A one-year prospective study (1994-1995) for a first evaluation of tuberculosis transmission in French prisons

SETTING: Ten correctional facilities in Paris, including suburbs. OBJECTIVE: TO prospectively determine the incidence of tuberculosis (TB) in prisons during a one-year period and to trace the transmission of tubercul osis by restriction fragment length polymorphism (RFLP) analysis of Mycobac terium tuberculosis strains from inmates. RESULTS: Of 93 cases of tuberculosis observed, 50 were culture-confirmed. T he incidence of tuberculosis in correctional facilities was 215 cases per 1 00 000 inmates. A high turnover of inmates was observed. All patients were male, and a quarter had been homeless. Seventy-two per cent were diagnosed with pulmonary tuberculosis. Several severe cases of TB were observed, incl uding three of tuberculous meningitis. No multidrug-resistant strains were noted. RFLP analysis (n = 24) revealed 22 distinct patterns which made up t wo clusters. Epidemiological investigation did not show direct tuberculosis transmission, which was, however, probable for one cluster. CONCLUSION: Independently of incarceration, prison inmates run a higher ris k of developing active tuberculosis than the general population, which migh t be the main reason for the high incidence of tuberculosis observed in pri sons. However, some cases of transmission map occur inside prisons.