Tuberculosis among city jail inmates in Campinas, Sao Paulo, Brazil

Objective. To describe the incidence of tuberculosis among inmates of the municipal prison system in the city of Campinas, State of Sao Paulo, Brazil, from 1993 through 2000. Methods. A retrospective study was carried out of the number of cases of tuberculosis that were notified among inmates over the study period. This involved reviewing data from a total of 4 293 inmates who were held in the four prisons that comprise Campinas' municipal prison system. Data were obtained from the tuberculosis database belonging to the Department of Social and Preventive Medicine of the School of Medical Sciences at the State University of Campinas. Results. The incidence of tuberculosis peaked in 1994 (1 397.62 cases per 100 000) and was lowest in 1999 (559.04 cases per 100 000). Most cases of tuberculosis occurred in inmates in the 25 to 34 year age group (62.6%). Acquired immunodeficiency syndrome (AIDS) was the disease most commonly associated with tuberculosis (49.9%), which was most often pulmonary in type (91.9%), with positive sputum smears in 70.3% of the inmates tested. Most inmates had not received treatment before (75.4%). The treatment dropout rate reached 49%, and a cure was achieved in only 20.8% of the cases notified over the study period. Conclusions. The incidence of tuberculosis observed in this study was moderate when compared to incidence rates found in other studies of prison inmates, but this could be due to underreporting. The frequency of treatment failure noted was low, since patients who were treated under supervision showed good adherence and were cured in the majority of cases. However, the high treatment dropout rate seen in the study is alarming because it could facilitate the spread of drug resistant strains of Mycobacterium tuberculosis to the community at large. Controlling tuberculosis among prison inmates should be part of routine interventions aimed at eliminating this disease from the community and at preventing resistance to antituberculosis therapy.