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Editor: It was with great interest that I read your recent supplement on tuberculosis in correctional facilities (Infection Control Consultant, October 1996, pp. 127-130). In general, I felt that the article outlined the problem well and highlighted the general lack of support from community public health entities. However, as medical director of the Harris County Jail in Houston, Texas, I feel I must respond. While I appreciate your efforts to focus on this highly significant area of infectious disease, I felt that the article could leave the reader with the impression that TB screening either does not occur in jails, or if present, is inadequate.
Since 1994, the Harris County Jail has been screening detainees for active tuberculosis with digital chest X-rays performed at booking and intake screening for symptoms. This year to date we have performed over 51,000 chest X-ray screenings (7,736 individuals had recent chest X-rays at our facility and so were not rescreened with X-rays). If an active tuberculosis case is suspected either clinically or by X-ray, the individual is housed in one of our 47 respiratory isolation cells to minimize the chance for exposure within the institution. Detainees are tested with skin-testing if they remain in the jail 14 days after incarceration. Currently, 586 individuals with TB skin-test conversion are being treated with prophylactic anti-tuberculosis medication. Our employees are tested annually with skin tests and/or chest X-rays if appropriate. Over 1,800 employees have been screened this year.
Large urban jails in Chicago and New York City also screen for active tuberculosis at intake, although with different X-ray modalities. Despite the apparent lack of public health support for such ventures, correctional institutions are taking the appropriate steps to prevent the spread of tuberculosis through early detection and treatment of their detainees. In my opinion, jail medical units deliver at least the level of care available to similar non-incarcerated populations, and in some ways are held to a higher standard than community public health clinics.
Michael Seale, MD
Medical Director and Assistant Professor
University of Texas Health Science Center