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首页> 外文期刊>The American Journal of Tropical Medicine and Hygiene >The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons
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The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons

机译：通气和早期诊断对巴西监狱中结核病传播的影响

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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.
机译：囚犯是全球结核病（TB）发病率最高的国家之一。然而，人们对监狱环境对传播的贡献还知之甚少，作为结核病控制中的有效流行病学干预措施，结构特征很少受到关注。我们使用稳态呼出的二氧化碳（CO2）水平评估了巴西中西部三个监狱中141个牢房的建筑特征和通风率。我们使用修正的Wells-Riley方程来估计与感染病例共用一个单元的囚犯的感染可能性，并预测干预措施的影响，包括早期诊断和改善通气。总体而言，监狱牢房人口稠密（每人平均2.1 m（2））且通风不良，只有三个符合世界卫生组织（WHO）人均通风标准（60 L / s）的牢房应用于感染控制环境。在没有干预措施的情况下，预计六个月内的平均感染风险为78.0％。诊断时间减少25％，传播风险降低8.3％。改善通风以达到WHO的标准可减少38.2％的传播，而优化交叉通风可减少64.4％的传播。监狱环境会在短时间内造成较高的感染风险。在这种情况下，增强的诊断对减少传输的影响有限。可能需要改善自然通风以有效控制监狱中的结核病。

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