Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/19312
Title: The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons
Authors: Urrego, Juliana
Ko, Albert Icksang
Carbone, Andrea da Silva Santos
Paião, Dayse Sanchez Guimarães
Sgarbi, Renata Viebrantz Enne
Yeckel, Catherine W
Andrews, Jason R
Croda, Julio
Affilliation: Yale School of Public Health. New Haven, CT
Yale School of Public Health. New Haven, CT / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil
Hospital Universitário de Dourados. Dourados, MS, Brasil
Hospital Universitário de Dourados. Dourados, MS, Brasil
Hospital Universitário de Dourados. Dourados, MS, Brasil
Yale School of Public Health. New Haven, CT
Stanford University School of Medicine. Stanford, CA
Universidade Federal da Grande Dourados. Faculdade de Ciências da Saúde. Dourados, MS, Brasil
Abstract: Prisoners have among the highest incidence of tuberculosis (TB) globally. However, the contribution of the prison environment on transmission is not well understood and structural characteristics have received little attention as effective epidemiological interventions in TB control. We evaluated architectural characteristics and estimated ventilation rates in 141 cells in three prisons in central west Brazil using steady-state exhaled carbon dioxide (CO2) levels. We used a modified Wells-Riley equation to estimate the probability of infection for inmates sharing a cell with an infectious case and projected the impact of interventions, including early diagnosis and improved ventilation. Overall, prison cells were densely populated (mean 2.1 m(2) per occupant) and poorly ventilated, with only three cells meeting World Health Organization (WHO) standards for per-person ventilation (60 L/s) applied in infection control settings. In the absence of interventions, projected mean risk of infection was 78.0% during a 6-month period. Decreasing time-to-diagnosis by 25% reduced transmission risk by 8.3%. Improving ventilation to WHO standards decreased transmission by 38.2%, whereas optimizing cross-ventilation reduced transmission by 64.4%. Prison environments promote high infection risk over short-time intervals. In this context, enhanced diagnostics have a limited impact on reducing transmission. Improving natural ventilation may be required to effectively control TB in prisons.
Keywords: Tuberculosis Pulmonary
Early Diagnosis
Ventilation
Risk Factors
Prisons
Humans
Brazil
keywords: Tuberculose Pulmonar
Diagnóstico precoce
Ventilação
Fatores de risco
Prisões
Humanos
Brasil
DeCS: Tuberculose Pulmonar
Diagnóstico precoce
Ventilação
Fatores de risco
Prisões
Humanos
Brazil
Issue Date: 2015
Publisher: American Society of Tropical Medicine and Hygiene
Citation: URREGO, J. et al. The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons. American Journal of Tropical Medicine and Hygiene, v. 93, n. 4, p. 739–746, 2015.
DOI: 10.4269/ajtmh.15-0166
ISSN: 0002-9637
Copyright: open access
Appears in Collections:BA - IGM - Artigos de Periódicos

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