Tuberculosis: Risk of acquiring the disease in prisons is extreme

Prevalence data shows that what happens in Mato Grosso do Sul may be happening all over the Country Jails need urgent new interventions

For Dr. Júlio Croda, one of the greatest challenges in the past years was to perform a cohort study in 12 prisons in Mato Grosso do Sul. The manu from the TB group recently published reveals alarming data. The risk of acquiring tuberculosis in prisons is an outrage. From the 1422 inmates: 1.3% acquired active tuberculosis and nothing else, while nothing less than 26% acquired latent tuberculosis after one year of follow-up, he alerts. The expert stresses that multiple interventions are needed, whether in early detection, annual surveys with X-ray and GenExpert and more active treatment of the latent form. Without these interventions, there will be no adequate control of the disease in these environments so favorable to the diseases transmission.

Find below the interview to the Brazilian Society of Tropical Medicines press office:

BSTM: According to your research, annually, one fourth of Mato Grosso do Suls inmates are infected. Would this be the case for a severe intervention by health entities in the local prisons? Has this been done?

Dr. Júlio Croda: We performed two studies with Mato Grosso do Suls inmate population. The first transversal study evidenced the prevalence of latent TB among people who have never been imprisoned and were in the first month in jail was 7.9% for men and 8.3% for women. These are very low indexes. They show the diseases prevalence in the general community is very low. However, the second study, published last October 3rd, we evidenced that after one year in jail, 26% of the individuals who did not have latent TB, acquired the disease inside prisons in the five largest cities in Mato Grosso do Sul state. This rate is alarming because it points to a strong infection force inside these environments: one fourth of these people become infected after a year.

Our prevalence data from all over Brazil, what we evidenced in Mato Grosso do Sul must be happening in the entire Country. Especially in places with overcrowding rates greater than MS. In previous studies, we demonstrated by mathematical modelling that TB transmission is directly linked to occupation rates. According to a report from the Justice Ministry, figure 9, the States occupation rate is 208%. At least five states have overcrowding rates greater than MS, therefore, we can present indicators worse than in Mato Grosso do Sul. I quote Rondônia (292%). Tocantins (251%), Amazonas (259%), Pernambuco (237%) and Alagoas (228%). This demonstrates that we need severe interventions, not only in Mato Grosso do Sul, but also in the whole Country. We must develop multiple interventions, whether in early detection of cases, annual X-ray and GenExpert screenings and more active treatment of the diseases latent form. Without these interventions, there will be no adequate control of the disease in these environments so favorable to the diseases transmission.

BSTM: Does this high incidence rate also evidences the need to alert national and international human rights organs about the matter?

Dr. Julio Croda: Yes. This is the main aspect. With our study, we definitively proved that imprisoned people are acquiring TB inside our prison system. The great problem is there are not many NGOs advocating for this population. Even under this aspect, this population is neglected. The stigma linked to imprisonment and TB favor the lack of civil organizations demanding more adequate imprisonment conditions.

BSTM: Has the States government shown interest in debating the theme? Are there questions regarding the risks not only for the inmates, but for all other people in Mato Grosso do Sul? Has de Federal Government been contacted?

Dr. Julio Croda: The greatest problem is the need for greater funding for operational researches in order to identify the most effective interventions combination. Questions as how frequently should the inmate population be screened? What is the best algorithm and exam combination to be used? What is the impact of mass treatment of the latent form over incidence? As we demonstrated in our published study, annual screening with bacilloscopy and culture alone were not effective to reduce the diseases incidence. However, in Mato Grosso do Sul, with a partnership established though an agreement, the State Health Secretary will fund along with the University the acquisition of a mobile unit that will help diagnose TB in several prisons in the State. We still need resources to begin this comparative study and the clinical assay, which will assess the role of treating latent TB in the diseases control. These interventions could be expanded to all other Brazilian states.

BSTM: How was the research performed in order to reach this number [25% of the prison population is infected by TB]?

Dr. Júlio Croda: This is a cohort study. We followed 1,422 inmates it 12 prisons in the five largest cities in the state every year. We repeated the TB test in all individuals who returned a negative result at the beginning of the research and 25.6% converted the test, i.e., they acquired latent tuberculosis.

BSTM: Does this research indicate a possibility of this index being greater or quickly raising in a short or medium term?

Dr. Júlio Croda: With the economic crisis and possible change in legal majority to 16 years-old, the overcrowding trends tend to intensify and, this way, bringing a greater infection force regarding TB, unfortunately. For this reason, since we know it will be difficult to revert this occupation rate increase trend, we must work with early diagnostic alternatives and new screening methods.

BSTM: In another interview to the BSTM, you once alerted for the need to revert this growing incarceration rate trend. How could this be achieved?

Dr. Júlio Croda: Brazil has the fourth largest inmate population in the world, behind the USA, China and Russia. In addition, among the four countries with largest populations, we were the only one to grow this population from 2008 to 2014 (33%). All the others had decreases. If we keep this pace, we will be third in prison population until 2020. We must revert this trend An alternative, considering the imprisonment rate, is decriminalizing possession of drugs, which will be discussed in the Supreme Federal Court (STF) in the next months; more use of alternative penalties for non-heinous crimes; and more use of ankle monitors.

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