Insights into the population structure of Mycobacterium tuberculosis using spoligotyping and RDRio in a southeastern Brazilian prison unit.

Tuberculosis (TB) is still a serious public health problem, continuing to be an important threat for confined populations. We used spoligotyping to estimate the genotypic clades of Mycobacterium tuberculosis isolates from inmates in two blocks in a southeastern Brazilian prison unit, with TB incidence rate of 8185/100.000. The Latin American Mediterranean (LAM) clade is well represented in the country, and the LAM specific molecular markers, RD(Rio) large sequence polymorphism and the SNP on the Rv3062 [ligB(1212)], were used to characterize spoligotype signatures from prison isolates. Typing of RD(Rio) and ligB increase LAM clade from 66.7% (n=72/108) to 69.4% (n=75). The LAM2 SIT17 (n=23) and SIT179 (n=12) signatures comprised one third of all isolates, followed by Haarlem (11.5%, n=12), T (8.7%, n=9) and X (5.7%, n=6) clades. Strains with unknown signatures represented 5.5% (n=6), and four (3.7%) did not match any lineage. We observed RD(Rio) among 64 (59.2%) isolates, and 54 (50%) were of the LAM clade. In particular, the LAM2/RD(Rio) sub-lineage was significantly associated with clustering (p=0.02) and its frequency was higher (32%) when compared to that of the previous general TB cases in RJ (4.29%). Overall cluster frequency defined by spoligotyping/IS6110-RFLP was 62%. The two evolutionary markers helped to evaluate some LAM signature misconceptions and demonstrate that LAM2/RD(Rio) was found with high frequency, hitherto being unnoticed. All these data, allied to high clustering, imply that public health measures to minimize the escalation of TB in prison is essential, and both spoligotyping as well as RD(Rio) would be useful tools to monitor the effects of the measures with respect to M. tuberculosis lineage variation.

[Tuberculosis in Rio de Janeiro prisons, Brazil: an urgent public health problem]. / A tuberculose nas prisões do Rio de Janeiro, Brasil: uma urgência de saúde pública.

The tuberculosis incidence rate in prisons in Rio de Janeiro State, Brazil, was 30 times higher in 2004 than in the general population and is probably underestimated, particularly given the difficult access to care in the prison setting. To obtain a better estimate, a survey used systematic X-ray screening and showed a prevalence rate of 4.6% in one such detention facility, A (n = 1,052). Two additional surveys, in facilities B (n = 590) and C (n = 1,372), showed even higher prevalence rates (6.3% and 8.6% respectively). A comparison of socio-demographic characteristics between A, B, and C showed a heterogeneous prison population. As compared to facility A, inmates in B and C come from poorer urban communities and have more frequent histories of incarceration and tuberculosis. These differences, consistent with the prevalence data, imply the necessary adaptation of tuberculosis control programs to each detention facility's epidemiological and socio-demographic profile.

A tuberculose nas prisões do Rio de Janeiro, Brasil: uma urgência de saúde pública / Tuberculosis in Rio de Janeiro prisons, Brazil: an urgent public health problem

Em 2004, a taxa de incidência da tuberculose nas prisões do Estado do Rio de Janeiro, Brasil, foi trinta vezes superior à da população geral do Estado. Essa taxa provavelmente é subestimada, especialmente pela dificuldade de acesso ao serviço de saúde nesse ambiente. Com o objetivo de melhor avaliar a situação, um primeiro inquérito radiológico sistemático foi realizado e mostrou taxa de prevalência de 4,6 por cento (prisão A, n = 1.052). Dois inquéritos adicionais revelaram, nas unidades B (n = 590) e C (n = 1.372), taxas maiores (6,3 por cento e 8,6 por cento, respectivamente). A comparação das características sócio-demográficas das prisões A, B e C mostrou que a população encarcerada não é homogênea. Em comparação com prisão A, os indivíduos encarcerados nas prisões B e C são oriundos de comunidades mais desfavorecidas e têm mais freqüentemente história de encarceramento anterior e de tuberculose. Essas diferenças, coerentes com os dados de prevalência, implicam a adaptação das medidas de controle da tuberculose ao perfil epidemiológico e sócio-demográfico de cada unidade prisional.

The tuberculosis incidence rate in prisons in Rio de Janeiro State, Brazil, was 30 times higher in 2004 than in the general population and is probably underestimated, particularly given the difficult access to care in the prison setting. To obtain a better estimate, a survey used systematic X-ray screening and showed a prevalence rate of 4.6 percent in one such detention facility, A (n = 1,052). Two additional surveys, in facilities B (n = 590) and C (n = 1,372), showed even higher prevalence rates (6.3 percent and 8.6 percent respectively). A comparison of socio-demographic characteristics between A, B, and C showed a heterogeneous prison population. As compared to facility A, inmates in B and C come from poorer urban communities and have more frequent histories of incarceration and tuberculosis. These differences, consistent with the prevalence data, imply the necessary adaptation of tuberculosis control programs to each detention facility's epidemiological and socio-demographic profile.