There tuberculosis, the leading cause of death due to a single pathogen globally, causes more than 1.5 million deaths each year. New research from the University of Cincinnati finds that being in prison or an ex-offender is responsible for high rates of multidrug-resistant (MDR) TB.
“Tuberculosis is a huge public health problem globally, and approximately half a million people are diagnosed with MDR-TB each year,” says Moises Huaman, MD, of the Division of Infectious Diseases at the UC College of Medicine . “MDR-TB is difficult to treat; these patients may require longer treatments and the risk of treatment failure and death is higher.”
MDR-TB is tuberculosis caused by a strain of bacteria resistant to isoniazid and rifampin, the two fundamental antibiotics in the first-line treatment of TB.
The research is a collaboration between UC, the Center for Technological, Biomedical and Environmental Research (CITBM) in Peru, the Borstel Research Center in Germany, and researchers in Brazil, Spain and Italy. Researchers sought to identify patterns of resistance and key drivers of recent MDR-TB transmission in a tuberculosis-prevalent area of Peru.
The study was published in The Lancet Regional Health—Americas.
Tuberculosis: the prison population is more at risk
“We were interested in understanding how MDR-TB is transmitted in the hot spots of Lima/Callao, Peru,” says Huaman, who is also the medical director of the Hamilton County TB Control Clinic.
“We studied 171 TB strains from 2017 to 2019 that were processed in Callao. All of these strains came from patients diagnosed with MDR-TB. Some of these strains came from individuals who were incarcerated. We found that MDR-TB transmission is very common in the area. One of the main factors associated with the transmission of MDR-TB is being in prison or having previously been in prison.”
Researchers have identified patterns of molecular resistance and defined recent transmissions.
“Tuberculosis is a disease where if an individual is exposed to bacteria in prison, that person may not get sick until they are back in the community,” Huaman says. “This demonstrates that, although transmission can occur in prisons, MDR-TB and the potential for further spread extends beyond the confines of prison and into the community.
“Our research identifies prisons as the main driver of the MDR-TB epidemic, and this is important because this is how interventions can be made. Prison-focused tuberculosis screening and control strategies can be planned. Additionally, having systems through which screening can also be done after people are released from prison is important.”
Huaman says a second important finding of the research is that it contradicts traditional thinking that the MDR-TB epidemic was caused primarily by patients not taking their medications as prescribed. He says most of the cases included in the study were the result of primary transmission of MDR-TB strains, and a major source of that transmission was prisons.
Hopefully, Huaman says, this will lead to more targeted interventions.
“Efforts to control tuberculosis are underway, and I think our data will help the global community take a step further on how important it is to control the MDR-TB epidemic in prisons,” he says.
“Our group and others are examining what interventions are most cost-effective for tuberculosis control and elimination. [Per] a disease that links lower socioeconomic conditions and disadvantaged populations, [è fondamentale] be able to put together interventions that are sustainable for these vulnerable populations.”
Detained people are at an alarming risk of tuberculosis (TB), and this risk persists for years after their release, according to a study conducted in Paraguay and led by the Universidad Nacional de Asunción and the Barcelona Institute for Global Health (ISGlobal).
The findings, published in The Lancet Regional Health—Americas, call for urgent and effective tuberculosis control measures to protect the health of incarcerated people and their communities.
Prisons are known to be high-risk environments for tuberculosis transmission, and the prevalence of tuberculosis in prisons far exceeds that in the community. “However, there is limited information on how tuberculosis risk progresses over time during detention and after release,” says Alberto García-Basteiro, head of the TB group at ISGlobal and senior author of the study.
This is important because people infected with Mycobacterium tuberculosis in prison and who are released can significantly contribute to community transmission of the disease.
The study, led by ISGlobal researcher Guillermo Sequera, was carried out in Paraguay, where the incidence of tuberculosis in 2020 was 48 cases per 100,000 people in the community but higher than 3,000 cases per 100,000 people in prisons. This is one of the few studies evaluating the risk of tuberculosis among persons deprived of liberty in prison and after release, and the one with the longest follow-up.
The research team analyzed tuberculosis reports of nearly 3,000 incarcerated and formerly incarcerated men from five of Paraguay's 18 prisons. “The selected prisons are the largest and oldest and have digital archives with high-quality data covering an 11-year period, from 2010 to 2021,” explains Sequera, the first author of the study. The authors measured risk factors associated with tuberculosis during incarceration and after release, including prison overcrowding, time spent in prison, or re-incarceration.
The results show that, among the 2,996 individuals, 451 (15%) were diagnosed with tuberculosis. 58% of these cases occurred in prison and 42% in the community after release. The risk of tuberculosis is already double after six months in prison and increases markedly with each year spent in prison: from 1,335 cases per 100,000 person-years in the first year to 8,455 after eight years.
Not surprisin
gly, the higher the density of prisoners per cell, the higher the risk of developing the disease. After release, the incidence of tuberculosis decreases but remains ten times higher than in the community.
“Our study shows the alarming risk of tuberculosis associated with the prison environment in Paraguay and how this risk persists for years after incarceration,” says Sequera. “Effective tuberculosis control measures are urgently needed to protect people's health during and after detention.” Indeed, effective control interventions in prisons (including reducing overcrowding) are expected to have a major impact on the burden of tuberculosis nationwide.
In the first global assessment of tuberculosis (TB) among prisoners, a new study found consistently high tuberculosis case rates and low case detection in prisons, suggesting the need for health organizations to increase efforts to reduce the spread of TB among these high-risk groups. population.
Incarcerated people around the world developed tuberculosis at a rate nearly 10 times higher than the general population in 2019, according to a new study led by the Boston University School of Public Health (BUSPH).
Published in The Lancet Public Health, the study found that 125,105 of the 11 million incarcerated people worldwide developed tuberculosis in 2019, a rate of 1,148 cases per 100,000 people per year.
Despite this high rate, nearly half of tuberculosis cases among prisoners went undetected.
The findings reveal the first global and regional estimates of new tuberculosis cases among incarcerated people, a population at high risk of developing this deadly disease. Overall, the high case rate and poor detection highlight the need for greater awareness and resources to reduce the burden of tuberculosis in prisons and other high-risk settings.
“Our study showed that only 53% of people who develop tuberculosis in prisons are diagnosed, which suggests that incarcerated people are neglected and have minimal health services to diagnose tuberculosis,” says study leader and corresponding author , Dr. Leonardo Martinez, assistant professor of epidemiology at BUSPH.
To better understand tuberculosis rates among this population, Dr. Martinez and colleagues acquired data from published research and from federal country officials to analyze the prevalence and incidence of tuberculosis in 193 countries at the national, regional, and global levels among the 2000 and 2019. The team also calculated tuberculosis case detection rates per year in each country for 193 countries.
The African region recorded the highest rate of new tuberculosis cases in 2019, with 2,242 cases per 100,000 people per year, but the Americas region, largely led by Central and South America, recorded the highest number total cases, which have since increased by nearly 90%. 2000. The countries with the highest number of new prison cases in 2019 were Brazil, Russia, China, the Philippines and Thailand.
Importantly, the team found that new TB case rates remained consistently between 1,100 and 1,200 cases per 100,000 people per year from 2012 to 2019.
“This stagnation suggests that current TB control policy in prisons is insufficient to reduce the burden of TB and that additional interventions and policy implementation are needed,” says Dr. C. Robert Horsburgh, professor of global health at BUSPH.
Mass incarceration is a major driver of TB transmission, both inside and outside prisons. Overcrowding, where some prison cells can hold up to 30 people, causes TB to “spread like wildfire,” says Dr. Martinez, and this transmission can easily spread into the community.
“Contrary to popular belief, incarcerated people are a mobile population and, in many countries, the length of incarceration is very short,” he says. “People go to prison, then they get out, then they can go back in again. So, very often, people who develop TB in prison end up transmitting the disease to many people outside prison once they are released. Because nearly half of people with TB in prisons go undiagnosed, many still remain contagious when they return to the general community.”
The team hopes that these findings will encourage global and regional health organizations to develop routine TB monitoring among incarcerated people, as they do for other high-risk populations such as people with HIV and household contacts.
The researchers say their comprehensive collection of TB case notifications – which they retrieved directly from federal officials, national and regional organizations, and non-governmental organizations – is a clear indication that information on TB in prisons is accessible and retrievable by global organizations as per World Health Organization.
The team is currently working with several health organizations to try to update global guidelines on how to manage and reduce TB in prisons, as the most recent guidelines were written in 2000.
“One of the reasons this population is so overlooked is the lack of data,” says Dr. Martinez. “Our hope is that these findings will help stakeholders understand the urgency of the problem and the number of people in prisons who develop TB and remain undiagnosed for long periods of time and can spur them to take action.”
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