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A one-year prospective study (1994-1995) for a first evaluation of tuberculosis transmission in French prisons
B Hanau-Berçot1, I Grémy, L Raskine
1Laboratoire de Microbiologie, Centre Hospitalier Universitaire Lariboisière, Paris, France. laurent.raskine@lrb.ap-hop-paris.fr
Setting:
Ten correctional facilities in Paris, including suburbs.
Objective:
To prospectively determine the incidence of tuberculosis (TB) in prisons during a one-year period and to trace the transmission of tuberculosis by restriction fragment length polymorphism (RFLP) analysis of Mycobacterium tuberculosis strains from inmates.
Results:
Of 93 cases of tuberculosis observed, 50 were culture-confirmed. The incidence of tuberculosis in correctional facilities was 215 cases per 100,000 inmates. A high turnover of inmates was observed. All patients were male, and a quarter had been homeless. Seventy-two per cent were diagnosed with pulmonary tuberculosis. Several severe cases of TB were observed, including three of tuberculous meningitis. No multidrug-resistant strains were noted. RFLP analysis (n = 24) revealed 22 distinct patterns which made up two clusters. Epidemiological investigation did not show direct tuberculosis transmission, which was, however, probable for one cluster.
Conclusion:
Independently of incarceration, prison inmates run a higher risk of developing active tuberculosis than the general population, which might be the main reason for the high incidence of tuberculosis observed in prisons. However, some cases of transmission may occur inside prisons.