Methicillin-resistant Staphylococcus aureus is increasingly responsible for staphylococcal outbreaks in prison. There is limited information on the source of the outbreak strains, risk factors for infection, and transmission of these strains within a prison. We conducted a survey to determine the prevalence of nasal colonization with S. aureus in 2 New York State prisons. S. aureus isolates from clinical cultures collected from all New York State prisons during a 6-month period were compared with the colonizing strains. Analyses were conducted to determine whether prison-level characteristics were associated with colonization or infection with S. aureus. The colonization rate was 25.5% (124/487); 10.5% of the isolates were methicillin resistant, all were staphylococcal chromosomal cassette (SCC)mec type IV, and 61.5% were Panton Valentine leukocidin (PVL) positive. Surprisingly, 21.6% of the methicillin-susceptible isolates were also PVL positive. Of the clinical isolates, 48.3% were methicillin resistant, with 93.1% of the latter being SCCmec type IV and 48.3% being PVL positive. The predominant clone was USA 300. Prison-level risk factors for infection included the proportion of inmates with drug offenses, the length of inmate stay, and the jail from which inmates originated. This study suggests that both new and long-term inmates act as sources of S. aureus strains, with the more virulent of the latter preferentially being selected as pathogens.
Throat carriage (42.7%) of Staphylococcus aureus exceeded nasal carriage (35.0%) in 2 New York prisons. Methicillin resistance, primarily due to USA300, was high at both sites; 25% of dually colonized inmates had different strains. Strategies to reduce S. aureus transmission will need to consider the high frequency of throat colonization.
SYNOPSISThis article describes the development of a statewide program providing continuity of hepatitis C virus (HCV) treatment to prisoners upon release to the community. We discussed length of stay as a barrier to treatment with key collaborators; developed protocols, a referral process, and forms; mobilized staff; recruited heath-care facilities to accept referrals; and provided short-term access to HCV medications for inmates upon release. The Hepatitis C Continuity Program, including 70 prisons and 21 health-care facilities, is a resource for as many as 130 inmates eligible to start treatment annually. Health-care facilities provide fairly convenient access to 87.1% of releasees, and 100% offer integrated HCV-human immunodeficiency virus/acquired immunodeficiency syndrome care. As of March 2006, 24 inmates had been enrolled. The program was replicated in the New York City Rikers Island jail. The program is operational statewide, referrals sometimes require priority attention, and data collection and other details are still being addressed.
To improve knowledge of and encourage testing for HIV, hepatitis, and sexually transmitted diseases among inmates, Albany Medical College and the New York State Department of Corrections developed a peer-led videotape and comic-book-style pamphlet. Inmates assigned to an intervention group viewed the videotape and pamphlet and completed pre- and posttest questionnaires; a control group did not. Both groups completed a risk assessment and testing request form. Analysis sought to detect testing request differences between groups and changes in disease knowledge among intervention group participants. Although more intervention participants requested testing, the differences were not statistically significant. After viewing the videotape, significantly more inmates agreed that communicable diseases are treatable (78.3%), that not all have symptoms (70.8%), and that a positive diagnosis is not a death sentence (82.5%). Videotapes and pamphlets can improve inmate knowledge, information retention, attitudes, and requests for communicable disease testing.
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