In the New Mexico Corrections Department, mass screening of male inmates revealed a purified protein derivative of tuberculin (PPD) conversion rate of 3.9 percent and led to the institution of two-stage skin testing of all new inmates. This policy change resulted in a drop of the annual conversion rate to O.9 percent. An analysis of the two-stage testing program showed that of 518 subjects classified as PPD positive, 121 were so classified on the basis of a documented history of a prior positive test, and 397 underwent the two-stage protocol. Of these, 273 (69%) had a significant reaction to the first test. The remaining 124 (31%) required the booster effect of the first test and had significant reactions only to the second test. Two-stage testing is recommended for new inmates of long-term correctional facilities, in order to establish accurate baseline information and to avoid the trap of false converter rates.
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References
1.
AbelesH., FeibesH., & MandelE. (1970). The large city prison: A reservoir of tuberculosis. American Review of Respiratory Disease, 101, 706-709.
2.
Alexander, W. J., & Roper, W. L. (1982). ’Boosted’ tuberculin reactions among Cambodian refugees. Journal of the American Medical Association, 248, 1177-1177.
3.
Amin, N. M. (1994). Tuberculin skin testing: Can it contain the impending tuberculosis epidemic?. Postgraduate Medicine, 95, 46-56.
A strategic plan for the elimination of tuberculosis in the United States. (1989). Morbidity and Mortality Weekly Review, 38, 1-21.
6.
Barry, M. A., Regan, A. M., & Kunches, L. M. (1987). Two-stage tuberculin testing with control antigens in patients residing in two chronic disease hospitals. Journal of the American Geriatrics Society, 35, 147-153.
7.
Bass, J. B. (1990). Tuberculin test, preventive therapy, and elimination of tuberculosis. American Review of Respiratory Disease, 141, 812-813.
8.
Bass, J. B., & Serio, R. A. (1981). The use of repeat skin tests to eliminate the booster phenomenon in serial tuberculin testing. American Review of Respiratory Disease, 123, 394-396.
9.
Braun, M. M., Truman, S. I., & MaguireB. (1989). Increasing incidence of tuberculosis in a prison inmate population associated with HIV infection. Journal of the American Medical Association, 261, 393-397.
10.
Burstin, S. J., Muspratt, J. A., & Rossing, T. H. (1986). Studies of the dynamics of reactivity to tuberculin and candida antigen in institutionalized patients. American Review of Respiratory Disease, 134, 1072-1074.
11.
Chaparas, S. D., Vandiviere, H. M., & MelvinI. (1985). Tuberculin test: Variability with the Mantoux Procedure. American Review of Respiratory Disease, 132, 175-177.
12.
Comstock, G. W. (1975). False tuberculin test results. Chest, 68, Suppl: 465-469.
13.
Comstock, G. W., & Woolpert, S. F. (1978). Tuberculin conversions: True or false?. American Review of Respiratory Disease, 118, 215-217.
14.
Control of tuberculosis in correctional facilities: A guide for health care workers. (1992). Centers for Disease Control and Prevention, 3-16.
15.
Dahnstrom, A. W. (1940). The instability of the tuberculin reaction. American Review of Tuberculosis, 42, 471-487.
16.
Daniel, T. M. (1987). Tuberculosis. Harrison’s Principles of Internal Medicine, 625-633.
17.
Ferebee, S. H., & MountF.W. (1963). Evidence of booster effect in serial tuberculin testing. American Review of Respiratory Disease, 88, 118-119.
18.
Finucane, T. E. (1988). The American Geriatrics Society statement on two-step PPD testing for nursing home patients on admission. Journal of the American Geriatrics Society, 36, 77-78.
19.
FriedenT. (Spring/Summer, 1993). The limitations of population-based tuberculin testing. Centers for Disease Control-Reported in TB Notes, 10-11.
20.
Gordin, F. M., Perez-Stable, E. J., & FlahertyD. (1988). Evaluation of a third sequential tuberculin skin test in a chronic care population. American Review of Respiratory Disease, 137, 153-157.
21.
Gostin, L. O. (1993). Controlling the resurgent tuberculosis epidemic. Journal of the American Medical Association, 269, 255-261.
22.
GrzybowskiS., & Allen, E. A. (1964). The challenge of tuberculosis in decline: A study based on the epidemiology of tuberculosis in Ontario, Canada. American Review of Respiratory Disease, 90, 707-720.
23.
JenP. (1987). Office Practice of Medicine. Colorado: W.B. Saunders.
24.
KatzJ., & PlunkettR. (1950). Prevalence of clinically significant pulmonary tuberculosis among inmates of New York State penal institutions. American Review of Tuberculosis, 61, 51-56.
25.
Kearns, T. J., ColeC.H., & Farer, L. S. (1985). Public health issues in control of tuberculosis. Chest, 87, 1355-1375.
26.
Large urban jail. (1977). Journal of the American Medical Association, 237, 791-792.
27.
MagnusK., & Edwards, L. B. (September, 1955). The effect of repeated tuberculin testing on post-vaccination allergy. Lancet, 24, 643-644.
28.
March-AyuelaP. (1990). Choosing an appropriate criterion for true or false conversion in serial tuberculin testing. American Review of Respiratory Disease, 141, 815-820.
29.
MenziesR., VissandjeeB., & RocherI. (1994). The booster effect in two-step tuberculin testing among young adults in Montreal. Annals of Internal Medicine, 120, 190-198.
30.
Morse, D. L., Hansen, R. E., & Grabau, J. C. (1985). Tuberculin conversions in Indochinese refugees: An assessment of boosting and anergy. Respiratory Disease, 132, 516-519.
31.
Morse, D. L., Hansen, R. E., & SwalbachO. (1982). High rate of tuberculin conversion in Indochinese refugees. Journal of the American Medical Association, 248, 2983-2986.
32.
Page, M. I., & Lunn, J. S. (1984). Experience with tuberculosis in a public teaching hospital. American Journal of Medicine, 77, 667-669.
33.
Perez-Stable, E. J., FlahertyD., & SchecterO. (1988). Conversion and reversion of tuberculin reactions in nursing home residents. American Review of Respiratory Disease, 137, 801-804.
34.
Prevention and control of tuberculosis in correctional institutions: Recommendations of the advisory committee for the elimination of tuberculosis. (1989). Morbidity and Mortality Weekly Review, 38, 313-325.
35.
Reichman, L. B., and O’DayR. (1977). The influence of a history of a previous test on the prevalence and size of reactions to tuberculin. American Review of Respiratory Disease, 115, 737-741.
36.
Report of the American Trudeau Society Committee on tuberculosis in penal and other institutions. (1947). American Review of Tuberculosis, 56, 467-473.
37.
Richards, N. M., Nelson, K. E., & Batt, M. D. (1979). Tuberculin test conversion during repeated skin testing associated with sensitivity to nontuberculous mycobacteria. American Review of Respiratory Disease, 120, 59-65.
38.
Rieder, H. L., Cauthen, G. M., & Kelly, G. D. (1989). Tuberculosis in the United States. Journal of the American Medical Association, 262, 385-389.
39.
Robbins, S. L. (1984). Mycobacteria. Pathologic Basis of Disease, 340-346.
40.
Ruben, F. L., Norden, D. W., & SchusterN. (1977). Analysis of a community hospital employee tuberculosis screening program 31 months after its inception. American Review of Respiratory Disease, 115, 23-28.
41.
Sack, B. R., & KosterF. (1991). Tuberculosis in the ambulatory patient. Principles of Ambulatory Medicine, 320-328.
42.
Screening for tuberculosis and tuberculous infection in high-risk populations: Recommendations of the advisory committee for elimination of tuberculosis. (1990). Morbidity and Mortality Weekly Review, 39, 7-20.
43.
Simon, J. A., McVicker, S. J., & Ferrell, C. R. (1983). Two-step tuberculin testing in a veterans domiciliary population. Southern Journal of Medicine, 76, 866-869.
44.
SkolnickA. (1989). Government issues: Guidelines to stem rising tuberculosis rates in prisons. Journal of the American Medical Association, 262, 3249-3253.
45.
Skolnick, A. A. (1992). Correction facility TB rates soar: Some jails bring back chest roentgenograms. Journal of the American Medical Association, 268, 3175-3176.
46.
Smith, D. T. (1967). Diagnostic and prognostic significance of the quantitative tuberculin tests: The influence of subclinical infections with atypical mycobacteria. Annals of Internal Medicine, 67, 919-946.
47.
Snider, D. E., & Hutton, M. D. (1989). Tuberculosis in correctional institutions. Journal of the American Medical Association, 261, 436-437.
48.
Spencer, S. S. (1989). Improving prison tuberculosis surveillance in the AIDS era. Presented to The American Public Health Association Annual Meeting (unpublished).
49.
Spencer, S. S., & Morton, A. R. (1989). Tuberculosis surveillance in a state prison system. American Journal of Public Health, 79, 507-509.
50.
Stead, W. W. (1979). Undetected tuberculosis in prison. Journal of the American Medical Association, 240, 2544-2547.
51.
Stead, W. W., Lofgren, J. P., & WarrenE. (1985). Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. New England Journal of Medicine, 312, 1483-1487.
52.
The tuberculin skin test. (1981). American Thoracic Society, 1-8.
53.
Thompson, N. J., Glassroth, J. L., & Snider, D. E. (1979). The booster phenomenon in serial tuberculin testing. American Review of Respiratory Disease, 119, 587-597.
54.
Transmission of multidrug-resistant tuberculosis among immunocompromised persons in a correctional system. (New York, 1991). Morbidity and Mortality Weekly Review, 41, 507-509.
55.
Tuberculosis in the United States-1985. (1986). Morbidity and Mortality Weekly Review, 35, 699-703.
56.
Tuberculosis transmission in a state correctional institution. (California, 1990-199 1). Morbidity and Mortality Weekly Review, 41, 927-929.
57.
Valenti, W. M., Andrews, B. A., & Presley, B. A. (1982). Absence of the booster phenomenon in serial tuberculin testing. American Review of Respiratory Disease, 125, 323-325.
58.
WeltyC., BurstinS., & MusprattS. (1985). Epidemiology of tuberculous infection in a chronic care population. American Review of Respiratory Disease, 132, 133-136.
