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

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.