Girma M. Teumelissan, MPH¹, Farah M. Parvez, MD, MPH², Reena Mahajan, MHS¹, and James L. Capoziello, JD³. (1) New York City Department of Health and Mental Hygiene, Office of Correctional Public Health, 225 Broadway Street, 23rd Floor, Room 1, New York, NY 10007, 212-788-3928, gteumeli@health.nyc.gov, (2) Office of Correctional Public Health, New York City Department of Health and Mental Hygiene, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 225 Broadway Street, 23rd Floor, Room 27, New York, NY 10007, (3) Health Care Access and Improvement, New York City Department of Health and Mental Hygiene, 161 William Street, 5th Floor, New York, NY 10038

Background: In New York City, implementation of national tuberculosis (TB) control initiatives has helped decrease the TB epidemic from its peak in 1992 of 52 cases per 100,000 to the year 2000 rate of 15.3 per 100,000. Despite these advances, incarcerated populations remain particularly vulnerable to TB exposure and subsequent infection. The prevalence of TB in incarcerated populations is 4-17 times greater than in the general population and an estimated 35% of those with TB in the United States have served time in correctional facilities. Prevalence studies of reactive tuberculin skin tests (TST) in correctional populations reveal rates of 3.9-27.6%. In May 2003, we initiated a TB surveillance system at Rikers Island, one of the country’s largest jails, to determine the prevalence of reactive TSTs in newly incarcerated populations. Methods: We analyzed data from the Rikers Island TB infection surveillance system. Data was reviewed for all new inmate admissions from May to December 2003. Results: During the study period, 47,074 inmates were incarcerated at Rikers Island; 85% were male. Of 47,074 inmates, 6916 (14.7%) self-reported a history of reactive TST and 291 (0.6%) reported a recent non-reactive TST. Of 39,867 eligible inmates, TSTs were performed on 39,387 (98.7%) inmates; the remaining inmates either refused the TST (n=461; 1.2%) or were discharged prior to TST being conducted (n=19; 0.05%). Of inmates receiving the TST, 22% (8,754/39,387) were either discharged or transferred within 48-72 hours, preventing TST evaluation by a clinical provider. Of 30,633 TSTs available for evaluation, 1,294 (4.2%) were reactive; of these, 775 (60%) were released into the community before further evaluation regarding treatment could be conducted. Conclusions: Our data reveal that 1) the prevalence of reactive TSTs in recently incarcerated inmates of NYC jails was 4.2%; and 2) nearly 1/4 of inmates with reactive TSTs were released from jail before clinical evaluation could be completed. Jails conducting screening for TB should develop methods to improve continuity of care for inmates released into the community. In addition, given the short duration of incarceration for many jail inmates, the use of newer or alternative testing methods should be considered.

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