The risk of tuberculosis (TB) and latent TB (in which the bacteria that cause TB lie dormant but can reactivate later to cause active TB disease) is higher in the prison population than in the general population. And importantly, the spread of TB and latent TB within prisons can substantially increase their incidence in the general population. These key findings from a systematic review by Iacopo Baussano from the University "Amedeo Avogadro", Italy, and the Imperial College, London, UK, and colleagues and published in this week's PLoS Medicine, suggest that improvements in prison TB control would not only help to protect prisoners and staff from within-prison spread of TB, but would also reduce national TB burdens.
Using previous findings from published studies and data from the World Health Organization, the authors calculated the ratio between the incidence rates for TB and latent TB in prison and in the general population. The average incidence of TB in prisons was 23 times higher that of the general population, and for latent TB, was 26 times higher in prisons than in the general population. The authors also estimated the fraction of TB in the general population attributable to within-prison exposure to TB and found that, on average, the population attributable fraction for TB in high-income countries was 8.5% (that is, one in 11 cases of TB in the general population was attributable to within-prison spread of TB); in middle-to-low–income countries, the average the population attributable fraction for TB was 6.3%.
The authors say: "These data may prove useful to inform the development of rational policies to control TB transmission in correctional facilities." They add: "Future studies should assess the population attributable risk of prison-to-community spread and describe the conditions in the prison that influence TB transmission."
In an accompanying editorial, the PLoS Medicine editors conclude: "The publication of this systematic review marks a shift from considering the incidence of TB in each prison population to considering the massive global impact of tuberculosis in prisons."
Funding: This work was financially supported by WHO to inform the policy on tuberculosis infection control. WHO supported study design; collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the paper for publication. IB was supported by the ''Regione Piemonte'' Italy, Assessorato Sanita, Progetti di Ricerca Sanitaria Finalizzata, 2008. The Regione Piemonte had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of WHO.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Baussano I, Williams BG, Nunn P, Beggiato M, Fedeli U, et al. (2010) Tuberculosis Incidence in Prisons: A Systematic Review. PLoS Med 7(12): e1000381.doi:10.1371/journal.pmed.1000381
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CONTACT:
Iacopo Baussano
SCDU di Epidemiologia dei Tumori .
Università del Piemonte Orientale "Amedeo Avogadro" – Alessandria, Novara, Vercelli.
Via Solaroli, 17
28100 - NOVARA
Italy
Tel + 39 0321 660690
Fax +39 0321 3733112
Email: iacopo.baussano@med.unipmn.it
or
Imperial College of Science, Technology and Medicine
Department of Infectious Diseases Epidemiology
St Mary's Campus, Norfolk Place
London, UK W2 1PG
United Kingdom
00393498421810
i.baussano06@imperial.ac.uk
The Health Crisis of Tuberculosis in Prisons Extends beyond the Prison Walls (PLoS Medicine Editorial)
Funding: The authors are each paid a salary by the Public Library of Science, and they wrote this editorial during their salaried time.
Competing Interests: The authors' individual competing interests are at http://www.plosmedicine.org/static/editorsInterests.action. PLoS is funded partly through manuscript publication charges, but the PLoS Medicine Editors are paid a fixed salary (their salary is not linked to the number of papers published in the journal).
Citation: The PLoS Medicine Editors (2010) The Health Crisis of Tuberculosis in Prisons Extends beyond the Prison Walls. PLoS Med 7(12): e1000383. doi:10.1371/journal.pmed.1000383
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CONTACT:
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