URL:  http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/02/02/MN139615.DTL
 

Mount Pleasant, Mich. -- Marva Johnson was thrilled when her longtime boyfriend, Randy Vallad, was paroled from prison in 1999. 

They went back to living together, and once when he got a bad cut on his head, she took care of him. She was splattered with his blood, but the couple did not think anything of it at the time. 

It was not until Vallad was sent back to prison in 2001 for a parole violation that he accidentally was shown his Michigan Department of Corrections medical records. They reported that Vallad had tested positive for hepatitis C, a blood-borne virus that can cause potentially fatal liver disease, when he was first admitted to prison years before. 

"They knew and didn't tell him," Johnson, 33, said from this small city in central Michigan. "As a result, they also let him infect me." For the past 11 months, she has been taking a powerful, enervating course of drugs for hepatitis C. 

Such cases are becoming increasingly common across the United States, as jails and prisons have become giant incubators for some of the worst infectious diseases. 

According to a recent study, an estimated 1.4 million inmates released from jail or prison in 1996 were infected with hepatitis C. That was 31 percent of the 4.5 million cases of the disease nationwide. 

Similarly, newly released inmates accounted for 35 percent of the 34,000 Americans with tuberculosis in 1996, the study found. And newly released inmates also accounted for 14 to 17 percent of all Americans infected with HIV, the study estimated. 

The problem has become so acute that health care officials and prisoner rights groups are calling for widespread testing of prison populations for hepatitis C and faster treatment of prisoners. 

"This is a public health problem that has been growing and growing, but we are reluctant to do anything about it, because these are bad guys," said Dr. Robert Greifinger, a former chief medical officer for the New York State Department of Correctional Services and the author of the study, which was commissioned by Congress and prepared for the Justice Department. 

The issue has become so pressing that the federal Centers for Disease Control recently held a conference on the issue in San Antonio for prison medical officers. At the conference, the agency said public vaccination efforts against hepatitis should be extended to prisons. 

The centers also issued new guidelines urging states to test all prisoners with a history of intravenous drug use and other risky behavior for hepatitis C. Sharing of needles and unprotected sex are common ways the virus is spread. 

The problem is not that large numbers of prisoners are contracting hepatitis C while incarcerated, experts say. Most were infected years ago. The experts say the high rate of communicable diseases among inmates is a critical issue for two pressing reasons: the danger that inmates pose of infecting others when they are released, and the opportunity to treat them that is now being largely wasted. 

Greifinger noted that Americans tend to forget that most inmates eventually return home. 

In 2000, about 9 million people were released from jail and prison, according to Allen Beck of the Bureau of Justice Statistics, the statistical arm of the Justice Department. 

But in a sign of changing attitudes, the Centers for Disease Control and Prevention recently made public Greifinger's report. It had been given to the Justice Department in March 2001, Greifinger said, but never before released to the public. 

In a separate action, the American Civil Liberties Union and two dozen other organizations interested in prison conditions recently issued a call for a congressional investigation into the state of medical care in jails and prisons. 

"Correctional systems have buried their heads in the sand because they don't want to know how many prisoners have hepatitis C," said Eric Balabin, a staff attorney with the National Prison Project of the ACLU. 

"It's simple economics," Balabin said. "Because once prisons know, they will have to treat prisoners." Under Supreme Court rulings, prisoners are entitled to reasonable health care. 

©2003 San Francisco Chronicle

 http://www.timesonline.co.uk/article/0,,3-601135,00.html 

March 06, 2003 

Superbug's new strain thrives outside hospitals
By Mark Henderson, Science Correspondent
 
 
 
A NEW strain of the drug- resistant superbug MRSA has escaped from hospitals to infect thousands of healthy adults across the United States, hitting hardest among homosexual men. 
The bacterium, which normally affects only sick and elderly hospital in-patients, is striking fit Americans with no links to the hospitals in which it thrives, raising fears of an epidemic that could spread to Britain. The germs, which can withstand many common antibiotics, are transmitted by skin contact, with no need for an open wound. 

Outbreaks have been reported in Los Angeles, San Francisco, New York, Boston and Miami. Most of those affected are homosexual men and prison inmates, but athletes and schoolchildren involved in contact sports have also fallen ill. Precise figures for the number of infections are not available, because MRSA is not a notifiable disease in the United States, but public health officials believe cases already run into the thousands, with several deaths. 

The disease normally manifests itself as a skin condition, beginning with sores that resemble insect bites, and progressing to cause painful abscesses and boils. In rarer cases, when it reaches the lungs or the bloodstream, it can cause life-threatening pneumonia or septicaemia. 

MRSA, which stands for methicillin-resistant Staphylococcus aureus, has for years been a problem in hospitals, where it infects open wounds and bedsores, taking advantage of the weakened immune systems of seriously ill or elderly patients.It is named as a contributory cause of death in 20 per cent of death certificates issued in British hospitals where staphylococcal infection was a factor. 

The bacteria, however, have never been considered dangerous beyond the wards. The emergence of a strain that is spreading through the wider community, details of which are reported today in New Scientist magazine, has alarmed public health officials on both sides of the Atlantic. Scott Fridkin, a medical epidemiologist at the US Centres for Disease Control and Prevention (CDC) in Atlanta, said: “We are greatly concerned that MRSA has emerged in the community in people with no ties to healthcare.” 

Tyrone Pitt, deputy director of the Laboratory of Healthcare Associated Infections, said that while there was no evidence that the strain had arrived in Britain, it was a genuine threat. “It is very difficult to predict its impact. If it manifests itself just as a skin infection, that is not that threatening. If the result is pneumonia in relatively healthy people, that’s a completely different scenario,” he said. 

The Atlanta centre has yet to complete testing to confirm the strain that is spreading in the community, but health officials in Los Angeles said all the outbreaks there appeared to have been caused by a strain first isolated in New York in 1997. Most of the US cases so far have occurred in San Francisco and Los Angeles, among homosexual men who have had multiple sexual partners. The disease is not thought to be sexually transmitted, but as it is contagious through skin contact, sexual promiscuity has an indirect effect on risk. Its effects are not confined to HIV-positive men. 

Several prisons in California have reported MRSA outbreaks among inmates, and there have also been outbreaks in schools, particularly among athletes involved in contact sports. In Pasadena 50 pupils at one school were diagnosed with the condition, mostly members of the school’s football team.

On the rise

MRSA: Methicillin- resistant Staphylococcus aureus 

First identified: mid-eighties 

Recorded UK cases 1992: 104 2001: 4,904 

Confirmed UK deaths 1993: 13 1998: 114 

Resistant to: methicillin, oxacillin, nafcillin, cephalosporins 

Susceptible to: vancomycin