Dear Corrections Colleagues,

As long as there have been humans, there has been tuberculosis. For millennia Mycobacterium tuberculosis has been shortening lives and today continues to ravage. Over a third of the population of our planet harbors the bacterium and an increasing subset is infected with drug resistant strains.

As with many of today's major infectious disease threats, human behavior has played a major role in fostering crisis. Indiscriminate use of anti-tuberculosis medications, suboptimal treatment adherence, cuts in the funding of successful tuberculosis (TB) control programs, global migration and the concentrating of persons at risk for the infection in medical and correctional facilities have each contributed to the resurgence in this infection; added to these is the companion epidemic of HIV.

Together these factors conspire within prisons and jails to create a 'perfect storm' in which the organism can be efficiently transmitted. Therefore, it is essential that correctional systems take seriously the threat posed by TB and implement policies and procedures to screen, diagnosis and treat those with the disease while limiting opportunities for the spread of the infection. Effective TB control programming requires knowledge, diligence and funding. We at IDCR cannot help with the last two but have dedicated this issue to the first in order to help increase understanding of TB for those working within jails and prisons.

IDCR Editor in Chief, Dr. Anne DeGroot and Dr. Renee Ridzon of the Bill and Melinda Gates Foundation have co-authored a comprehensive review of the major issues in the management and control of TB in correctional settings. A pair of case studies from Drs. Edward Gardner and Robert Belknap from Denver Public Health accompanies their article.

As we confront a world where multiple drug resistant TB is a frightening reality, it is essential we in corrections, of all people, not be lax when it comes to TB. The consequence of our failure would be dire and can be summed up vividly in one word: Russia.

Sincerely,

David A. Wohl, MD
Associate Professor of Medicine
Division of Infectious Diseases
AIDS Clinical Research Unit
University of North Carolina

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