Control of tuberculosis in institutions.

]1”uberculosis remains a public health problem in several circumstances in the U.S. even today, due largely to the ability of M tuberculosis to persist for decades in healthy persons. It manifests most commonly as sporadic disease in elderly persons infected years before. In Arkansas, for example, more than 50 percent of our new cases are patients over the age of 65. When the disease appears in a group of institutionalized persons, it may endanger the health of a significant number of other persons. This is most likely to occur in nursing homes, mental hospitals, prisons, colonies for retarded persons and ordinary schools. Spread of tuberculous infection aboard ship has been well documented’-2 and the Navy now has a program of tuberculin testing and prophylactic therapy to prevent a recurrence. Spread of infection to personnel in a nursing home in North Dakota has recently been described.3 I once observed 11 of 44 tuberculin-negative hospital employees who were infected when they were exposed to a single patient in a Milwaukee hospital, King and Geis4 described an epidemic of tuberculosis in the Cook County jail in Chicago. We have recently described evidence of a prolonged and subclinical epidemic of tuberculosis in a prison and showed that infection acquired in a prison often manifests as disease only after the subject has been released.5 More recently, we have encountered a small epidemic in each of two nursing homes.6 A description of the salient features of these experiences will illustrate the problem and form the basis for describing practical control measures for various situations. losis in 1969. Repeat skin testing on an annual basis