Prison populations globally face a nine-fold higher risk of tuberculosis (TB) compared to the general population. TB is an infectious disease primarily affecting the lungs, transmitted through the air when infected individuals cough, sneeze, or spit. A recent study, analyzing data from nearly all countries worldwide between 2000 and 2019, reveals that approximately 125,105 of the 11 million incarcerated individuals developed TB in 2019.

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This represents a rate of 1,148 cases per 100,000 people per year, significantly higher than the global incidence rate of 127 cases per 100,000 people. The study also highlights a strong correlation between tuberculosis rates and prison overcrowding.

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Leonardo Martinez, study lead from the School of Public Health, Boston University, USA, said: “This connection between TB and overcrowding suggests that efforts to limit the number of people who are detained may be one potential public health tool to combat the TB epidemic in prisons.

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”Martinez said, “The high incidence rate globally and across regions, low case detection rates, and consistency over time indicate that this population represents an important, under-prioritised group. Continued failure to detect, treat, and prevent tuberculosis in prisons will result in the unnecessary disease and deaths of many incarcerated persons.

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”“And, of course, when incarcerated persons are released from prison, they can take this infectious disease back into the communities in which they live, further contributing to the spread of tuberculosis globally. Greater focus and resources for addressing the tuberculosis epidemic in prisons are needed to protect the health of incarcerated people and their communities.

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”The risk of tuberculosis (TB) among incarcerated populations surpasses that of other health conditions such as diabetes, alcohol use disorders, smoking, and undernourishment.

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Researchers from various countries conducted a study and discovered significant regional variations in prison TB rates in 2019, with the highest incidence observed in the African region at 2,242 cases per 100,000 people annually—almost double the global estimate for this population. The Americas region, particularly Central and South America, had the largest absolute number of TB cases among incarcerated individuals, reaching 30,509.

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Factors contributing to the increased TB burden in the Americas may include the significant rise in mass incarceration, leading to overcrowding. The study also highlighted the strong association between crowding and TB incidence, suggesting it plays a crucial role in the rising TB rates in prisons, particularly in Central and South America.

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Anthony D Harries, senior adviser at the International Union Against Tuberculosis and Lung Disease, said: “These findings give us a much clearer picture of tuberculosis in prisons than we’ve ever had before. The high rate of tuberculosis and low rate of detection indicates that current control measures are insufficient for preventing the spread of the disease in prisons globally.

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Therefore, further research is vital to identify and implement the most effective interventions.”Karabo Rafube, who developed TB in a South African prison, said: “There was no screening when you entered, and we were crowded into small spaces, so it was no surprise that I caught TB. I was very sick, but it took a long time to find out that I had TB. I took treatment for six months and luckily fully recovered.

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Some people would sell their medicines to other inmates. “After recovering I was appointed as a TB teacher in the prison. Ever since I left, I’ve been supporting others with TB in prison.“It is important to break the silence of TB. Prisoners have the right to be screened and have access to medicines, but they are often neglected. We can’t end TB without treating everyone – that includes prisoners.

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”The International Union Against Tuberculosis and Lung Disease (The Union) officially sponsored the four-year project, providing TB research expertise, logistical and operational support and accountability for success.

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