Tuberculosis in Irish prisons: New study recommends increased testing

Investigators from Trinity College Dublin, the Irish Mycobacteria Reference Laboratory, St James’s Hospital, and the Department of Public Health HSE East believe tuberculosis (TB) care in Irish Prisons should be supported, considering the findings of their study which is published today (Tuesday, 1st June, 2021) in the International Journal of Tuberculosis and Lung Disease.

The study describes an investigation into a large outbreak of tuberculosis which occurred in an Irish prison in 2011. This resulted in 34 people contracting active TB from a single infectious case. The use of Whole Genome Sequencing enabled the investigators to track the course of onward transmission, and to link TB cases identified as recently as 2019 to the 2011 outbreak.

The outbreak resulted in litigation costs to the State of more than €5 million euro. The study found that in addition to the active TB cases, 50% of the prison staff tested as close contacts of cases may have developed Latent TB as a result of occupational exposure. This is an asymptomatic, non-infectious form of TB, which may progress to the active form of TB at a future date, in a small number of cases.

Professor Joe Keane, Clinical Medicine, Trinity College Dublin and St James’s Hospital Dublin, and co-senior author of the study said:

“This report shows that tuberculosis is an issue in our prisons and will be followed by a ‘test and educate’ program that will mitigate the risk in congregate settings.”

Professor Tom Rogers, Clinical Microbiology, Trinity, and formerly Clinical Director, Irish Mycobacteria Reference Laboratory (IMRL) based at St. James’s Hospital, said:

“This report demonstrates the power of whole genome sequencing to enhance epidemiological investigations of TB outbreaks over prolonged periods of time. The IMRL has created a national database of TB genomes which will facilitate future public health investigations of TB in Ireland.”

Dr. Marcus Butler, vice-president, Irish Thoracic Society said:

“This study, along with recommendations from the CDC TB controllers association and a recent review of TB rates in prisons published by The Lancet Public Health, supports the need for improving early TB diagnosis and care in the Irish prison system, through a three-step approach:

  1. A TB information and testing service in prisons
  2. A Latent TB clinic at St James’s Hospital Dublin
  3. A National TB lead to oversee this as part of an integrated national TB control service

This integrated national service should comprise a national TB screening program for high risk groups, investment in contact tracing and TB surveillance activities, and a TB education and awareness program for healthcare professionals and the public.”

Dr. Mary O Meara, Specialist in Public Health Medicine , HSE East said, “This report supports the need for augmenting the public health contact tracing response for infectious diseases such as tuberculosis.”