MULTIDRUG-RESISTANT TUBERCULOSIS IN THE NEW-YORK-STATE PRISON SYSTEM,1990-1991

Three epidemiologically linked multidrug-resistant (MDR) tuberculosis (TB) outbreaks in 1990-1991 involving New York State (NYS) inmates sug gested MDR-TB was widespread in NYS prisons. Inmate lists were linked to 1990-1992 TB registries, medical records were reviewed, and movemen t histories for inmates with MDR-TB were examined within and between p risons and hospitals. In 1990-1991, 171 inmates were diagnosed with TB . This rate (156.2/ 100,000) was significantly higher than the 1990-19 91 US rate (10.4/100,000) and the 1986 rate among NYS inmates (105.5/1 00,000). Of 171 cases, 155 were culture-confirmed; 37 (32%) of 116 wit h drug susceptibilities determined had MDR-TB. Two other inmates with TB before 1990 were diagnosed with MDR-TB in 1990-1991. Of 39 inmates with MDR-TB, 38 (97%) were infected with the human immunodeficiency vi rus and 34 (87%) have died. These 39 lived in 23 of the 68 NYS prisons while potentially infectious; 12 were transferred through 20 prisons while ill with MDR-TB. Policies of correctional systems on infection c ontrol and inmate transfers need to be reevaluated to prevent spread o f TB.