Transcript TUBERCULOSIS DISEASE - Urban Strategies Council

Communicable Diseases
in the Reentry Equation
Dr. Rosilyn Ryals
Division of Communicable Disease and Prevention
Alameda County Public Health Department
November 8, 2007
Presentation at: Alameda County Reentry Health Task Force Meeting
OVERVIEW
According to Bureau of Justice reports in 2005,
approximately 650,000 state and federal
prisoners reenter the community each year:
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91% of those released are men
55% are White; 44% are African American; 17% Hispanic
Median age of released prisoners is 33 years
Median level of education is 11th grade
Studies demonstrate a high prevalence of substance abuse
and physical and mental health problems
OVERVIEW
• In a 2004 study, 56% of state prisoners and 50%
of federal prisoners used drugs in the month
before committing the offense for which they
were incarcerated
• Inmates with substance abuse problems before
incarceration have a greater risk of contracting a
variety of diseases, including HIV, tuberculosis
(especially multi-drug resistant), Hepatitis B and
C, and sexually transmitted diseases
OVERVIEW
• There are significant limitations to data available on
communicable diseases among inmates and releasees
of correctional facilities
• Prevalence estimates on communicable diseases from
the National Commission on Correctional Health Care
will be applied to Alameda County releasee data for
2005 to estimate the substantial and disproportionate
burden of communicable diseases on this population.
OVERVIEW IN ALAMEDA
COUNTY
From the Urban Strategies Council
September 13th, 2007 report:
– Total Reentry population in 2005 was 21, 384
– Of this population, 3,462 were parolees
• 91% were males
• 67.5% of parolees were African American; 16% White; and
12.9% Latino
TUBERCULOSIS DISEASE
Source: Hammett, T.M., P. Harmon, and W. Rhodes, “The Burden of Infectious Disease Among Inmates and Releasees from
Correctional Facilities,” paper submitted to the National Commission on Correctional Health Care, Chicago, Illinois, May
2000. (Copy in volume 2 of this report.)
Epidemiology of Tuberculosis
(TB)
• Airborne disease transmitted person to person, for
example, through talking, coughing, sneezing, laughing,
singing of an infected person
• Active Disease versus Infection
• Factors increasing risk:
• Environmental crowding/poor ventilation (e.g. residence in
jails, prisons, homeless shelters)
• Use of illicit drugs
• HIV infection
• Immigrants from countries with high rates of active TB
• Socioeconomic status
Tuberculosis (TB) in Releasees
• Estimated U.S. prevalence of TB disease among
inmates is 0.04 -0.17%
• Applied to Alameda County inmates, this
estimates between 9 – 36 individuals released
with TB disease
• Estimated U.S. prevalence of TB infection
among inmates is 7.4%
• Applied to Alameda County inmates, this
estimates 1582 individuals released with TB
infection.
Public Health Opportunities for TB
• Screen all new entrants
• Re-screen entrants annually based upon length of stay
• Organize new intake and sick-call areas to be well
ventilated
• Reduce duration of infectiousness through timely
diagnosis of disease; isolation; and prompt and effective
treatment
• Prompt reporting to the Public Health Department
• Strategy for managing TB infections
• Staff vigilance for signs and symptoms in inmate
population
• Contact investigation of cases still incarcerated
• Discharge/transition planning with PHD on cases being
released for follow-up by TB Control Program case
management system
HEPATITIS B INFECTION
Source: Hammett, T.M., P. Harmon, and W. Rhodes, “The Burden of Infectious Disease Among Inmates and Releasees from Correctional
Facilities,” paper submitted to the National Commission on Correctional Health Care, Chicago, Illinois, May 2000. (Copy in volume 2 of this
report.)
Epidemiology of Hepatitis B
Efficiently transmitted by percutaneous or mucous
membrane exposure to infectious blood or body fluids
that contain blood.
Primary risk factors:
• Unprotected sex with an infected partner
• Unprotected sex with more than one partner
• MSM
• History of other STDs
• Illegal injection drug use
• Tattooing/body piercing
Define “chronic” and “current”
Hepatitis B in Releasees
• Estimated U.S. prevalence of Hepatitis B
infection (current or chronic) among
inmates is 2.0%
• Applied to Alameda County inmates, this
estimates 428 individuals released with
current or chronic Hepatitis B
Public Health Opportunities for
Hepatitis B
• Reducing disease transmission:
• Harm-reduction messages identical to those for
HIV and Hepatitis C on safer sexual practices and
needle sharing
• Hepatitis B screening and immunization of
uninfected and non-immune persons
• Refer infected inmates for anti-viral treatment
• Report chronic and current cases promptly to the
Public Health Department
• Investigate contacts of infectious prisoners
HEPATITIS C INFECTION
Source: Hammett, T.M., P. Harmon, and W. Rhodes, “The Burden of Infectious Disease Among Inmates and Releasees from Correctional Facilities,”
paper submitted to the National Commission on Correctional Health Care, Chicago, Illinois, May 2000. (Copy in volume 2 of this report.)
Epidemiology of Hepatitis C
Most efficiently transmitted through large or
repeated percutaneous exposure to infected
blood (e.g. through transfusion of blood from
unscreened donors or through use of injecting
drugs.
Although less efficient than Hepatitis B,
occupational, perinatal, and sexual exposures
also can result in transmission.
Epidemiology of Hepatitis C
Hepatitis C is the most common chronic
bloodborne viral infection in the U.S.
Primary risk factors:
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Injection or illegal drug use
HIV infection
Blood transfusion or solid organ transplant before July 1992
Received clotting factor concentrates produced before 1987
Long-term dialysis
Those with signs and symptoms of liver disease
Epidemiology of Hepatitis C
• There is no vaccine against Hepatitis C
• Persons with chronic or current Hepatitis B are more
likely to transmit their infection to susceptible contacts
than patients with Hepatitis C
• Hepatitis C carrier state is common. Communicability
may persist indefinitely
• Co-infection of Hepatitis C with HIV can lead to more
rapid progression to HCV-related liver disease, and
increased risk of HCV-related cirrhosis.
Hepatitis C in Releasees
• Estimated U.S. prevalence of Hepatitis C
infection among inmates is 17 – 18.6%
• Applied to Alameda County inmates, this
estimates 3,635 – 3,977 individuals
released with Hepatitis C
Public Health Opportunities for
Hepatitis C
• Reducing disease transmission:
• Harm-reduction messages identical to those for
HIV and Hepatitis B on safer sexual practices and
needle sharing
• Hepatitis C screening
• Refer infected inmates for anti-viral treatment
• Report infections to the Public Health Department
• Investigate contacts of infectious inmates
AIDS
HIV INFECTION
Source: Hammett, T.M., P. Harmon, and W. Rhodes, “The Burden of Infectious Disease Among Inmates and Releasees from
Correctional Facilities,” paper submitted to the National Commission on Correctional Health Care, Chicago, Illinois, May 2000.
(Copy in volume 2 of this report.)
Epidemiology of HIV/AIDS
Essentially same mode of transmission as
Hepatitis B and C
Risk Factors:
• Unprotected sex with an infected partner
• Unprotected sex with more than one partner
• MSM
• History of other STDs, especially genital ulcer
disease
• Illegal injection drug use
• Tattooing/body piercing
• Racial minority, particularly African American
HIV/AIDS Releasees
• Estimated U.S. prevalence of HIV infection
among inmates is 1.2 – 2.98%
• Applied to Alameda County inmates, this
estimates 257 – 637 individuals released with
HIV infection
• Estimated U.S. prevalence of AIDS among
inmates is 0.5%
• Applied to Alameda County inmates, this
estimates 107 individuals released with AIDS
Public Health Opportunities for
HIV/AIDS
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HIV testing
Harm-reduction training
Refer for treatment of HIV disease
Report Infections to Public Health
Department
• Diagnosis and treatment of other STDs
Summary
Communicable Diseases:
(1) By virtue of their infectious nature, can impact
others to whom they are transferred
(2) Can cause substantial morbidity and death
(3) Can challenge public health and other
community resources in the investigation,
prevention, or control of outbreaks
(4) Can challenge public health and other
resources though the long-term management
of chronic disease that may result from
infection (e.g. HIV, Hepatitis B, Hepatitis C,
etc.)