TB Risk and People Who Live or Work in Correctional Facilities

Overview

TB is a challenging disease to identify, treat, and control, especially in settings like correctional facilities (e.g., prisons or jails) where people live and work close to each other.

People have a higher risk of being exposed to TB germs who:

• Live or used to live in large group settings where TB is more common, such as correctional facilities
• Work in places where TB is more likely to spread, such as correctional facilities

TB germs are more likely to spread in correctional facilities due to several factors, including:

• People who may have increased risk for TB due to other health conditions,
• Environment of the facilities such as people living in close proximity, poor air flow, shared airspaces, and overcrowding, and
• Movement of people between facilities.

Correctional facility staff or other service providers can contact their local or state TB program for information about TB prevention and control. Correctional facilities should develop plans to identify and treat TB disease to prevent TB outbreaks.

Definition of correctional health

Correctional health encompasses all aspects of health and well-being for adults and juveniles who are justice systemA-involved, from their arrest, during detention or incarceration, and through the time they return to their community (called “reentry”).

A person who is 'justice systemA-involved' is any person who is currently or has ever been arrested or incarcerated in a detention or correctional facility. This term also includes those reentering their communities after detention or incarceration, including those on parole or probation. Correctional health also includes the health of families and communities of persons who are justice systemA-involved and of the administrators and staff who work in facilities.

Persons who are justice systemA-involved may have had varying levels of medical care before entering a correctional facility1. They may not have had access to medical care to diagnose inactive TB (or latent TB infection) or active TB disease early.

People with inactive TB do not feel sick, do not have symptoms, and cannot spread TB germs to others. Without treatment, people with inactive TB can develop active TB disease at any time and become sick. Active TB disease can spread to others and be deadly. Preventing, finding and treating active TB disease early is important to stop the spread of TB germs and keep people who live or work in correctional facilities safe.

Conditions that can increase risk

People who live or work in correctional facilities and have certain medical conditions may be at higher risk of developing active TB disease once they are infected with TB germs.

Some people in prison or jail are more likely to use substances, such as drugs and alcohol1. Substance use is a risk factor for TB disease. It includes excess alcohol use, noninjecting drug use, and injecting drug use. Substance use can be a barrier to TB diagnosis and treatment.

Some people have a weaker immune system because of certain medications or health conditions such as diabetes, cancer, or HIV. A weakened immune system increases a person's risk for developing active TB disease once infected with TB germs.

Places with increased risk

Correctional facilities are places with increased risk for TB because of the environment of the facilities.

Correctional facilities:

• Are places where people live in close physical proximity,
• May have poor air flow and shared airspaces, and
• May be overcrowded.

These characteristics can make it more likely for some diseases, including active TB disease, to spread.

Movement between facilities

Moving people into and out of facilities that may be overcrowded and have poor air flow increase the risk for the spread of active TB disease1.

Moving people from one facility to another also makes it challenging for people with inactive TB or active TB disease to complete treatment1. Treatment for inactive TB or active TB disease can take several months. Moving to a different facility may interrupt a person's medical care making it difficult to adhere to treatment.

Correctional facilities should coordinate with other correctional facilities and health departments to help people continue and complete their treatment for inactive TB or active TB disease even if they are moved to a different facility or reenter their community1.

Prevention and control

Effective TB prevention and control measures are important to protect people who live or work in correctional facilities and the community. These measures include:

• Implementing a TB screening program,
• Treating people for inactive TB and active TB disease, and
• Conducting a thorough and efficient contact investigation when a case of active TB disease is diagnosed.

Correctional facilities should work closely with local or state TB programs and other partners to implement TB prevention and control measures.

Resources