Tuberculosis screening of all inmates and staff at the Roxbury Correctional Institution in Hagerstown began yesterday after initial tests revealed that 68 prisoners and 21 officers harbored the infection.
Only one person at the prison -- an inmate -- has an active case of tuberculosis, leading authorities at Roxbury to speculate that he may have infected the others who have tested positive for the bacteria.
"I don't think we're dealing with hysteria at this point, but to say that people are concerned is probably an understatement," said Roxbury Warden Jon P. Galley, who himself got a skin test yesterday. Results of tests on more than 1,700 inmates and 200 officers should be known Friday.
Mr. Galley said one of his biggest challenges was "being able to manage the fear" of contracting TB.
Two parole commissioners refused to enter the prison yesterday because they were afraid of contracting TB, he said.
But Dr. Newton Kendig, chief of medical services for the prison system, said everyone testing positive is getting antibiotics that should prevent them from becoming ill and spreading the disease.
Tuberculosis is a potentially deadly infection of the lungs spread by a patient's coughing. The main symptoms include a severe cough, chest pain, shortness of breath, fever, sweating and weight loss.
A positive skin test reveals if someone carries TB bacteria -- not if he or she has active tuberculosis. Only 10 percent of infected people will develop active TB and pose a threat to others. By taking antibiotics, carriers can virtually eliminate their chance of getting ill, according to the American Lung Association.
The outbreak comes amid a national resurgence of tuberculosis, a disease that just 30 years ago appeared to be headed toward extinction in the United States. But tuberculosis has recently thrived among AIDS patients and drug addicts living in the nation's cities -- people who also populate prisons in large numbers.
"This is a concern but it's not unexpected," Dr. Kendig said. "This is something we anticipated because of the high rate of HIV infection and TB infection coming into the system."
The Roxbury inmate with active TB is apparently not infected with the virus that causes acquired immune deficiency syndrome, according to Dr. Kendig.
Sgt. Gregory M. Shipley, spokesman for the state Division of Correction, said 10 inmates elsewhere in the prison system have had active cases of tuberculosis in the past year. When inmates were tested after the discovery of active cases at the Central Laundry Pre-Release Unit in Sykesville and the Poplar Hill Pre-Release Unit in Wicomico County, about 10 percent were positive.
The Hagerstown outbreak appears to be the largest by far anywhere in the prison system, according to Dr. Kendig.
He said the Roxbury inmate does not carry the virulent strain of TB that raced through the New York State prison system last year, killing 12 inmates and one guard. That strain has proven difficult and in some cases impossible to treat because it is resistant to several conventional drugs.
The Roxbury inmate first developed symptoms of a respiratory illness late last summer, said Dr. Kendig.
A lung biopsy showed that he was infected with TB but several sputum samples examined over the course of several months showed no evidence of the bacteria.
But one tested positive earlier this month -- the first sign that he could spread the infection.
That prompted the testing two weeks ago of 194 officers and 142 inmates who came into regular contact with him either on his housing unit or his work detail.
Of those, 21 officers and 68 inmates tested positive.