• Marshall Wilburn, a man infected with TB, recently died in the Milwaukee County Jail.
• Health officials requested Wilburn be quarantined in the jail after he was uncooperative with health procedures for his disease.
• The Milwaukee Health Department is conducting an investigation to assess, test, and treat individuals at risk of TB exposure as a result of this incident.

An inmate with tuberculosis died in the Milwaukee County Jail on Feb. 8. Marshall Wilburn was charged for disorderly conduct on Jan. 22 and held on a $100 bail.

Wilburn was quarantined in the medical ward, as health officials were concerned he could expose others to TB. Wilburn's unexpected death hampered the investigation of Wilburn's recent movements throughout the city to determine populations at risk of TB exposure.

The Milwaukee County Medical Examiner's Office is still determining results from Wilburn's autopsy. However, various agencies are collaborating to determine if any populations in Milwaukee may have been exposed.

Wilburn periodically stayed at the Milwaukee Rescue Mission on North 18th Street. Chuck Schumacher, spokesman for the Mission, said Wilburn was in and out a number of times per year.

"We weren't aware that he was infected with active TB, otherwise we would have helped him find active health care immediately," Schumacher said.

The Milwaukee Health Department is still unsure if Wilburn's TB was active while he was staying at the Rescue Mission, Schumacher said.

"The Health Department contacted us as soon as they found out that Wilburn had active TB, and we have completely cooperated with them," Schumacher said.

He said a nurse from the Health Department came in last Friday to test several men for TB that had been known to sleep near Wilburn.

"The people here are safe," Schumacher said. "We are not looking at some huge explosion of TB here. We are working carefully and closely with the city's Health Department."

Schumacher said active TB is not particularly easy to contract for healthy people with sound immune systems. However, he said, it is a significant concern among the homeless due to a harsher lifestyle and a lack of regular doctor's visits.

Paul Biedrzycki, director of disease control and environmental health for the MHD, said Wilburn had been infectious for a number of months before it came to the attention of the MHD.

Since the information came to light, Biedrzycki said the MHD has been tracing the level and scope of Wilburn's contact with the community.

He said it is known Wilburn visited the detention center in Franklin, the Central Library, Repairers of the Breech Homeless Center, Genesis Detox and the Milwaukee Rescue Mission.

"We are in the process of visiting the sites, assessing exposure and testing individuals for TB using blood samples or skin tests," Biedrzycki said.

He said the issue is more complex, however, because negative skin tests do not always mean an individual does not have TB. Skin tests can take up to 12 weeks after exposure to show positive TB infection.

"In addition, some individuals may be positive due to previous exposure unrelated to Mr. Wilburn," he said.

Biedrzycki said TB is often introduced to the United States by people who have visited third-world countries, or by people who have immigrated from these countries. He said the city of Milwaukee carries nearly one-third of the entire state's TB burden.

"This is a serious health issue," Biedrzycki said. "This requires a long-term commitment and we are embarking on a fairly widespread case contact investigation."

Though Wilburn's case has excited attention, Nikki Kay, spokeswoman for the U.S. Center for Disease Control and Prevention, said TB rates in the United States were at an all-time low in 2007.

This reassuring statistic does not change the fact that the overall progress to eliminate TB in the United States is slowing, she said.

"The challenges of preventing TB vary by population and by area," Kay said. "There are underlying economic factors, and minorities and foreign born individuals face higher rates of TB."