TUBERCULOSIS IN A PRISON, JEDDAH, SAUDI ARABIA, JULY 1993-MARCH 1995 Page 5 After recognizing four extra were interviewed in the prison or Chest mellitus (Odds ratio [OR)=16, 95% pulmonary tuberculosis cases among Hospital. Confidence Interval [CI)7-37) and prisoners hospitalized in a Jeddah From July 1993 to February 1995,53 smokers (OR=2.9, 95% CI 1.1-7.9) had a hospital, an additional 40 prisoners with cases of pulmonary (49 cases) and extra greater risk ofTB. pulmonary TB were identified from TB pulmonary (4 cases) TB were diagnosed We screened 297 prisoners using chest surveillance between July 1993 to among prisoners (incidence rate= 456 film sputum smears and tuberculin skin December 1994. An epidemiologic per 100,000 per year). TB cases had been testing. Prisoners were selected because investigation was begun to determine the detected in the correctional institute since they were in a ward with known TB reasons for the large number ofTB cases the beginning (July 1993) of the study cases or because they had a risk factor for among prisoners in a prison in Jeddah. period and the first seven cases had onset TB (HIV positive, diabetes mellitus, The prison has two sections: a of illness more than one month after im chronic renal failure, hematological correctional institute and a general prisonment (prison-acquired). In disorder). Twenty-six previously prison according to the crime. One contrast, no TB cases had been undetected TB cases were identified clinic serves both sections of the prisons. discovered in the general prison during (8754 per 100,000). The mean PPD prisoners with suspect TB are referred to the first five months of the case review reaction was 7 mm with a range from 0- the Jeddah TB Center for chest x ray, . and one of the first three cases had onset 20 mm among all screened prisoners. tuberculin skin testing, and sputum less than one month after imprisonment The rate of tuberculin positively examination. Those with acid fast bacilli (community-acquired). For all TB cases increased with increasing months of on sputum examinatiol! or time between imprisonment and onset of imprisonment (R= 0.27,95% confidence Mycobacterium tuberculosis o.n symptoms ranged from 0 to 1162 days limits 0.08-0.44). Screening of guards are referred to the Chest Hospitals 10 Taif (median 216) and 87% were prison- and social workers (18) detected one for treatment. New prisoners had not acquired. guard and one social worker from the been screened for TB. Referral from the prison clinic for TB Correctional Institute with pulmonary To find cases we reviewed patients' diagnosis was delayed from 31 to 65 days TB. . records of the two hospitals used by the (mean 54) after onset of cough. The risk -- Reported by Dr. Nadir Hassan AI prison and the Jeddah TB Center. A ofTB increased with crowding in the Shareef, Dr. Robert Fontaine, Field pulmonary TB case was defined a ward (Chi square for trend = 5.1, p< Epidemiology Training Program and prisoner who developed 0.05) and time spent in prison (p< 0.01, I1ham Qattan,Diseases Control with a sputum smear positive for aCid ANOVA). When compared to control Department, Jeddah fast bacilli and extra pulmonary TB cases prisoners selected at random from all Editorial note: Prisons throughout the as an illness with TB granuloma prisoners, prisoners with diabetes world represent a situation where risk demonstrated by histology from July (Continued onpage 7) 1993 to March 1995. Prisoners with TB LEISHMANIASIS (Continuedfrom page 4) (Rodentia:Gerbillidae), a possible reservoir host of zoonotic cutaneous leishmaniasis in Riyadh province, Saudi Arabia. Trans R Soc Trop Med and Hyg 1994; 88:39. 4. AI-Gindan Y, Abdul-Aziz 0, Kubba R. Some clinical aspects of cutaneous leishmaniasis in AI-Hassa, Saudi Arabia. Proceedings of the medical symposium on leishmaniasis, 1980 Mar 22-24; . Dammam, Kingdom of Saudi Arabia. College of Medicine and Medical Sciences, King Faisal University, and Ministry of Health, 57-72. Distribution of CL cases by month of onset Omrajown town, Al Majmaah, Riyadh region, KSA 1992-1994 Cases " 15 ,. 1992 1993 1 994
Transcript
TUBERCULOSIS IN A PRISON, JEDDAH, SAUDI ARABIA, JULY 1993-MARCH 1995
Page 5
After recognizing four extra were interviewed in the prison or Chest mellitus (Odds ratio [OR)=16, 95% pulmonary tuberculosis cases among Hospital. Confidence Interval [CI)7-37) and prisoners hospitalized in a Jeddah From July 1993 to February 1995,53 smokers (OR=2.9, 95% CI 1.1-7.9) had a hospital, an additional 40 prisoners with cases of pulmonary (49 cases) and extra greater risk ofTB. pulmonary TB were identified from TB pulmonary (4 cases) TB were diagnosed We screened 297 prisoners using chest surveillance between July 1993 to among prisoners (incidence rate= 456 film sputum smears and tuberculin skin December 1994. An epidemiologic per 100,000 per year). TB cases had been testing. Prisoners were selected because investigation was begun to determine the detected in the correctional institute since they were in a ward with known TB reasons for the large number ofTB cases the beginning (July 1993) of the study cases or because they had a risk factor for among prisoners in a prison in Jeddah. period and the first seven cases had onset TB (HIV positive, diabetes mellitus,
The prison has two sections: a of illness more than one month after im chronic renal failure, hematological correctional institute and a general prisonment (prison-acquired). In disorder). Twenty-six previously prison according to the crime. One contrast, no TB cases had been undetected TB cases were identified clinic serves both sections of the prisons. discovered in the general prison during (8754 per 100,000). The mean PPD prisoners with suspect TB are referred to the first five months of the case review reaction was 7 mm with a range from 0-the Jeddah TB Center for chest x ray, . and one of the first three cases had onset 20 mm among all screened prisoners. tuberculin skin testing, and sputum less than one month after imprisonment The rate of tuberculin positively examination. Those with acid fast bacilli (community-acquired). For all TB cases increased with increasing months of on sputum examinatiol! or time between imprisonment and onset of imprisonment (R= 0.27,95% confidence Mycobacterium tuberculosis o.n c~ture. symptoms ranged from 0 to 1162 days limits 0.08-0.44). Screening of guards are referred to the Chest Hospitals 10 Taif (median 216) and 87% were prison- and social workers (18) detected one for treatment. New prisoners had not acquired. guard and one social worker from the been screened for TB. Referral from the prison clinic for TB Correctional Institute with pulmonary
To find cases we reviewed patients' diagnosis was delayed from 31 to 65 days TB. . records of the two hospitals used by the (mean 54) after onset of cough. The risk -- Reported by Dr. Nadir Hassan AI prison and the Jeddah TB Center. A ofTB increased with crowding in the Shareef, Dr. Robert Fontaine, Field pulmonary TB case was defined a~ a ward (Chi square for trend = 5.1, p< Epidemiology Training Program and prisoner who developed ~.coug~ Ill~ess 0.05) and time spent in prison (p< 0.01, I1ham Qattan,Diseases Control with a sputum smear positive for aCid ANOVA). When compared to control Department, Jeddah fast bacilli and extra pulmonary TB cases prisoners selected at random from all Editorial note: Prisons throughout the as an illness with TB granuloma prisoners, prisoners with diabetes world represent a situation where risk demonstrated by histology from July (Continued onpage 7) 1993 to March 1995. Prisoners with TB
LEISHMANIASIS
(Continuedfrom page 4) (Rodentia:Gerbillidae), a possible reservoir host of zoonotic cutaneous leishmaniasis in Riyadh province, Saudi Arabia. Trans R Soc Trop Med and Hyg 1994; 88:39. 4. AI-Gindan Y, Abdul-Aziz 0, Kubba R. Some clinical aspects of cutaneous leishmaniasis in AI-Hassa, Saudi Arabia. Proceedings of the medical symposium on leishmaniasis, 1980 Mar 22-24; . Dammam, Kingdom of Saudi Arabia. College of Medicine and Medical Sciences, King Faisal University, and Ministry of Health, 57-72.
Distribution of CL cases by month of onset Omrajown town, Al Majmaah, Riyadh region, KSA
1992-1994
Cases
"
15
,.
1992 1993 1994
TB (Continued from page 5)
factors for acquiring tuberculosis (TB) are common and require special attention for TB control and prevention. 1,2 The prisoners themselves come from groups of people in the community that are at relatively high risk ofTB. In the prisons relatively crowded conditions and close contact between prisoners increase the risk of TB transmission. 3
Many of the factors previously noted in other prisons were demonstrated as contributing to TB in this prison. These include crowding and length of time spent in the prison, smokinj' and underlying chronic disease. Prisoners may have been selected from a high risk social groups in the community. However, this could not be shown because prisoners were not screened when first imprisoned. Transmission had probably been ongoing in the correctional institute before July 1993, whereas the community-acquired case among the initial cases in the general prison suggests that transmission there was more recent. The lack of screening of new prisoners and the delay of
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In the Kingdom April 1-3, 1~96: "SYlllp()siu~on RecentAdvances in Me.dical Microbiology and Infectious .Disease.s. ". Sponsored by-the CoilegeofMedicine) King Saud University. Contact: Dr. Saleh S,A. Al~HedaHhy,Ch~i1':trian, .prgariiiing Committee, Symposium on Recent Advances in MediCal Microbiology and Infectious Diseases,. Postgraduate Center. College of Medicine, King Saud University, P.O. Box 2925. Riyadh 11461~ Saudi Arabia. (01)467- .. 15SlIJS54/1556/15M (ph9n~}(>1'(On481-1853(fux). . '
May 25-30, 1996: "3rd Safety & OccupatioMl Health Conferellce& ExhibitiQn." Sponsored by lheCffil.mber of Commercean4 Industry in cOOperation wi~h I<i#~fF~sa1 . UrUvers.ty, A~$Emt(ftWIA . . Contact:~aeedR AJ.;Ghamdi, Cbai1111ari,'l:~hnicafCotnnuttee, 3t4Safety andOcctipational HealthCome.renge & Exhibitilill, Chamber ()fCQnurter~ ~lndustry, EastemPr9vince, P;();. Box .719, Dammaml1421, SaudiArabia. (966)3857';1111 · ext. 3333 (phone) or (966)3 857-0607 (fax). .... .
.. . Qu~si~~ the~i.,g~()m A pdt. is .. 19 , 1996 : Field Epidemiology Ttainillg J>tRgt;arns' (FETP) . Scientific Meetirig; . April ·22 ... 26, J 996; ·1996 Centets·forDi$AAse Control (CDC)EIS Conference; Aprit23, ·1996: · IrtteOlational Night pf the 1996 BIS Conference Al.JlVe~ CDC spoij§()r~d)y~~t$~ .. e~6beh~ld · blAtla~ta. Coijiact: · Dr; p()llgIas HariUndn, InterriatibnatBranch,DFE,JEPO, MailstopC-Q8, Centers for Disease Contr.()!. At1anta; G~l'lrgia3033 3, YSAElectroilic mail via Internet DHHO@EPO~EM;CDC:GOV. . . .. .
diagnosis ofTB through the prison clinic Aligns! 27-30, 19'~: The 14th In!erl1ational Sqie1l4fiqMeetin~()fthe were important contributors to this IntetnationalEpide:mio16gica1 AssQCi~tipll!!'.ChangjngEnviJ:o.n,men~atld:Qlobal outbreak. In addition the screening HealthJssues. Cont~cfSe¢retariat oft1\e14thlnterrtationaI ScieIltificMeeting of indicated that there was a significant lEA, c/ODepartment O['PreventiveMediCine, Nagoya University School of reservoir of undiagnosed pulmonary TB Medicine, 65 Tsurumru-cho, Showa-ku, Nagoya 466, Japan. (81)52-733,.6729 (fax). among the prisoners. . ..
The problem ofTB in prisons must be 346: 948-9. dealt with by increasing awareness of 2. Centers for Disease Control, prison medical staff and authorities. To Prevention and control of tuberculosis in
correctional institutions: eliminate introduction of community- Recommendations of the advisory acquired TB, all new prisoners and committee for the elimination of prison employees should be screened tuberculosis. MMWR 1989; 38: 313-20, with TB skin tests and chest x ray.2 In 325. prison, a more comprehensive screening 3. Braun MM, Truman BI, Maguire B. of existing prisoners and staff is Increasing incidence of tuberculosis in a indicated. To prevent spread to the prison inmate population. JAMA 1989; community, similar screening should 261 : 393-7.
4. Buskin SE, Gale JL, Weiss NS, Nolan also apply to released prisoners, CM. Tuberculosis risk factors in adults in especially those in contact with TB cases. King County, Washington, 1988 through Surveillance should include full access of 1990. AJPH 1994; 84: 1750-5. prisoners to clinic services and heightened awareness of TB among clinic staff to promptly identify any new case of TB developing among prisoners. As soon as TB is diagnosed treatment should be started and contacts evaluated.
References: 1. Drobniewski F. Tuberculosis in prisons--forgotten plague. Lancet 1995;
Send correspondenoe, comments. calendar listings or articles to:
Saudi Epidemiology Bulletin Editor-in-Chief.
P.O. Box 6344, Riyadh 11442 Saudi Arabia.
For epidemiological assistElnce, call or fax the FETP at 01-479-0726 or 01-478-1424.
Saudi Epidemiology Bulletin (SEB) is published quarterly by the Department of Preventive Medicine and the Field Epidemiology Training Program. Preventive Medicine Department: Dr.Yagoub AI-Mazroa, Assistant
Deputy Minister for Preventive Medicine. SEB Supervisor
Dr. Mohammed AI-Jefri, General Director. Parasitic and Infectious Diseases Department
Dr. Amin Mishkhes. Director. Infectious Diseases Department
Field Epidemiology Training Program: Dr. Nasser AI-Hamdan. Supervisor,
Field Epidemiology Training Program. SEB Editor-in-Chief.
Dr. Robert Fontaine. Consultant Epidemiologist, CDC
