Tuberculosis behind bars in Israel: policy making within a dynamic situation

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease Control

Background:

• Correctional facilities present a high-risk environment for infectious disease transmission, including tuberculosis (TB).
• Israel has a low national incidence of TB, but incarceration rates and annual inmate numbers are significant.
• Understanding the TB burden within prisons is crucial for targeted public health interventions.

Purpose of the Study:

• To determine the prevalence and characteristics of tuberculosis (TB) among inmates in Israeli prisons.
• To compare the TB burden in prisons to the general population in Israel.
• To propose policy recommendations for effective TB control within correctional facilities.

Main Methods:

• A retrospective review of pulmonary TB patient records from all Israeli prison clinics between 1998 and 2004.
• Epidemiological investigation files from a northern prison (2002-2005) were analyzed to assess disease transmission.
• Data collection focused on identifying TB cases and evaluating risk factors.

Main Results:

• A total of 23 inmates were diagnosed with pulmonary TB, resulting in an incidence rate of 25 cases per 100,000 prisoners, 3.5 times higher than the general population.
• A significant majority (78%) of TB cases were among inmates born in the former Soviet Union and who immigrated after 1990.
• In one prison, four pulmonary TB cases were identified, and 22% of inmates and staff required treatment for latent TB infection.

Conclusions:

• Incarceration provides a critical opportunity for TB detection and treatment initiation in a hard-to-reach population.
• Recommended prevention strategies include symptom questionnaires for new inmates and targeted tuberculin skin testing for high-risk groups (HIV/AIDS, drug users, recent immigrants from the former Soviet Union).
• New prison staff should undergo two-step tuberculin skin testing and annual symptom screening to prevent TB transmission.