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      Estudio multicéntrico de prevalencia de infección tuberculosa latente en los internados en prisiones españolas Translated title: Multi-centre study of the prevalance of latent tuberculosis infection amongst inmates in spanish prisons


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          Objetivo: Estudiar la prevalencia de infección tuberculosa latente (ITL) entre los presos internados en las prisiones españolas. Material y Método: Estudio multicéntrico, observacional y transversal; muestreo por conglomerado bietápico. Se recogieron variables sociodemográficas, penitenciarias y clínico-serológicas. Se realizó análisis univariante, bivariante y multivariante mediante regresión logística con las variables que mostraron significación estadística. Se calculó la odds ratio con intervalo de confianza del 95%. Resultados: 378 pacientes. Se dispuso de intradermorreacción de Mantoux (IDRM) valorable en el 90,2%. 91,2% hombres, 37,8% extranjeros con edad media de 35,9±10,3 años. Mediana de estancia en prisión: 2 años y el 28,7% había estado > 5 años en prisión. El 49,6% ingresó en prisión en 2006 o antes. El 24,5% tenía antecedentes de uso de drogas intravenosas (UDI). El 50,4% presentaba ITL que se asoció a: edad > 40 años (63,2 vs 43,8%; IC: 1,39-3,49; OR: 2,20; p=0,001); haber estado > 5 años en prisión (71,2 vs 41,3%; IC: 2,13-5,75; OR: 3,50; p<0,001); estar en prisión desde 2006 o antes (58,1 vs 42,6%; IC: 1,22-2,88; OR:1,87; p=0,004); estar infectado por el VHC+ (66,3 vs 45,3%; IC:1,40-4,0; OR: 2,37; p=0,001). El modelo de regresión logística confirmó la asociación independiente de la ITL con: a) edad > 40 años (OR:1,76; IC: 1,08-2,87; p=0,024); y b) estancia > 5 años en prisión (OR: 2,50; IC: 1,41-4,43; p=0,002). Conclusiones: La prevalencia de ITL en prisión es muy alta, sobre todo en los mayores de 40 años y los que están más de cinco años en prisión. Para evitar el riesgo de progresión a tuberculosis, se recomienda tratar a los infectados que lo precisen y mantener los programas de control de esta patología.

          Translated abstract

          Aims: To study the prevalence of latent tuberculosis infection (LTBI) amongst inmates in Spanish prisons. Materials and Methods: Multi-centre, cross-sectional study; two stage sampling. Socio-demographic, prison and clinical variables were gathered. A univariate, bivariate and multivariate analysis was carried out using logistic regression with the variables that showed statistical significance. The odds ratio was calculated with a confidence interval of 95%. Results: 378 patients. The Mantoux test (PPD) assessable in 90.2% was available. 91.2% men, 37.8% foreigners with average age of 35.9±10.3 years. Average stay in prison: 2 years, 28.7% had been > 5 years in prison. 49.6% entered prison in 2006 or before. 24.5% had a history of intravenous drug use (IDU). 50.4% presented LTBI that was associated with: age > 40 years (63.2 vs 43.8%; CI: 1.39-3.49; OR: 2.20; p=0.001); stay of > 5 years in prison (71.2 vs 41.3%; CI: 2.13-5.75; OR: 3.50; p<0.001); in prison since 2006 or before (58.1 vs 42.6%; CI: 1.22-2.88; OR:1.87; p=0.004); infected with HCV+ (66.3 vs 45.3%; CI:1.40-4.0; OR: 2.37; p=0.001). The logistic regression model confirmed the independent association of LTBI with: a) age > 40 years (OR: 1.76; CI: 1.08-2.87; p=0.024); and length of prison stay > 5 years (OR: 2.50; CI: 1.41-4.43; p=0.002). Conclusions: The prevalence of LTBI in prison is very high, especially amongst inmates over 40 and those who have been in prison for more than five years. To prevent the risk of progression to tuberculosis, treatment is recommended for those who require it along with the maintenance of control programmes for this pathology.

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          Prevalence of and risk factors associated with Mycobacterium tuberculosis infection in prisoners, North West Frontier Province, Pakistan.

          This cross-sectional study was conducted to assess the prevalence of and identify factors associated with latent Mycobacterium tuberculosis (MTB) infection in prisoners of North West Frontier Province (NWFP). A stratified random sampling technique was used to select a sample of 425 from a total of 6607 male prisoners aged 18-60 years from the five central prisons of NWFP, Pakistan (Peshawar, Dera Ismail Khan, Haripur, Kohat, and Mardan). The selected inmates were interviewed using a structured pre-tested questionnaire; a Mantoux tuberculin skin test (TST) was also performed. Latent MTB infection status of the prisoner was determined by the size of the induration of the TST in the presence/absence of a previous BCG scar. Overall prevalence of latent MTB infection among prisoners was 48% (204/425). Using multiple logistic regression, a prisoner's age, educational level, smoking status, duration of current incarceration, and average accommodation area of 60 ft(2) or less in prison barracks were found to be statistically significant (P < 0.05) predictors of latent MTB infection. The high prevalence of latent MTB infection as assessed by TST in prisoners requires immediate steps be taken to identify and confirm MTB infection, and to treat and counsel those found to be positive in this setting. Efforts to halt MTB transmission in prisons should include: routine screening of prisoners on entry using sputum smear and TST for diagnosis of tuberculosis (TB) and latent MTB infection, respectively. The isolation and treatment of TB positive prisoners and chemo-prophylactic treatment of TST positives, reduction of overcrowding, education regarding the harmful effects of smoking, and intensive monitoring of those serving longer prison terms may help reduce the MTB transmission in this setting and in the community at large.
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            Effect of preventive treatment for tuberculosis in adults infected with HIV: systematic review of randomised placebo controlled trials.

            To determine whether preventive treatment for tuberculosis in adults infected with HIV reduces the frequency of tuberculosis and overall mortality. Systematic review and data synthesis of randomised placebo controlled trials. Active tuberculosis, mortality, and adverse drug reaction requiring cessation of the study regimen. Outcomes stratified by status of purified protein derivative skin test. Four trials comprising 4055 adults from Haiti, Kenya, the United States, and Uganda were included. All compared isoniazid (6-12 months) with placebo, and one trial also compared multidrug treatment for 3 months with placebo. Mean follow up was 15-33 months. Overall, frequency of tuberculosis (relative risk 0.57, 95% confidence interval 0.41 to 0.79) was reduced in those receiving preventive treatment compared with placebo: mortality was not significantly reduced (0.93, 0.83 to 1.05). In subjects positive for purified protein derivative receiving preventive treatment, the risk of tuberculosis was reduced substantially (0.32, 0.19 to 0.51) and the risk of death was reduced moderately (0.73, 0.57 to 0.95) compared with those taking placebo. In adults negative for purified protein derivative receiving preventive treatment, the risk of tuberculosis (0.82, 0.50 to 1.36) and the risk of death (1.02, 0.89 to 1.17) were not reduced significantly. Adverse drug reactions were more frequent, but not significantly so, in patients receiving drug compared with placebo (1.45, 0.98 to 2.14). Preventive treatment given for 3-12 months protects against tuberculosis in adults infected with HIV, at least in the short to medium term. Protection is greatest in subjects positive for purified protein derivative, in whom death is also less frequent. Long term benefits remain to be shown.
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              Global tuberculosis control: Surveillance, planning, financing. WHO report


                Author and article information

                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Revista Española de Sanidad Penitenciaria
                Rev. esp. sanid. penit.
                Sociedad Española de Sanidad Penitenciaria (Barcelona, Barcelona, Spain )
                February 2010
                : 12
                : 3
                : 79-85
                [02] Barcelona orgnameCentro Penitenciario de Barcelona-Hombres
                [01] Castellón orgnameCentro Penitenciario de Castellón I
                [03] Alicante orgnameCentro Penitenciario de Alicante I

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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