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M9480019.TXT
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1994-08-09
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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).