A significant outbreak of tuberculosis in a prison in England
PHE ePoster Library. Tyrer M. 09/12/17; 186523; 188
Dr. Matthew Tyrer
Dr. Matthew Tyrer
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Abstract IntroductionThis report describes the circumstances surrounding and the lessons learned from an outbreak of tuberculosis (TB). In this outbreak 9 linked cases of TB were identified across 2 wings of the prison. A high prevalence of latent TB infection (LTBI) was also observed.MethodThe scale of this outbreak resulted in several mass screening exercises. Firstly an Interferon Gamma Release Assay (IGRA) screening of the prison wing on which the first 3 cases were resident. The high LTBI prevalence led to chest x-rays being offered to all on the wing. The identification of a case of TB meningitis on a different wing led to an IGRA screening of that wing which did not show a high prevalence. 24loci MIRU-VNTR genotyping was undertaken on all obtainable samples confirming the link between the cases.ResultsThe strain of TB identified was part of an ongoing cluster particularly associated with prisons and the MIRU-VNTR profiles were indistinguishable. The IGRA screening of the first wing showed an LTBI prevalence of 37.5% amongst the prisoners (22.2% amongst prisoners and staff). IGRA screening of the second wing showed a prevalence of 6.8%.ConclusionLate detection of the initial case along with poor compliance with medication were likely to have been contributory factors to the scale of this outbreak and the high LTBI prevalence observed. PHE is working with prison healthcare teams to comply with NICE guidance on TB control and prevention. This is key to reducing the likelihood of this kind of outbreak in future.
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