Valway S E, Richards S B, Kovacovich J, Greifinger R B, Crawford J T, Dooley S W
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA 30333.
Am J Epidemiol. 1994 Jul 15;140(2):113-22. doi: 10.1093/oxfordjournals.aje.a117222.
In the summer of 1991, four inmates from prison A in Upstate New York died of multi-drug-resistant tuberculosis. To determine the extent of resistant tuberculosis at prison A and transmission patterns, the authors interviewed staff and reviewed medical records and inmate movement histories. Contact investigation results were examined to determine tuberculin skin test conversions and to estimate risk of infection and disease for inmates who were seropositive for human immunodeficiency virus (HIV). Eight HIV-positive inmates and one HIV-negative guard, who was immunocompromised with cancer, had multi-drug-resistant tuberculosis. Eight died, a median of 28 days after the first culture-positive specimen was collected. All isolates had identical seven-drug resistance and DNA fingerprint patterns. Of exposed inmates, 92 out of 306 (30%) had skin test conversions. HIV infection was not associated with becoming infected with drug-resistant tuberculosis (active disease or skin test conversion), but once infected, HIV-positive inmates were significantly more likely to develop disease than were HIV-negative inmates (p < 0.001). The source case transferred to prison A in February 1991, was ill with undiagnosed multi-drug-resistant tuberculosis, refused medical care, and lived in the general prison population, where he transmitted the disease to other inmates. Lapses in infection control and laboratory delays contributed to this outbreak. Prisons should fully implement infection control guidelines to prevent tuberculosis transmission.
1991年夏天，纽约州北部A监狱的4名囚犯死于耐多药结核病。为了确定A监狱耐多药结核病的范围和传播模式，作者采访了工作人员，查阅了医疗记录和囚犯流动历史。对接触者调查结果进行了检查，以确定结核菌素皮肤试验的阳转情况，并估计人类免疫缺陷病毒（HIV）血清学阳性囚犯的感染和发病风险。8名HIV阳性囚犯和1名HIV阴性狱警（因癌症免疫功能低下）患有耐多药结核病。8人死亡，从采集到第一份培养阳性标本起，中位时间为28天。所有分离株具有相同的七药耐药性和DNA指纹图谱。在接触过的囚犯中，306人中有92人（30%）皮肤试验阳转。HIV感染与感染耐多药结核病（活动性疾病或皮肤试验阳转）无关，但一旦感染，HIV阳性囚犯比HIV阴性囚犯患疾病的可能性显著更高（p<0.001）。传染源病例于1991年2月转至A监狱，患有未确诊的耐多药结核病，拒绝接受治疗，生活在普通监狱人群中，并在那里将疾病传播给其他囚犯。感染控制措施的疏漏和实验室延误导致了此次疫情爆发。监狱应全面实施感染控制指南以预防结核病传播。
