On February 27, 2002, the National Institute for Occupational Safety and Health (NIOSH) received a request from the City of Altus to conduct a Health Hazard Evaluation (HHE) at the City of Altus Police Department (PD) and jail, Altus, Oklahoma. The request concerned potential occupational exposure to Mycobacterium tuberculosis (M. tuberculosis) among employees having contact with a prisoner with infectious tuberculosis (TB) who was incarcerated in the Altus city jail during June 2001. NIOSH responded to the request by conducting a site visit in March 2002. This site visit consisted of confidential medical interviews with staff and employees of the Altus PD and jail, a review of tuberculin skin test (TST) records, and a formal ventilation assessment of the work site. At the time of the site visit, 63 persons were employed by the Altus PD and jail. Fifty-eight (of the 63) were working at the Altus PD and jail between June 4, 2001, and June 25, 2001, the period of incarceration of the infected prisoner. All 58 were considered to be potentially exposed to the prisoner (index case). Approximately two months after the release of the index case from the Altus PD jail (and one month after it became known that the index case had active TB disease), the Jackson County Health Department (JCHD) undertook comprehensive TST screening of the employees of the Altus PD and jail. The only employees excluded from testing were those known to be previously TST positive. A total of 55 employees participated in tuberculin skin testing in August 2001. Twelve persons were identified by the JCHD as having TST readings greater than or equal to (=) 5 millimeters (mm) induration

4 of 12 (33%) were documented skin test conversions. One employee was diagnosed as having active TB disease. Three months later, in November 2001, 39 employees participated in tuberculin skin testing. At this time, 9 employees were identified as newly TST positive

3 of 9 (33%) were documented skin test conversions. All nine TST positive employees underwent chest radiography

none were identified as having active TB disease. In January 2002, 5 employees were tested and 1 was identified as newly TST positive. In March 2002, 30 employees who had remained TST negative were tested

2 were identified as being TST converters at that time. The ventilation assessment conducted by NIOSH investigators revealed that at the time of the site visit, no outdoor air was being supplied to the building through any of the existing heating, ventilation, and air conditioning (HVAC) systems. Coupled with an insufficient fresh air supply, the air within the PD and jail was not being properly vented outside the building. Given the design and operation of the ventilation system in place at the time of this HHE, there were no areas within the building that would have provided adequate isolation for an inmate with infectious TB. NIOSH investigators have determined that there was a health hazard present to the employees and staff of the Altus City PD and jail in 2001 due to occupational exposure to an inmate with unidentified active tuberculosis. The number of employees who developed TB infection as a result of this exposure cannot be completely characterized due to insufficient TST data. Recommendations are included in this report to establish a TB control plan for the City of Altus PD and jail and to make needed renovations to the building's ventilation system.