease or skin test conversion), but once
       infected, HIV-positive inmates were significantly more likely to develop
       disease than were HIV-negative inmates (p < 0.001). The source case
       transferred to prison A in February 1991, was ill with undiagnosed
       multi-drug-resistant tuberculosis, refused medical care, and lived in
       the general prison population, where he transmitted the disease to other
       inmates. Lapses in infection control and laboratory delays contributed
       to this outbreak. Prisons should fully implement infection control
       guidelines to prevent tuberculosis transmission.
 DE    Adult  Contact Tracing  *Disease Outbreaks  Human  HIV
       Infections/COMPLICATIONS  Middle Age  New York/EPIDEMIOLOGY  *Prisoners
       Prisons  Risk Factors  Tuberculosis,
       Multidrug-Resistant/*EPIDEMIOLOGY/ETIOLOGY/  TRANSMISSION  Tuberculosis,
       Pulmonary/*EPIDEMIOLOGY/ETIOLOGY/TRANSMISSION  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).