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

Abstract

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-SpotA.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.