Tuberculosis among correctional facility workers: a systematic review and meta-analysis |
Objective: Prison inmates can transmit tuberculosis, including drug-resistant strains, to correctional facility workers (CFW) and the community. In this systematic literature review, we investigated the magnitude of active and latent tuberculosis infection (LTBI) and associated risk factors among CFW. Methods: We searched the MEDLINE, EMBASE, LILACS, Cochrane CENTRAL, ISI Web of Science, CINAHL, and SCOPUS databases (January 1, 1989–December 31, 2017) for studies with the MeSH terms “prison” (and similar) AND “tuberculosis,” without language restriction. We searched for gray literature in Google Scholar and conference proceedings. Studies were classified as being of good, fair, or poor quality according to the risk of bias. Findings: Of the 974 titles identified, 15 (nine good, six fair quality) fulfilled the inclusion criteria (110,393 CFW; six countries; 82,668, active tuberculosis; 110,192, LTBI). Pooled LTBI prevalence and incidence rates were 26% (12–42, I 2 =99.0%) and 2% (1–3, I 2 =98.6%), respectively. LTBI prevalence reached 44% (12–79, I 2 =99.0% ) in high-burden countries. Active tuberculosis was reported only in low-burden countries (incidence range, 0.61–450/10,000 CFW/year). LTBI-associated risk factors included job duration, older age, country of birth, current tobacco smoking, reported contact with prisoners, and BCG vaccination. Conclusion : Despite risk of bias and high heterogeneity, LTBI was found to be prevalent in CFW, mainly in high-burden countries. LTBI risk factors suggest both occupational and community exposure. Active tuberculosis occurrence in low-burden countries suggests higher vulnerability from recent infection among CFW. Systematic surveillance and infection control measures are necessary to protect these highly vulnerable workers. |