One-third of the world's population is believed to carry the TB bacillus mostly in densely (over)populated impoverished third-world nations. Despite international humanitarian efforts, TB persists and kills millions annually. TB usually affects the lungs but can also damage the kidneys, spine or brain, and if untreated can be deadly. It is spread through airborne germs. The TB infection rate in the United States is only 4.6 per 100,000 population, but approximately 90% of known cases occur among prisoners. The combination of low socioeconomic status (with its attendant poor healthcare) and crowded living conditions in prisons and jails provide fertile ground for TB. Past efforts to curb the diseases spread among America's incarcerated have been inadequate, resulting in new standards announced by the National Centres for Disease Control (CDC) in 2006. [See related article, this issue]. The Advisory Council for the Elimination of Tuberculosis recommends that all prisons and jails have a TB infection control plan. In Arizona, a patient with TB can be locked up in a hospital jail ward without having committed any crime. Robert Daniels, 27, was raised in Scottsdale but returned to his native Russia ten years ago, where he caught a strain of multi-drug-resistant (MDR) TB known as XDR-TB. When he began coughing up blood he returned to Arizona to obtain better medical treatment. His virulent infection of the highly contagious XDR-TB required his hospitalization in an aerobically isolated room. The only one available was at the jail ward at the Maricopa County Medical Center, where Daniels has been guarded around the clock for almost a year to prevent his infecting others. During his involuntary incarceration he has been deprived of a television, radio and personal phone; he is unable to shower, and the lights in his bare room are on constantly. Yet he has not been charged with or convicted of any crime, only deemed a public health risk. The Arizona ACLU filed a lawsuit on his behalf in May 2007 seeking relief from such restrictive housing conditions, but this action pits Daniels' rights against the public welfare. “It's good news for me,” Daniels said of the suit. “I finally have a chance to get out of this black hole.” See: Daniels v. Maricopa County, USDC AZ, Case No. 2:2007cv01080. Alabama reported three prisoner TB cases in 2006. At the Tutwiler women prison, two unrelated infections were reported in May and June. The June case involved a county jail transferee from Houston County. While that prisoner was placed in isolation, another 106 prisoners who had come into contact with her had to be quarantined as well. On September 22, a Kilby Correctional Facility prisoner was placed in respiratory isolation. He had arrived at Kilby, an intake facility, on August 11. All who came in contact with him at the Talledega County Jail and at Kilby were isolated and monitored for three weeks pending test results. In February 2007, 8 out of 24 Escambia County, Florida jail prisoners tested positive for TB after one had became infected and contagious. More recently, forty-five Coconino County, Arizona jail prisoners and employees were notified in June 2007 that they may have been exposed to active TB from a sick prisoner. The prisoner, who was not named, had symptoms of TB infection when he was being booked into the facility. “We will be following up to make sure the individual is complying with treatment,” stated County Health Director Barbara Worgess. It was also reported in June 2007 that a female prisoner at the Corrections Corporation of America-operated Gadsden Correctional Facility in Florida had been diagnosed with TB. She was taken to the Capital Regional Medical Center for treatment; she had reportedly experienced symptoms for a week before being diagnosed. Detention facilities are not the only institutions at risk of TB transmission. In June 2006, three mental health care patients from group homes in Devine, Texas were hospitalized with active TB. Because the victims in one group home had interacted with patients at other homes, some 200 people were placed at risk. California logs approximately 2,900 cases of TB each year, inclusive of prisoners. This has resulted in a state law requiring annual TB tests for all DOC staff and prisoners (Penal Code BB 6006.5, 7570 et seq.), as well as testing when prisoners are transferred between facilities. All new county jail arrivals are tested within 72 hours; however, TB still persists. In June 2006, a Modesto County Jail prisoner tested positive for TB at intake but the results weren't announced for seven days. All prisoners and staff were subsequently tested. At the California State Prison (Solano), more than 6,000 prisoners and 1,400 staff had to be tested in September 2006 after two prisoners came down with active TB. Additionally, a prisoner arriving from the San Diego County Jail tested positive upon his November 2006 arrival at the R.J. Donovan State Prison. His possible exposure to the disease since his incarceration on August 22 was traced to six jail transfers and four other bus transports.