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https://www.arca.fiocruz.br/handle/icict/19312
THE IMPACT OF VENTILATION AND EARLY DIAGNOSIS ON TUBERCULOSIS TRANSMISSION IN BRAZILIAN PRISONS
Diagnóstico precoce
Ventilação
Fatores de risco
Prisões
Humanos
Brasil
Author
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
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 in Portuguese
Tuberculose PulmonarDiagnóstico precoce
Ventilação
Fatores de risco
Prisões
Humanos
Brasil
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