MENINGOCOCCAL DISEASE IN LOS-ANGELES-COUNTY, CALIFORNIA, AND AMONG MEN IN THE COUNTY JAILS

Background From January through March 1993, there were 54 cases of men ingococcal disease in Los Angeles County, California, of which 9 occur red among men incarcerated in the county's jail system, which was 40 p ercent above capacity at the time. Several of the 45 patients from the community had had contact with men recently released from a county ja il. Methods We interviewed patients from the community (n = 42) and ne ighborhood controls matched with the patients for age, race, and ethni c group (n = 84) about potential exposures. We collected and cultured pharyngeal swabs for Neisseria meningitidis from men entering the cent ral jail (n = 162), men leaving the central jail (n = 379), members of the jail staff (n = 121), and patients at a community health center ( n = 214). Meningococcal isolates were identified by serogrouping and m ultilocus enzyme electrophoresis. Results The presence of community-ac quired meningococcal disease was strongly associated with exposure to a person who had been in or worked at one of the county jails (multiva riate matched odds ratio, 18.5; 95 percent confidence interval, 3.8 to 90.8; P<0.001). Pharyngeal carriage of meningococcus was significantl y more frequent among men released from jail (19 percent) or entering jail (17 percent) than among workers at the jails (3 percent) or commu nity residents seen at the clinic (1 percent). Among men entering jail , those who had previously been incarcerated were more often carriers than those who had not (21 percent vs. 7 percent, P = 0.03). Of the is olates from nine community residents with serogroup C meningococcal di sease, eight were the same strain as that isolated from the eight inma tes with serogroup C disease. Conclusions In this outbreak of meningoc occal disease in Los Angeles County, nearly half of community resident s with the disease had contact with persons who had been in a county j ail. The high rates of carriage among recidivists and released inmates suggest that the men became meningococcal carriers while in jail. (C) 1996, Massachusetts Medical Society.