PR Newswire - 29 September 1995

A systemwide tuberculosis (TB) screening of inmates and employees; and

A seroprevalence study of 5,000 incoming inmates for HIV and hepatitis.

"We are adding an entirely new chapter of scientific data to the study of infectious diseases," said Director of Corrections James H. Gomez. "The public health issues we find in our prisons are a reflection of what is going on in the community at large," said Gomez.

Inmate TB Tests

More than 118,000 inmates in the state prison system were tested during a three day period in April 1993 and again in April 1994. Inmates previously documented as TB negative were tested with Purified Protein Derivative (PPD) injected between layers of the skin. All inmate movement was halted for three consecutive days while the tests were administered and then read.

The 1994 results showed a 28.2% prevalence rate, meaning that a little over one-fourth of the inmates had been exposed to and infected with TB at some point in their lives. The test does not indicate when the individual was exposed. The prevalence rate is up slightly from the 1993 rate of 25.5%.

Prevalence was higher for males (28.9%) than for females (17.9%). Hispanics made up the largest percentage of those testing positive (49.7%), followed by African-Americans (28.1%), Caucasians (14.8%), and others (7.4%). Nearly half (45.1%) of those testing positive came from Los Angeles County.

There was a significant decrease in the number of inmates with active TB disease. Only 82 cases were found in 1994 compared to 250 in 1993. Nineteen of the 82 cases were diagnosed in state prison; the rest had the disease when they arrived.

"These figures show that we are doing an excellent job of controlling TB in our prisons," said Director Gomez.

The conversion rate -- the percent of the population whose test results went from negative to positive within 12 months -- was 6.6%. This was the first year conversion rates could be calculated. It takes 10 to 12 weeks after exposure to "convert."

"This is believed to be the largest such study ever conducted of prison inmates, a risk population for which little comparative data exists," said Dr. Susann Steinberg, the department's Chief Medical Officer over public health. "It is difficult to make comparisons between high risk populations," said Dr. Steinberg. "However, a small study of San Francisco's adult homeless population showed that 32% were positive for TB infection."

Managing TB in Prisons

Corrections attributes its overall success to a program of aggressive screening and follow-up treatment of suspected TB. CDC physicians isolate suspected cases of TB. The computerized TB Alert Coding System identifies and tracks the TB status of every inmate in the Department of Corrections.

The system is designed to prevent infectious inmates from being mistakenly moved to other institutions. It also alerts health care staff that certain inmates need particular medication. For example, those inmates with active and infectious TB are treated using Directly Observed Therapy (DOT). Under DOT, the inmates are handed daily medications by health care staff who ensure first-hand that the medicine is swallowed.

"Our TB control procedures are being studied and emulated by other state, federal and local correctional systems," said Dr. Steinberg.

Staff TB Tests

The first mandatory TB screening of CDC staff took place in January 1994. "This is the largest single employee group that has ever been studied," said Director Gomez. "We tested more than 35,000 individuals. Previous studies were limited to just a few hundred." "The California Department of Corrections is the first organization to fully study the employee side of the equation," said Gomez.

TB prevalence rates for Corrections staff are much lower than those for inmates. Overall, 6.4% of CDC staff tested positive for TB infections. No cases of active TB were reported among CDC staff members in the last year. Correctional Officers, the largest group of CDC employees and those with the most direct daily contact with inmates, had a prevalence rate of 5.3%.

Because 1994 was the first year for staff screening, conversion rates are not yet available. However, CDC employees will continue to be tested annually, with the results publicly reported.

HIV and Hepatitis Prevalence

The California Department of Corrections initiated a separate seroprevalence study of the incoming inmate population to determine the prevalence of Human Immunodeficiency Virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among incoming inmates. Viral hepatitis is a common contagious disease caused by several viruses that attack the liver. Hepatitis means inflammation of the liver, usually producing swelling and tenderness and sometimes permanent damage to the liver.

In 1994, the California Department of Health Services (DHS) Office of AIDS, with CDC, tested 5,000 inmates entering six CDC reception centers. The seroprevalence survey was entirely blinded, meaning test results could not be linked to any individual inmate.

The DHS/CDC study found that 2.4% of male inmates and 3.2% of female inmates entering state prison were infected with the HIV virus. This is relatively unchanged from the 1988 test results of 2.5 percent for male inmates and 3.1 percent for female inmates. The HIV seroprevalence rate for the community at large is reported to be 0.4%.

"California's inmate HIV infection rates are comparable to those reported in federal correctional facilities," said Dr. Steinberg. "However, the rate of HBV and HCV infection among incoming prisoners is a growing concern."

Almost half of the incoming female inmates (47.9%) and almost one third of the males (32.1%) tested positive for HBV. The numbers were higher for HCV: 54.5% for females and 39.4% for males. HIV and hepatitis are spread through the same high risk behavior, such as injection drug use, tattooing and unsafe sex. "These diseases are coming from the local communities," said Dr. Steinberg." The high HBV and HCV rates are an indicator of a potential for significant future growth in HIV/AIDS throughout California and the nation."

Corrections plans to intensify and reinforce its educational programs so that inmates throughout the state prison system are made fully aware that AIDS and Hepatitis are preventable. Corrections also will study other steps that may be taken in coordination with state and local health officials to reduce the prevalence of Hepatitis in the communities that these inmates are coming from.

Summary of TB Test Results

38.1% of the inmates tested were sent to prison from Los Angeles County, and 45% of those LA commitments tested positive for tuberculosis.

8.1% of the inmates tested were sent to prison from San Diego County, and 9.4% of them tested positive for TB. 4.7% of the inmates tested were sent to prison from Orange County, and 5.4% tested positive for tuberculosis.

3.8% of the inmates tested were sent to state prison from Santa Clara County and 3.6% of them tested positive for TB.

2.8% of the inmates tested were sent to state prison from San Francisco County and 3.4% of them tested positive for tuberculosis.

CONTACT: Tip Kindel, Assistant Director of California Department of Corrections, 916-445-4950

COMPANY NAME: CALIFORNIA DEPARTMENT OF CORRECTIONS STATE: CALIFORNIA (CA) SECTION HEADING: HEALTH; STATE

Copyright (c) 1995/PR NewsWire. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Permissions Desk, PR Newswire, 810 Seventh Avenue, New York, NY 10019.
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