Meningococcal Disease in Los Angeles County, California, and among Men in the County Jails
Jordan W. Tappero, M.D., M.P.H., Roshan Reporter, M.D., M.P.H., Jay D. Wenger, M.D., Bridget A. Ward, R.N., B.S.N., Michael W. Reeves, Ph.D., Timm S. Missbach, M.D., Brian D. Plikaytis, M.S., Laurene Mascola, M.D., M.P.H., and Anne Schuchat, M.D.
Background From January through March 1993, there were 54 casesof meningococcal disease in Los Angeles County, California,of which 9 occurred among men incarcerated in the county's jailsystem, which was 40 percent above capacity at the time. Severalof the 45 patients from the community had had contact with menrecently released from a county jail.
Methods We interviewed patients from the community (n =42) andneighborhood controls matched with the patients for age, race,and ethnic group (n = 84) about potential exposures. We collectedand cultured pharyngeal swabs for Neisseria meningitidis frommen entering the central jail (n = 162), men leaving the centraljail (n = 379), members of the jail staff (n = 121), and patientsat a community health center (n = 214). Meningococcal isolateswere identified by serogrouping and multilocus enzyme electrophoresis.
Results The presence of community-acquired meningococcal diseasewas strongly associated with exposure to a person who had beenin or worked at one of the county jails (multivariate matchedodds ratio, 18.5; 95 percent confidence interval, 3.8 to 90.8;P<0.001). Pharyngeal carriage of meningococcus was significantlymore frequent among men released from jail (19 percent) or enteringjail (17 percent) than among workers at the jails (3 percent)or community residents seen at the clinic (1 percent). Amongmen entering jail, those who had previously been incarceratedwere more often carriers than those who had not (21 percentvs. 7 percent, P = 0.03). Of the isolates from nine communityresidents with serogroup C meningococcal disease, eight werethe same strain as that isolated from the eight inmates withserogroup C disease.
Conclusions In this outbreak of meningococcal disease in LosAngeles County, nearly half of community residents with thedisease had contact with persons who had been in a county jail.The high rates of carriage among recidivists and released inmatessuggest that the men became meningococcal carriers while injail.
Source Information
From the Childhood and Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases (J.W.T., J.D.W., M.W.R., T.S.M., A.S.), and the Biostatistics and Information Branch (B.D.P.), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta; and Acute Communicable Disease Control, Public Health Programs and Services, Los Angeles County Department of Health Services, Los Angeles (R.R., B.A.W., L.M.).
Address reprint requests to Dr. Schuchat at the Childhood and Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Mailstop C-09, Centers for Disease Control and Prevention, 1600 Clifton Rd., N.E., Atlanta, GA 30333.
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