Tuberculosis in UK prisoners: a challenge for control.
OBJECTIVE
Prisoners include a disproportionate number of those with social and clinical risk factors for tuberculosis and pose a challenge for control. The aim of this study was to investigate the characteristics of prisoners with tuberculosis in order to inform clinical management and control policy.


METHODS
Between 2004 and 2007, 205 patients newly diagnosed as having tuberculosis in prison in the UK identified in national surveillance reports were studied. Isolates from prisoners were tested for susceptibility to first-line antituberculosis drugs and strain typed where possible.


RESULTS
Prisoners were significantly more likely to be UK-born (47 vs 25%), to be white (33 vs 22%) and to have pulmonary disease (75 vs 56%) than other tuberculosis patients. Pulmonary cases were also more likely to be sputum-smear-positive (69 vs 57%). Over one-third of culture confirmed cases among prisoners were resistant to isoniazid. Less than half (48%) of patients diagnosed as having tuberculosis in prison completed treatment, with a fifth lost to follow-up.


CONCLUSIONS
In the UK, imprisonment is an important risk factor for tuberculosis, especially drug-resistant and infectious forms of the disease. The management of tuberculosis among UK prisoners is further complicated by high rates of loss to follow-up care and poor treatment outcomes.
Tuberculosis Section, Respiratory and Systemic Infections Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK. charlotte.anderson@hpa.org.uk
Charlotte
C
Anderson
Alistair
A
Story
Tim
T
Brown
Francis
F
Drobniewski
Ibrahim
I
Abubakar
D000995:Antitubercular Agents / Q000627:therapeutic use; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D011329:Prisoners / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D006113:United Kingdom / Q000453:epidemiology
D000995:Antitubercular Agents; D007538:Isoniazid