title: Active and latent tuberculosis in Brazilian correctional facilities: a cross-sectional study.
abstract: BACKGROUND
  Tuberculosis (TB) rates among prisoners are more than 20 times that of the general population in Brazil, yet there are limited data available to facilitate the development of effective interventions in this high-transmission setting. We aimed to assess risk factors for TB infection and evaluate the yield of mass screening for active disease among inmates.
  
  
  METHODS
  We administered a questionnaire and tuberculin skin test (TST) to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV testing and two sputum samples for smear microscopy and culture from participants reporting a cough of any duration. Hierarchical Poisson regression models were used to evaluate factors associated with latent tuberculosis infection (LTBI).
  
  
  RESULTS
  We recruited 3,380 inmates, of which 2,861 (84.6%) were males from 8 prisons, and 519 (15.4%) were females from 4 prisons. Among the 1,020 (30%) subjects who reported a cough, we obtained sputum from 691 (68%) and identified 31 cases of active TB for a point prevalence of 917 (95% CI, 623-1302) per 100,000 prisoners. Evaluation of the two sputum smear samples failed to identify 74% of the TB cases, and 29% of the cases reported less than 2 weeks of symptoms. Obtaining a second culture identified an additional 7 (24%) cases. The prevalences of LTBI were 22.5% and 11.7% for male and female prisoners, respectively and duration of incarceration (in years) was associated with LTBI in male and female in the multivariable model (1.04, 95% CI, 1.01-1.07 and 1.34, 95% CI, 1.06-1.70, respectively). The prevalence of LTBI is 8.6% among newly incarcerated inmates, among whom LTBI prevalence significantly increased by 5% with each year of incarceration.
  
  
  CONCLUSIONS
  Although the overall LTBI prevalence among inmates in Central-West Brazil is low, tuberculosis incidence is high (>1,800/100,00), likely due to the high force of infection among a largely susceptible inmate population. Efforts to reduce transmission in prisons may require mass screening for active TB, utilizing sputum culture in case-detection protocols.
authors.affiliation: University Hospital, Federal University of Grande Dourados, Dourados, Brazil. andreasantos@ufgd.edu.br.
authors.forename: Andrea da Silva Santos
authors.initials: Ada S
authors.lastname: Carbone
authors.affiliation: University Hospital, Federal University of Grande Dourados, Dourados, Brazil. dayseguimaraes@ufgd.udu.br.
authors.forename: Dayse Sanchez Guimarães
authors.initials: DS
authors.lastname: Paião
authors.affiliation: University Hospital, Federal University of Grande Dourados, Dourados, Brazil. renataenne@ufgd.edu.br.
authors.forename: Renata Viebrantz Enne
authors.initials: RV
authors.lastname: Sgarbi
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil. tonufms@gmail.com.
authors.forename: Everton Ferreira
authors.initials: EF
authors.lastname: Lemos
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil. recazanti@gmail.com.
authors.forename: Renato Fernando
authors.initials: RF
authors.lastname: Cazanti
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil. markin_ota@hotmail.com.
authors.forename: Marcos Massaki
authors.initials: MM
authors.lastname: Ota
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil. alexandre.laranjeira21@gmail.com.
authors.forename: Alexandre Laranjeira
authors.initials: AL
authors.lastname: Junior
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil. jose16med@gmail.com.
authors.forename: José Victor Bortolotto
authors.initials: JV
authors.lastname: Bampi
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil. vanessa.pfelias@gmail.com.
authors.forename: Vanessa Perreira Fayad
authors.initials: VP
authors.lastname: Elias
authors.affiliation: Faculty of Ambiental and Biological Sciences, Federal University of Grande Dourados, Dourados, Brazil. s_simionatto@yahoo.com.br.
authors.forename: Simone
authors.initials: S
authors.lastname: Simionatto
authors.affiliation: Department of Biochemical Pharmacy, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil. arcm.castro@hotmail.com.|Oswaldo Cruz Foundation, Campo Grande, Brazil. arcm.castro@hotmail.com.
authors.forename: Ana Rita Coimbra
authors.initials: AR
authors.lastname: Motta-Castro
authors.affiliation: Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil. mapompilio@yahoo.com.br.
authors.forename: Maurício Antonio
authors.initials: MA
authors.lastname: Pompílio
authors.affiliation: University Hospital, Federal University of Mato Grosso do Sul, Campo Grande, Brazil. sandrinhaleone@gmail.com.
authors.forename: Sandra Maria do Valle
authors.initials: SM
authors.lastname: de Oliveira
authors.affiliation: Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil. albert.ko@yale.edu.|Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT, USA. albert.ko@yale.edu.
authors.forename: Albert I
authors.initials: AI
authors.lastname: Ko
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA. jandr@stanford.edu.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Andrews
authors.affiliation: Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil. juliocroda@ufgd.edu.br.|Oswaldo Cruz Foundation, Campo Grande, Brazil. juliocroda@ufgd.edu.br.
authors.forename: Julio
authors.initials: J
authors.lastname: Croda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016012:Poisson Distribution; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult