Diana Marín

High prevalence and risk factors associated with latent tuberculous infection in two Colombian prisons.

SETTING Two prisons in Medellín and Itagüí, Colombia. OBJECTIVE To determine the prevalence of tuberculin skin test (TST) positivity in prisoners and the annual risk of tuberculous infection (ARTI), to identify risk factors associated with a positive result, and to describe progression to active disease. DESIGN Cross-sectional study. Inmates were included if time of incarceration was ⩾1 year and excluded if subjects had had previous or active tuberculosis (TB), or conditions that could hamper TST administration or interpretation. RESULTS We screened 1014 inmates. The overall prevalence of TST positivity was 77.6%. The first TST administration resulted in 66% positivity, and the second TST an additional 11.6%. In Prison One, the ARTI was 5.09% in high TB incidence cell blocks and 2.72% in low TB incidence blocks. In Prison Two, the ARTI was 2.77%. Risk factors associated with TST positivity were history of previous incarceration and length of incarceration. Among all those included in the study, four individuals developed active pulmonary TB. CONCLUSION Prevalence of TST positivity in prisoners and the ARTI were higher than in the general population, but differed between prisons; it is important to apply a second TST to avoid an overestimation of converters during follow-up.

Human prevalence of the spotted fever group (SFG) rickettsiae in endemic zones of Northwestern Colombia

In February 2006, an outbreak of human rickettsiosis occurred in the municipality of Necoclí Colombia, with 35% of lethality. This episode was, followed by two more, one in the municipality of Los Cordobas in 2007 with a 54% of lethality and the other one in the municipality of Turbo in 2008 with 27% of lethality. The aim of this study was to perform serological tests in healthy persons to determine the seroprevalence of antibodies against spotted fever group (SFG) rickettsiae and develop a survey to study some infection risk-related factors. A cross-sectional study was performed in 2011 and 2012. A blood sample and survey of associated factors was performed in healthy persons. A prevalence of 32%-41% was found in healthy people. From the multivariate analysis, we found that people living more than 16 years in these sites had a 79% higher risk of being seropositive and a 46% higher risk when they reported having birds in their houses if the variable of having a horse was included in the model. In conclusion, this study shows endemicity of at least one spotted fever group Rickettsia in the study zone.

Negative latent tuberculosis at time of incarceration: identifying a very high-risk group for infection

The main aim was to measure the incidence of latent tuberculosis infection (LTBI) and identify risk factors associated with infection. In addition, we determined the number needed to screen (NNS) to identify LTBI and active tuberculosis. We followed 129 prisoners for 2 years following a negative two-step tuberculin skin test (TST). The cumulative incidence of TST conversion over 2 years was 29·5% (38/129), among the new TST converters, nine developed active TB. Among persons with no evidence of LTBI, the NNS to identify a LTBI case was 3·4 and an active TB case was 14·3. The adjusted risk factors for LTBI conversion were incarceration in prison number 1, being formerly incarcerated, and overweight. In conclusion, prisoners have higher risk of LTBI acquisition compared with high-risk groups, such as HIV-infected individuals and children for whom LTBI testing should be performed according to World Health Organization guidance. The high conversion rate is associated with high incidence of active TB disease, and therefore we recommend mandatory LTBI screening at the time of prison entry. Individuals with a negative TST at the time of entry to prison are at high risk of acquiring infection, and should therefore be followed in order to detect convertors and offer LTBI treatment. This approach has a very low NNS for each identified case, and it can be utilized to decrease development of active TB disease and transmission.

Pérdida de años de vida saludable por la población de Medellín, Colombia 2006-2012

espanolSe determino la carga de la enfermedad de la poblacion de Medellin entre los anos 2006 y 2012 por los tres grandes grupos de causas siguiendo la metodologia del estudio Global de la Carga de Enfermedad. Para el calculo de los Anos Potenciales de Vida Perdidos (APVP) se utilizo la informacion oficial de mortalidad. Para el calculo de los Anos de Vida Ajustados por Discapacidad (AVD) se recurrio a la informacion registrada que referia la morbilidad. El 87 por ciento de los Anos de Vida Saludable Perdidos (AVISA), suma de los APVP y los AVD, se debio a la discapacidad. Las enfermedades no transmisibles y las lesiones accidentales aportaron la mayor cantidad de AVISA. El protagonismo de las enfermedades no transmisibles avizora incremento de las comorbilidades de alto costo. EnglishThe burden of disease in the population of Medellin between 2006 and 2012 was determined by the three broad cause groups following the methodology of the Global of burden of disease study. Official mortality information was used for the calculation of potential years of life lost (YPLL). The registered information referring morbidity were used for the calculation of the years of life adjusted by disability (YLD). 87 per cent of the Disability-Adjusted Life Year (DALY), sum of the YPLL and the YLD, was due to the disability. Non-communicable diseases and accidental injuries contributed the largest number of alerts. The role of non-communicable diseases yet increase in Comorbidities of high cost.

Guards in Prisons: A Risk Group for Latent Tuberculosis Infection

To determine the prevalence and incidence of LTBI among prison guards and to the risk factors associated with infection. Two male prisons in Medellín and Itaguí, Colombia. A cohort study was conducted in adult prison guards that consented to participate. Exclusion criteria included: previous or current active TB, or conditions that preclude TST administration. We screened 194 guards and completed 155 TST administrations. The prevalence of LTBI was 55.8% in prison one, and 39.1% in prison two. The risk factors associated with LTBI diagnosis included drug use at least once in a lifetime (PR: 1.75; 95% CI 1.42–2.15) and male sex (PR: 2.16; 95% CI 1.01–4.62). The cumulative incidence of TST conversion over 6 months was 3.2%. All conversions occurred in prison 1. Our findings suggest an occupational risk for LTBI prevalence and incidence among guards (different prevalence and incidence according to the prison they work).