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Chest Infections |

The Trouble With Incarcerating Tuberculosis: Experiences of Tuberculosis in a Prison in the UK

Arthee Yogendran*, MBBS; Anita Webb, BS; Gihan Hettiarachchi, MBBS
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Medway Maritime Hospital, Gillingham, United Kingdom


Chest. 2012;142(4_MeetingAbstracts):212A. doi:10.1378/chest.1373735
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Abstract

SESSION TYPE: Respiratory Infections Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Tuberculosis (TB) is a growing problem in prisons worldwide. Limited screening prior to incarceration combined with personal and environmental risk factors have resulted in an amplified risk of TB transmission in prisons.

METHODS: A retrospective study identified cases of TB in a low incidence UK prison from August 2010 - March 2012. Inmate and officer contacts of the index case were screened using either Mantoux or T-Spot®.TB blood tests. Health questionnaires, occupational health and funding were reviewed to explore issues in the management of screening.

RESULTS: Initial screening identified 58 contacts of the index case: 11 inmates and 47 officers. 66% were screened, with 3 inmates released prior to testing and 20 officers not disclosing contact details. 3 months later another inmate case was identified following transfer to another prison with identical variable number of tandem repeats (VNTR) as the index, who had not originally been determined a contact. Screening was offered to all officers as intermittent exposure was reassessed a potential risk. A reactive T-spot test in an officer resulted in a further round contact screening. Questionnaires at incarceration explored history of TB without inquiring about current symptoms. BCG vaccination and TB screening were not available through occupational health services, so funding for screening and treatment was provided by the primary care trust.

CONCLUSIONS: Prisons are dynamic settings, acting as a reservoir for the spread of infection. In the prison system reviewed, the health questionnaire was inadequate for identifying active TB. Multiple rounds of screening were required due to new cases being identified with common VNTRs reflecting potential limitations in contact tracing.

CLINICAL IMPLICATIONS: All individuals are at risk of TB in the prison setting. Repeated TB screening over a 20 month period highlights the need for improved investigation prior to incarceration and prisoner transfer. Greater emphasis is needed in occupational health departments, such as that for healthcare workers, to limit prisoner-officer transmission. Financial responsibility of screening needs to be determined to avoid delays and reduce further transmission.

DISCLOSURE: The following authors have nothing to disclose: Arthee Yogendran, Anita Webb, Gihan Hettiarachchi

No Product/Research Disclosure Information

Medway Maritime Hospital, Gillingham, United Kingdom

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