High Prevalence of and Risk Factors for Latent Tuberculosis Infection among Prisoners, Tianjin, China

Tuberculosis in prison: What about after release? The example of French Guiana

INTRODUCTION

Tuberculosis is a major cause of mortality worldwide. Prisoners in Guiana have multiple risk factors. The primary objective of this study was to describe tuberculosis occurring in prison and after release in French Guiana between 2008 and 2020. Secondary objectives were to identify tuberculosis risk factors and determine annual incidences.

METHODS

A retrospective cohort study of tuberculosis cases was carried out at the Guiana prison between 2008 and 2020. Data were collected from prison registers and cross-referenced with the list of tuberculosis notifications in French Guiana.

RESULTS

A total of 36 cases of tuberculosis were studied. Incidence was high, at 263/100,000 per year, higher than elsewhere in France and comparable to that in Brazil. Despite visibly effective screening on entry, with little evidence of intra-prison circulation of tuberculosis, 39% of patients were diagnosed within two years of leaving prison (76% were symptomatic). This could be explained by the high prevalence of latent forms (LTI).

DISCUSSION

Continued screening on entry, in combination with annual radiological and clinical screening, and reinforced follow-up on release seem indicated to improve patient management and the search for possible LTI.

Positive rate and risk factors of latent tuberculosis infection among persons living with HIV in Jiangsu Province, China

Objective

To analyze the latent tuberculosis infection (LTBI) among persons living with HIV(PLWH) in Jiangsu Province, to explore the factors affecting the positive rate of LTBI, and to take appropriate measures to control tuberculosis (TB) infection.

Methods

A cross-sectional study was conducted among PLWH in Jiangsu Province from June to July 2021. All PLWH in Jiangsu Province were used as the study population. Currently, the diagnosis of LTBI lacks a "gold standard" and can only be assisted by the immunological method. In this study, Tuberculin skin test (TST), ESAT6-CFP10 test (EC), and QuantiFERON-TB gold in-tube (QFT) were used to detect the positive rate of LTBI among PLWH and to analyze their risk factors.

Results

A total of 340 prisoners were included, 89.7% were male, the median age was 38 years [Interquartile Range (IQR):32-46 years], these patients were on Antiviral Therapy (ART), and median CD4 counts was 376 (IQR: 261-496), 103 (30.3%) were positive in at least one test, LTBI by TST was 16.5%, LTBI by EC was 15.9%, LTBI by QFT was 26.2%. Univariate analysis showed the results for TST, EC, and QFT were not affected by CD4 counts (p>0.05), and multivariate analysis showed that a history of incarceration was associated with an increased risk of positive TST (adjusted odds ratio [aOR]=1.98;95% CI,1.03-3.82), EC (aOR=2.65;95% CI,1.37-5.12) and QFT (aOR=2.01;95%CI,1.12-3.57), in addition, female gender was associated with increased risk of positive TST (aOR=3.66;95%CI,1.60-8.37) and EC (aOR=3.43;95%CI,1.46-8.07), and contact history of TB patients was associated with increased risk of TST (aOR= 2.54;95%CI,1.23-5.22) and QFT (aOR=2.03;95%CI,1.03-3.99), and ethnic minorities (aOR=0.26;95%CI,0.12-0.57), longer duration of incarceration was associated with an increased risk of positive QFT (aOR=1.12;95%CI,1.02-1.24). Conclusions Female gender, and ethnic minorities, history of incarceration, longer duration of incarceration, and contact history of TB patients are risk factors for LTBI among PLWH in Jiangsu Province, and attention should be paid to TB control in this population.

Prevalence and risk factors of latent tuberculosis infection among college students: a systematic review and meta-analysis

OBJECTIVES

College students are at increased risk of tuberculosis (TB), which increases their likelihood of developing latent tuberculosis infections (LTBI). This study aimed to estimate the pooled prevalence of LTBI and identify its risk factors.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

We searched PubMed, Embase, Scopus, Web of Science, CNKI, Wanfang and CBM databases (10 March 2022) for studies published in any language. The pooled prevalence of LTBI was estimated using random effects methods. Factors associated with LTBI were evaluated by determining standardised mean difference (SMD) with 95% confidence interval (CI). All analyses were performed using the Stata 15.1.

RESULTS

A total of 50 studies from 18 countries were included, with 44 tuberculin skin test (n = 623,732) and 19 interferon gamma release assay (n = 38,266) estimates. The prevalence of a positive tuberculin skin test was 20% (95% CI: 17-23%), and the prevalence of a positive interferon gamma release assay was 9% (95% CI: 7%-11%) among college students. Older age (SMD: 1.67, 95% CI: 1.31-2.13), no Bacillus Calmette-Guérin vaccination/scar (SMD: 1.51, 95% CI: 1.06-2.16), contact with TB cases (SMD: 1.34, 95% CI: 1.11-1.62), clinical training (SMD: 1.93, 95% CI: 1.65-2.26) and overweight/obesity (SMD: 1.17, 95% CI: 1.06-1.30) were associated with a higher prevalence of LTBI. Sex was not associated with LTBI prevalence.

CONCLUSION

College students have an increased risk of LTBI, although it varies by geographical area. This meta-analysis provides evidence of risk factors for LTBI in college students. Infection control measures should be conducted for college students with LTBI.

Epidemiology and control strategies for tuberculosis in countries with the largest prison populations

Tuberculosis (TB) is a serious infectious disease, and its control is considered a challenge, especially among vulnerable populations such as prisoners. The occurrence of TB in prisons is an alarming public health problem in many countries. This integrative review aims to describe the epidemiology of TB and control strategies for this disease in countries with the largest prison populations. Studies have shown that it is essential to know the prevalence of TB in prisons of each country. This is because it can serve as an indication of the need for action in prisons to reduce TB rates, including improving the structure of prison environments, rapidly and accurately diagnosing new cases, identifying drug-resistant strains, and implementing effective and directly observed treatment for TB.

Prevalence of latent tuberculosis infection and feasibility of TB preventive therapy among Thai prisoners: a cross-sectional study

BACKGROUND

Prisons are considered as major reservoirs for tuberculosis. Preventive therapy for latent TB infection (LTBI) is an adjunctive strategy to control TB. However, LTBI data in Thai prisoners is limited. This study assessed the prevalence of LTBI and feasibility of isoniazid preventive therapy (IPT).

METHODS

A cross-sectional study was conducted among prisoners in Klong Prem Central Prison, Bangkok. Participants were screened for active TB by questionnaire and chest X-ray. LTBI was evaluated by Tuberculin skin test (TST) and QuantiFERON-TB Gold Plus (QFTP) among subgroup. Participants with positive TST or QFTP were considered to have LTBI. Participants with LTBI were offered IPT.

RESULTS

From August 2018-November 2019, 1002 participants were analyzed. All participants were male with a median age of 38 (IQR 32-50) years. LTBI identified by either TST/QFTP was present in 466 (46.5%) participants. TST was positive in 359 (36%) participants. In the subgroup of 294 participants who had both TST and QFTP results, 181/294 (61.6%) tested positive by QFTP. Agreement between TST and QFTP was 55.1% (Kappa = 0.17). The risk factors associated with LTBI were previous incarceration (aOR 1.53, 95%CI, 1.16-2.01, p = 0.002), history of prior active TB (aOR 3.02, 95%CI, 1.74-5.24, p < 0.001) and duration of incarceration ≥10 years (aOR 1.86, 95%CI, 1.24-2.79, p = 0.003). Majority of LTBI participants (82%) agreed to take IPT. Three hundred and 56 (93%) participants completed treatment whereas 27 (7%) participants discontinued IPT due to the side effects of INH.

CONCLUSION

This is the first study to evaluate the prevalence of LTBI and feasibility of IPT among Thai prisoners. LTBI prevalence in male prisoners in Thailand is high. LTBI screening and treatment should be implemented together with other preventive components.