190822 Multi-drug resistant tuberculosis without borders: A multi-jurisdictional, tri-national, jail investigation in South Texas

Sunday, October 26, 2008

Cara J. Hausler, BS , Communicable Disease Program (TB-STD-HIV), San Antonio Metropolitan Health District, San Antonio, TX
Cherise J. Rohr-Allegrini, PhD, MPH , Communicable Disease Program, Texas Department of State Heatlh Services, Region 8, San Antonio, TX
Domingo J. Navarro, MBA , Communicable Disease Program (TB-STD-HIV), San Antonio Metropolitan Health District, San Antonio, TX
Dora A. Marrufo, BSN, RN , TB Prevention & Control Program, San Antonio Metropolitan Health District, San Antonio, TX
Edwardo Dominguez , TB Prevention & Control Program, San Antonio Metropolitan Health District, San Antonio, TX
Chris Camareno, LVN , Tuberculosis Program, Texas Department of State Heatlh Services, Region 8, San Antonio, TX
Enriqueta Carmona, LVN , Tuberculosis Program, Texas Department of State Heatlh Services, Region 8, Eagle Pass, TX
Rachel Wiseman, MPH , Correctional TB Program, Texas Department of State Health Services, Austin, TX
John J. Nava, MD , TB Prevention & Control Program, San Antonio Metropolitan Health District, San Antonio, TX
Sandra Guerra-Cantu, MD, MPH , Regional Medical Director, Texas Department of State Heatlh Services, Region 8, San Antonio, TX
Fernando A. Guerra, MD, MPH , Health Director, San Antonio Metropolitan Health District, San Antonio, TX
Bryan J. Alsip, MD, MPH , Assistant Director, San Antonio Metropolitan Health District, San Antonio, TX
Background: In March 2008, a frequent cross-border traveler was detained in Maverick County Jail (MCJ), which houses US Marshal and local detainees including persons from the Kickapoo Nation. The inmate was transferred to Bexar County Jail (BCJ) where initial screening found active TB. Following hospital treatment, he returned to BCJ until release on April 29, when he reported to San Antonio Metro Health District (SAMHD) for follow up. Two days later, rifampin and isoniazid resistant-MTB was discovered.

Methods: Inmates and staff who spent three or more hours in close contact with the case were screened. Jail screenings took place over a five week period, which included skin tests, medical/social history questionnaire, and blood tests for HIV, Syphilis, LFTs, and CBCs. Letters were sent to contacts that had already been released.

Results: At MCJ, on the Texas-Mexico border, 51% of inmates and 25% of staff were born in countries with high rates of TB. TST conversion was 18% for inmates and 3% for staff. All were determined to be free of active disease. At BCJ in San Antonio, 150 miles from the border, TST conversion was 8% for inmates and 3% for staff; five suspects were found. Blood screening identified one new HIV case and two new Syphilis cases.

Conclusions: This large scale investigation underscores the need for effective monitoring in jails, communication with local health departments, and collaboration across county and national borders. This experience emphasizes that any city can be significantly affected by tuberculosis and border health issues.

Learning Objectives:
Gain insight into methods used and practical considerations involved in establishing a large scale TB investigation in correctional facilities. Identify key elements of multi-jurisdictional, multi-agency collaborations. Recognize usefulness of an organizational structure in response to large scale investigations of infectious diseases.

Keywords: Epidemiology, Tuberculosis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Communicable Disease Control & Prevention Program Manager Department of State Health Services, Region 8 San Antonio, TX. Management of Programs in Tuberculosis, STD/HIV, Immunizations, Epidemiology including Zoonosis Control and EWIDS Adjunct Assistant Professor University of Texas, School of Public Health at Houston, San Antonio Regional Campus
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.