Active and latent tuberculosis in Brazilian correctional facilities: a cross-sectional study

BMC Infectious Diseases

Julio Croda³  Jason R Andrews⁷  Albert I Ko⁶  Sandra Maria do Valle de Oliveira¹  Maurício Antonio Pompílio²  Ana Rita Coimbra Motta-Castro³  Simone Simionatto⁸  Vanessa Perreira Fayad Elias⁴  José Victor Bortolotto Bampi⁴  Alexandre Laranjeira Junior⁴  Marcos Massaki Ota⁴  Renato Fernando Cazanti⁴  Everton Ferreira Lemos⁴  Renata Viebrantz Enne Sgarbi⁵  Dayse Sanchez Guimarães Paião⁵  Andrea da Silva Santos Carbone⁵ 

[1] University Hospital, Federal University of Mato Grosso do Sul, Campo Grande, Brazil;Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil;Oswaldo Cruz Foundation, Campo Grande, Brazil;Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil;University Hospital, Federal University of Grande Dourados, Dourados, Brazil;Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT, USA;Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA;Faculty of Ambiental and Biological Sciences, Federal University of Grande Dourados, Dourados, Brazil

关键词: Epidemiology;    Brazil;    Screening cross-sectional study;    Active case detection;    Infection;    TST;    Prisoners;    Tuberculosis;   

Others  :  1089838
DOI  :  10.1186/s12879-015-0764-8

 received in 2014-10-18, accepted in 2015-01-15,  发布年份 2015

【 摘 要 】

Background

Tuberculosis (TB) rates among prisoners are more than 20 times that of the general population in Brazil, yet there are limited data available to facilitate the development of effective interventions in this high-transmission setting. We aimed to assess risk factors for TB infection and evaluate the yield of mass screening for active disease among inmates.

Methods

We administered a questionnaire and tuberculin skin test (TST) to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV testing and two sputum samples for smear microscopy and culture from participants reporting a cough of any duration. Hierarchical Poisson regression models were used to evaluate factors associated with latent tuberculosis infection (LTBI).

Results

We recruited 3,380 inmates, of which 2,861 (84.6%) were males from 8 prisons, and 519 (15.4%) were females from 4 prisons. Among the 1,020 (30%) subjects who reported a cough, we obtained sputum from 691 (68%) and identified 31 cases of active TB for a point prevalence of 917 (95% CI, 623–1302) per 100,000 prisoners. Evaluation of the two sputum smear samples failed to identify 74% of the TB cases, and 29% of the cases reported less than 2 weeks of symptoms. Obtaining a second culture identified an additional 7 (24%) cases. The prevalences of LTBI were 22.5% and 11.7% for male and female prisoners, respectively and duration of incarceration (in years) was associated with LTBI in male and female in the multivariable model (1.04, 95% CI, 1.01-1.07 and 1.34, 95% CI, 1.06-1.70, respectively). The prevalence of LTBI is 8.6% among newly incarcerated inmates, among whom LTBI prevalence significantly increased by 5% with each year of incarceration.

Conclusions

Although the overall LTBI prevalence among inmates in Central-West Brazil is low, tuberculosis incidence is high (>1,800/100,00), likely due to the high force of infection among a largely susceptible inmate population. Efforts to reduce transmission in prisons may require mass screening for active TB, utilizing sputum culture in case-detection protocols.

【 授权许可】

   
2015 Carbone et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

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