Tuberculosis symptom screening among new prisoners in two Greater Manchester prisons

Abstract

The incidence of tuberculosis (TB) has increased in the UK over the last 15 years. In England, the TB rate in 2006 was 15.5 per 100,000 of the population. The rates varied in different parts of the country, with London having the highest rate (44.8 per 100,000). Greater Manchester had the highest rate in the northwest of England (16.6 per 100,000), and there were variations within the county, with Manchester having the highest rate (37.4 per 100,000) and Bury having the lowest rate (2.2 per 100,000).1,2 A recent study set in London reported that TB rates in the prison population are much higher than average (208 per 100,000).3 Late diagnosis, overcrowding, poor ventilation and repeated prison transfer of infectious individuals encourages the spread of infectionwithin the prison environment. TB incidents in prisons are challenging to manage and cause significant anxiety in prisoners and staff. A recent community outbreak of isoniazid-resistant TB in North London resulted in the first published report of TB transmission in a UK prison. The outbreak control team recommended, among other things, that standardized symptom assessment should be undertaken on reception, and adequate isolation facilities should be provided. In England, there is close liaison between the National Health Service (NHS) and the prison service, and this facilitates a partnership approach to developing policy relating to prison health. National guidelines were produced by the National Institute for Health and Clinical Excellence on TB in 2006, and several recommendations were made relating to prison health, including that prisoners should undergo TB symptom screening on each entry to the prison system.6 In line with this, a northwest prison TB control policy was developed jointly by the Northwest Regional TB Group