The cough that packed a punch: is boxing a risk for tuberculosis transmission?

Prevalence of Mantoux positivity and annual risk of infection for tuberculosis in New South Wales prisoners, 1996 and 2001

OBJECTIVES

This study compares the prevalence of Mantoux positivity among prisoners in NSW in 1996 and 2001 and examines factors associated with Mycobacterium tuberculosis infection.

DESIGN

Cross-sectional random samples of prisoners, including a longitudinal cohort of prisoners screened in both 1996 and 2001.

SETTING

29 correctional centres.

PARTICIPANTS

747 men and 167 women participated in the 2001 NSW Inmate Health Survey; a cohort of 104 prisoners from the 1996 and 2001 NSW Inmate Health Surveys.

RESULTS

The prevalence of Mantoux positivity remained stable between 1996 and 2001 (12% and 14%, p = 0.2), and increased among prisoners from Asian backgrounds (21% and 47%, p = 0.02). The annual risk of infection in the cohort among those detained continuously between 1996 and 2001 was 3.1%, and among recidivists it was 2.7% (p = 0.6).

CONCLUSION

The risk of M. tuberculosis infection for Australian prisoners is assessed to be approximately four times higher than that for the community, however there is no attributable risk to the prison environment itself.

Pox in the docks: varicella outbreak in an Australian prison system

OBJECTIVES

1. Describe an outbreak of varicella in a prison system. 2. Highlight the risks of disease transmission within the prison environment. 3. Promote infection control guidelines for high-risk sub-groups within the prison system, including the application of quarantine.

SETTING

Four prisons, one prison hospital, the prison transport system, one courthouse.

MAIN OUTCOME MEASURES

Number of cases of varicella infection; reported varicella immunity status of cases and contacts; immunity status of known HIV antibody positive inmates.

RESULTS

Five cases of chickenpox were identified. There were 23 contacts of the Index Case occurring during transport between prison and court and whilst being held in the court holding cells. Two of these contacts developed chickenpox despite having given a prior history of infection. There were over 300 inmates exposed to varicella zoster virus (VZV) during the outbreak, including one HIV antibody positive inmate who had serologically confirmed immunity. This inmate developed shingles following exposure to VZV from one of the cases.

CONCLUSIONS

There is an elevated risk of respiratory transmission of infections such as chickenpox in prisons. Clear guidelines should be in place to protect HIV antibody positive people, pregnant women, and others who are at increased risk of complications from such infections. In the case of varicella, all inmates and staff without documented immunity should be screened to determine immunity, and if non-immune, should be offered VZV vaccination. Every effort should be made to prevent HIV antibody positive inmates being exposed to varicella, regardless of their varicella immunity status. If an HIV antibody positive inmate, who is known to be non-immune is exposed to varicella, Varicella Zoster immunoglobulin should be given within 96 h.