Epidemiology of COVID-19 in Prisons, England, 2020.

Using laboratory data and a novel address matching methodology, we identified 734 cases of coronavirus disease in 88 prisons in England during March 16-October 12, 2020. An additional 412 cases were identified in prison staff and household members. We identified 84 prison outbreaks involving 86% of all prison-associated cases.

Health need assessment in an indigenous high-altitude population living on an island in Lake Titicaca, Perú.

BACKGROUND: Health needs and access to health care is a huge challenge in developing countries, especially in some isolated indigenous communities. Amantani is an island located at 3854 m above sea level in Lake Titicaca, Peru. There is no official date on key local health needs and determinants, which precludes the prioritization and efficient implementation of health interventions. The objective of this study is to validate a health need assessment tool and ascertain the main health needs of the indigenous high-altitude population living on Amantani. METHODS: We conducted a cross-sectional study to describe the health needs of the indigenous population of Amantani using a questionnaire based on the "Peruvian Demographic and Health Survey". The questionnaire underwent expert and field-work validation. We selected a random sample of the island residents using two-stage cluster sampling. We estimated the prevalence of key health needs and determinants, and evaluated their distribution by age, sex and education through prevalence ratio. All analyses accounted for the complex sampling design. RESULTS: We surveyed 337 individuals (223 adults and 144 children) in 151 houses. The most frequent health needs were: (i) lack of access to medical screening for a)non-communicable diseases (> 63.0%) and b)eye problems (76.5%); and (ii) poor knowledge about communicable diseases (> 54.3%), cancer (71.4%) and contraception (> 32.9%). Smoking and alcohol use was more frequent in males (PR = 4.70 IC95%:1.41-15.63 and PR = 1.69 95% CI:1.27-2.25, respectively). People with higher education had more knowledge about TB/HIV and cancer prevention (p < 0.05). Regarding children's health, > 38% have never undergone eye or dental examination. Corporal punishment and physical bullying at school in the last month were relatively common (23 and 33%, respectively). CONCLUSION: The main health needs in Amantani are related to poor healthcare access and lack of awareness of disease prevention. Our findings can be used to develop and implement efficient health interventions to improve the health and quality of life of indigenous populations living in the islands in Southern Peru/Northern Bolivia.

The global burden of tuberculous meningitis in adults: A modelling study.

Tuberculous meningitis (TBM) is the most lethal form of tuberculosis. The incidence and mortality of TBM is unknown due to diagnostic challenges and limited disaggregated reporting of treated TBM by existing surveillance systems. We aimed to estimate the incidence and mortality of TBM in adults (15+ years) globally. Using national surveillance data from Brazil, South Africa, the United Kingdom, the United States of America, and Vietnam, we estimated the fraction of reported tuberculosis that is TBM, and the case fatality ratios for treated TBM in each of these countries. We adjusted these estimates according to findings from a systematic review and meta-analysis and applied them to World Health Organization tuberculosis notifications and estimates to model the global TBM incidence and mortality. Assuming the case detection ratio (CDR) for TBM was the same as all TB, we estimated that in 2019, 164,000 (95% UI; 129,000-199,000) adults developed TBM globally; 23% were among people living with HIV. Almost 60% of incident TBM occurred in males and 20% were in adults 25-34 years old. 70% of global TBM incidence occurred in Southeast Asia and Africa. We estimated that 78,200 (95% UI; 52,300-104,000) adults died of TBM in 2019, representing 48% of incident TBM. TBM case fatality in those treated was on average 27%. Sensitivity analysis assuming improved detection of TBM compared to other forms of TB (CDR odds ratio of 2) reduced estimated global mortality to 54,900 (95% UI; 32,200-77,700); assuming instead worse detection for TBM (CDR odds ratio of 0.5) increased estimated mortality to 125,000 (95% UI; 88,800-161,000). Our results highlight the need for improved routine TBM monitoring, especially in high burden countries. Reducing TBM incidence and mortality will be necessary to achieve the End TB Strategy targets.