USA policing TB in prisons

Photo by arlenCore facts/news that make this article important:

    * TB is not an unavoidable consequence of imprisonment and can be controlled through the application of Directly Observed Treatment Short-course (DOTS) based programmes and improvements in prison conditions
    * Effective TB control in prison protects prisoners, staff, visitors and the community at large.
    * The level of TB in prisons has been reported to be up to 100 times higher than that of the civilian population.

Two most significant quotes from the article:

    * Prisoners have the right to at least the same level of medical care as that of the general community. Catching TB is not part of a prisoner's sentence
    * Prisons act as a reservoir for TB, pumping the disease into the civilian community through staff, visitors and inadequately treated former inmates. TB does not respect prison walls.

Web-links to relevant documents:

TB in Prisons (World Health Organization): click here

International Centre for Prison Studies

Prison and TB (Centre for Disease Control and Prevention (CDC) guidelines): click here

WHO: Health in prison document: click here

WHO: Manual for Programme Managers: TB control in Prisons: click here

Global TB Control Report 2007: click here
Global Plan to Stop TB (2006-2015): click here

NEWS:

A 71-year old man in Colorado US who was arrested and served a six-day sentence for contempt of court on a municipal charge last month, was later diagnosed for TB upon release, sending shivers down the spine of police officers. 15 police officers in Colorado, USA, have filed casualty reports already.

As many as 22 officers and some jail personnel may have come into contact with the man, a news report said. All of them are undergoing a skin reaction test. If they test negative they will be tested against in 10 to 12 weeks. A second negative test will clear them. A positive test, while not meaning the person has the disease, will result in further tests.

TB is not an unavoidable consequence of imprisonment and can be controlled through the application of DOTS based programmes and improvements in prison conditions. Effective TB control in prison protects prisoners, staff, visitors and the community at large.

According to the World Health Organization, the level of TB in prisons has been reported to be up to 100 times higher than that of the civilian population. Cases of TB in prisons may account for up to 25% of a country’s burden of TB. Late diagnosis, inadequate treatment, overcrowding, poor ventilation and repeated prison transfers encourage the transmission of TB infection. HIV infection and other pathology more common in prisons (e.g. malnutrition, substance abuse) encourage the development of active disease and further transmission of infection.

A disproportionate number of prisoners come from socio-economically disadvantaged populations where the burden of disease may be already high and access to medical care limited e.g. substance abusers, homeless, mentally ill, ethnic minorities, asylum seekers, immigrants. Prison conditions can fan the spread of disease through overcrowding, poor ventilation, weak nutrition, inadequate or inaccessible medical care, etc.

High levels of Multi-drug resistant (MDR)-TB have been reported from some prisons with up to 24% of TB cases suffering from MDR forms of the disease. Factors that encourage the spread of TB in prisons also promote the spread of MDR forms.

Another document by WHO says that ‘Prisons act as a reservoir for TB, pumping the disease into the civilian community through staff, visitors and inadequately treated former inmates. TB does not respect prison walls.’

Improving TB control in prisons benefits the community at large. Community TB control efforts cannot afford to ignore prison TB.

“Prisoners have the right to at least the same level of medical care as that of the general community. Catching TB is not part of a prisoner’s sentence” says another WHO Document on TB and prisons.

We don’t need to reinvent the wheel. WHO publications outline some recommendations to fight TB in prisons:

    * The priority strategy must be the widespread implementation of the DOTS package in the incarcerated population. Every prisoner should have unrestricted access to the correct diagnosis and treatment of TB.
    * Delays in the detection and treatment of TB cases must be minimised to reduce further transmission of infection and pressures to self-treat TB.
    * Unregulated, erratic treatment of TB in prisons should cease.
    * Urgent action is needed to integrate prison and civilian TB services to ensure treatment completion for prisoners released during treatment.
    * Measures to reduce overcrowding and to improve living conditions for all prisoners should be implemented to reduce transmission of TB.
    * Where MDR-TB is established and a functional DOTS programme is in place and accessible to all prisoners, a DOTS-Plus pilot programme should be considered.

Bobby Ramakant-CNS

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