The prisons across the globe reveal an alarming high tuberculosis (TB) rates and low case detection, according to a recent study claimed to be the first global assessment of TB among incarcerated individuals.
The study conducted by the Boston University School of Public Health emphasises the urgent need for health organizations to intensify their efforts in preventing the spread of TB among this vulnerable population.
In 2019, the study indicates that incarcerated individuals worldwide developed TB at a rate nearly ten times higher than that of the general population. The data reveals that out of the estimated 11 million people in prisons globally, 1,25,105 individuals developed TB during that year alone, resulting in a rate of 1,148 cases per 100,000 persons annually.
Despite the significant prevalence of TB cases, the study also highlights a concerning fact: close to half of the TB cases among incarcerated individuals went undetected. This suggests a substantial gap in identifying and addressing TB infections within prison settings, further underscoring the importance of implementing comprehensive measures to address the issue.
THE DIAGNOSIS
The combination of a high case rate and low detection highlights the urgent need for increased awareness and resources to reduce the burden of TB in prisons and other high-risk settings.
Dr. Leonardo Martinez, the lead author of the study emphasizes that only 53 percent of incarcerated individuals who develop TB are diagnosed, suggesting that this population is neglected and lacks adequate healthcare services for TB diagnosis. Martinez is an assistant professor of epidemiology at BUSPH.
METHOD
To gain insights into TB rates among incarcerated populations, Dr. Martinez and his colleagues collected data from published research and federal officials of various countries. They analyzed TB prevalence and incidence in 193 countries at the global, regional, and country levels from 2000 to 2019. The team also calculated TB case detection rates for each country.
THE NUMBERS
The African region had the highest rate of new TB cases in 2019, at 2,242 cases per 1,00,000 persons per year. However, the Americas region, particularly Central and South America, had the highest number of total cases, which increased by nearly 90 percent since 2000. Brazil, Russia, China, the Philippines, and Thailand had the highest number of new cases in prisons in 2019. The study found that new TB case rates remained consistently between 1,100 and 1,200 cases per 100,000 persons per year from 2012 to 2019. This stagnation indicates that the current TB control policies in prisons are insufficient to decrease the burden of TB, highlighting the need for supplementary interventions and policy implementation, according to Dr. C. Robert Horsburgh, a professor of global health at BUSPH.
OVERCROWDING
Mass incarceration is a significant driver of TB transmission both within and outside of prisons. Overcrowding, with some prison cells accommodating up to 30 people, facilitates the rapid spread of TB. This transmission can easily extend to the community.
Contrary to popular belief, incarcerated individuals are mobile, and their duration of incarceration is often short in many countries. This mobility means that individuals who develop TB in prison can transmit the disease to many people outside the prison once released. Since nearly half of the individuals with TB in prisons remain undiagnosed, they continue to be infectious when they re-enter the general community.
MONITORING
The researchers hope that these findings will prompt global and regional health organizations to establish routine monitoring of TB among incarcerated populations, similar to done for other high-risk groups like people with HIV and household contacts. The comprehensive compilation of TB case notifications, obtained from various sources, demonstrates that information about TB in prisons is accessible and retrievable by organizations such as the World Health Organization.
Dr. Martinez emphasizes that the neglect of this population is partly due to the lack of data. The researchers hope that these results will raise awareness among stakeholders about the urgency of the issue, the significant number of incarcerated individuals developing TB and remaining undiagnosed for extended periods, and ultimately spur action to address this problem.
