TB Prevention and Control in Correctional and Detention Facilities, 2006

1. TB Prevention and Control in Correctional and DetentionFacilities, 2006 Mark Lobato, MD Division of TB Elimination Centers for Disease Control and Prevention Northeast TB Controllers Meeting October 24, 2006

2. What’s New? (1) • Bases guidelines on existing evidence • Broadens definition of corrections to include detention facilities • Uses a risk assessment approach • Testing by TST or QFT-Gold

3. What’s New? (2) • Highlights importance of collaboration, education, and evaluation • Emphasizes case management • Expands environmental controls section and adds a section on respiratory protection • Recognizes the role of ICE in screening the foreign born in the U.S.

4. Symptom Screening • Specifies which questions to ask • Train staff on screening interview techniques

5. TB Testing • TST should be done within 7 days • Offer a menu of options (TST, QFT, CXR) • HIV-infected persons require a CXR

6. Facility Risk AssessmentMinimum Risk Facility • Zero TB cases in last year • Not a “high-risk” population (HIV, IDU) • Not large numbers of foreign born • Employees not otherwise at risk for TB • All other facilities are non-minimal risk

7. TB Screening: Minimal Risk Facility Entry Screen for symptoms TB Symptoms Present? Yes Isolate and evaluate No Yes TST or QFT – G CXR (HIV+) Inmate has TB risk? No No further test

8. Non-Minimum Risk Facility • Symptom review at entry • immediately place symptomatic in a AII room • TB test (TST, QFT-G, CXR) within 7 days • CXR for HIV infected or immunosuppressed • Consider therapy for positive test results

9. TB Screening: > Minimal Risk Facility Screen for symptoms Entry TB Symptoms Present? Isolate and evaluate No Obtain medical History If treatment not completed, CXR and evaluate Yes Previous TST + documented? No

10. TB Screening: > Minimal Risk Facility No previous TST+ documented TST* or QFT-G TST+ or QFT-G? Yes CXR and evaluate No HIV+ or at risk for HIV but status unknown? Yes CXR and evaluate No *2-step testing recommended for Initial testing in facilities that perform periodic TST testing Retest periodically In long-term facilities

11. Recommendations • Report suspect cases by all entities including federal facilities to local or state HD • Screen all incoming inmates at entry with a symptom review • Perform risk assessment • Screen high risk inmates with a tuberculin skin test (or QuantiFeron-TB) within 7 days of entry • Isolate TB suspects immediately • Plan for discharge early • Special section on ICE detainees

12. New and Renewed Emphasis • Summarizes changes in treatment for TB and latent TB infection • Expands collaboration between health departments and medical staff • Emphasizes contact tracing and outbreak investigations • Provides details for evaluation of TB control activities • Offers guidance on training and education

13. Jails – A Community Institution Shelter Homeless Soup Clinic Kitchen Hospital Clinic Jail Detention Center -

14. Discharge Planning • Requires coordination between corrections and public health • Begin soon after diagnosis • Interview by health department ideally should occur before release

15. Collaboration • Requires formal mechanisms • Designated liaisons • Regular meetings • Written agreements • Conduct contact investigations with input from health departments • Address referral of soon-to-be released inmates

16. Evaluation • Assess level of TB risk • Collect and organize data • Analyze data and present conclusions • Make improvements based on findings

17. Public health must go to jail.