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Background Rapid screening for tuberculosis (TB) disease at intake into immigrant detention facilities allows for early detection and treatment. Detention facilities with United States Immigration and Customs Enforcement (ICE) Health Service Corps (IHSC) medical staffing utilize chest radiography and symptom screening as the primary screening for pulmonary TB (PTB) disease. This analysis describes the demographic, clinical, and microbiological characteristics of individuals identified with TB disease at these facilities. Methods We conducted a retrospective analysis to describe the population of immigrant detainees identified via chest radiography with PTB disease between 1 January 2014 and 31 December 2016 at facilities with IHSC medical staffing. We collected demographic variables, clinical presentation, diagnostic testing results, and microbiological findings. We generated descriptive statistics and examined univariate and multivariate associations between the variables collected and symptomatic status. Results We identified 327 patients with confirmed PTB disease (incidence rate, 92.8 per 100 000); the majority of patients were asymptomatic (79.2%) at diagnosis. Adjusting for all other variables in the model, the presence of cavitary lesions, acid-fast bacillus smear positivity, and multilobar presentation were significantly associated with symptomatic status. Among all patients identified with TB disease who had a tuberculin skin test (TST) result recorded, 27.2% were both asymptomatic and TST negative, including those with smear-positive disease. Conclusions Asymptomatic PTB disease is a significant clinical entity among immigrant detainees and placement in a congregate setting calls for aggressive screening to prevent transmission. Early identification, isolation, and treatment of TB disease benefit not only the health of the patient, but also the surrounding community.

Background We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016. Methods Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes. Results We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May-26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units. Conclusions Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.

Background Starting in September 2018, an unusually high number of mumps cases were reported in US adult detention facilities. Detention facilities usually involve close contact among detainees, facilitating transmission of mumps. Detainees in close contact with a mumps patient are at increased risk for acquiring mumps and should be offered a dose of MMR vaccine. We summarize the epidemiologic, clinical, and laboratory data for mumps cases in adult detention facilities during September 2018-April 2019. Methods Data were collected by health departments and US Immigration and Customs Enforcement (ICE) Health Services Corps and reported to CDC. Cases were classified according to the CSTE case definition for mumps and confirmed by RT-qPCR; molecular sequencing was performed on mumps-positive specimens. Results From September 2018-April 2019, 389 confirmed and probable mumps cases in adult migrants detained by ICE in 44 detention facilities were reported in 16 states (figure). The median age of patients was 24 years (range: 18–66); 94% were male. Vaccination status was unknown for all patients. Most (80%) patients were exposed while in custody of ICE or other US legal agency, 7% were exposed before apprehension, and custody status at exposure was unknown for 13%. Among 265 patients with data on complications, 15% had orchitis; at least 3 were hospitalized. Mumps genotype G, the most common genotype in US, was identified in specimens from 70 patients. This mumps response included >7,000 MMR vaccine doses distributed to affected facilities, and hundreds of exposed detainees placed under restricted movement in their facility each week. The response is ongoing as new cases continue to be reported. Conclusion This is the first report of mumps outbreaks occurring in multiple states and detention facilities during the same period. These outbreaks are costly and challenging to control. Identifying target groups for vaccination is challenging since detainees are frequently transferred and MMR vaccine does not prevent mumps in persons already exposed and infected. Effective public health interventions require an understanding of detention settings. Development of national guidance and resources for public health response to mumps and other infectious diseases in detention facilities would be beneficial. Disclosures All authors: No reported disclosures.

U.S. Immigration and Customs Enforcement (ICE) is responsible for detaining unauthorized aliens during immigration proceedings. During 2014 to 2015, adult ICE detainees at a California facility were invited to complete a survey concerning self-reported varicella history and risk factors. Participants underwent serological testing for varicella-zoster virus (VZV) IgG; susceptible individuals were offered varicella vaccination. Among 400 detainees with available serology results, 48 (12%) were susceptible to varicella. Self-reported varicella history was negatively associated with susceptibility (adjusted odds ratio = 0.16; 95% confidence interval [0.07, 0.35]). Among 196 detainees reporting a positive history, 95% had VZV IgG levels suggestive of varicella immunity. Among 44 susceptible detainees offered vaccination, 86% accepted. Given relatively high varicella susceptibility, targeted screening and vaccination among ICE detainees lacking a positive history might reduce varicella transmission risks.

On June 7, 2013, a man was diagnosed in a Texas hospital with rabies. He had been detained in a U.S. detention facility during his infectious period. To identify persons exposed to rabies who might require rabies postexposure prophylaxis (PEP), CDC and the Texas Department of State Health Services (DSHS) conducted investigations at four detention facilities, one medical clinic, and two hospitals. In all, 25 of 742 persons assessed for rabies exposure were advised to receive PEP. Early diagnosis of rabies is essential for implementation of appropriate hospital infection control measures and for rapid assessment of potential contacts for PEP recommendations.