Extensive Mycobacterium tuberculosis circulation in a highly endemic prison and the need for urgent environmental interventions.
Aimed at assessing the circulation of Mycobacterium tuberculosis in a highly endemic prison, this 13-month prospective study was performed on strains isolated from tuberculosis (TB) cases detected passively and actively. We used X-ray screening of newly admitted inmates and mass screening at the beginning of the study and again 1 year later. Of the 94 strains genotyped by restriction fragment-length polymorphism, 79 (84·0%) belonged to one of the 12 identified clusters (2-21 strains each), including two main clusters (18 and 21 cases, respectively). A history of TB treatment was reported in 22/79 (27·8%) clustered cases. Time-space distribution of clustered cases was predominantly consistent with transmission, in micro-epidemics. Given the dominant pattern of exogenous infection and the extensive strain circulation, effective TB control should emphasize reduction of overcrowding and improvement of environmental measures as a complement to detection and treatment of cases.
Programa de Controle de Tuberculose, Coordenação de Gestão em Saúde Penitenciária, Secretaria de Estado de Administração Penitenciária, Rio de Janeiro, Brazil.
A
A
Sánchez
F D
FD
Huber
V
V
Massari
A
A
Barreto
L A B
LA
Camacho
V
V
Cesconi
M H
MH
Saad
B
B
Larouze
D000328:Adult; D016000:Cluster Analysis; D019353:Endemic Diseases; D005260:Female; D005838:Genotype; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D012150:Polymorphism, Restriction Fragment Length; D011330:Prisons; D011446:Prospective Studies; D013902:Radiography, Thoracic; D014376:Tuberculosis / Q000453:epidemiology*