More 'robust' TB screening of prisoners needed in the wake of major outbreaks

The Irish Prison Service says it may introduce a blood test for TB for all prisoners upon committal in the wake of two outbreaks in Irish prisons over the last decade, at Cloverhill and Shelton Abbey. Stock Picture: Getty

Researchers have called for a more robust tuberculosis (TB) screening programme in prisons, after finding that a major outbreak in Cloverhill Prison in 2011 led to further infections in the community in subsequent years.

Researchers from Trinity College in Dublin, the Irish Mycobacteria Reference Laboratory, St James’s Hospital, and HSE public health specialists investigated the wider impacts of the 2011 TB outbreak, which led to claims from prisoners and prison staff and cost the state €5m in compensation.

The study comes as the Irish Prison Service (IPS) has confirmed to the Irish Examiner that a second TB outbreak occurred in Shelton Abbey in 2018, making it the second TB outbreak in the past 10 years.

34 people contracted TB from a single case 

The TCD-led study involved the genetic sequencing of TB samples, which identified some linked infections in the community nine years after the initial prison outbreak.

The study, published in the International Journal of Tuberculosis and Lung Disease, found that 34 people contracted active TB from a single case in the prison.

It also found that half of 143 prison staff, who were tested as close contacts, had ‘latent TB’, which can progress to the active form of TB at a future date.

The study into the wider impacts of the 2011 TB outbreak in Irish prisons recommends a one-off blood test for all prisoners and staff, as well as an education programme. 

The number of TB infections arising from the prison outbreak peaked in 2011 but, on further investigation, public health specialists detected 12 other linked cases between 2013 and 2020, some in the community. A case of multi-drug resistant TB was also identified.

A 39-year-old prisoner, who was sharing a cell with three others and was carrying out cleaning duties at the facility, was identified as the index case and a ‘superspreader’ in the Cloverhill outbreak.

Several people were hospitalised following the TB outbreak but no deaths were recorded from the potentially fatal lung disease.

While the prevalence of TB is low in Ireland, it is not clear how prevalent the disease is in Irish prisons, where international evidence points to higher infection rates in the prison population, in particular among prisoners who inject drugs, or who have hepatitis or HIV.

The authors of the study said the current TB screening programme, which comprises of a symptom-based questionnaire and temperature check on entry to prison, was “not robust” enough and should be strengthened to include a one-off blood test on prisoners and staff, as well as an education programme.

The TB blood test costs around €30 and would only need to be carried out when a prisoner enters the facility or when new prison staff join the service.

TCD Professor in clinical medicine Joe Keane said the findings showed that tuberculosis was an issue in prisons and that a ‘test and educate’ programme could help to reduce risk.

Further measures to tackle TB

The researchers also called for the appointment of a national TB lead to oversee a new latent TB clinic at St James’s Hospital Dublin, as part of an integrated national TB control service.

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

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

The IPS has since confirmed a second TB outbreak in Shelton Abbey in 2018 but declined to confirm how many cases were involved or if the outbreak led to new compensation claims against the service.

Prison Service adopting new policies

The IPS said it had worked closely with the HSE to develop a new infection control policy in 2019 and a standard operating procedure specifically for the management of TB in prisons.

A national infection control committee was also established, and infection control audits were regularly carried out.

A spokesperson for IPS said all prisoners undergo a healthcare interview on committal, which includes screening for TB symptoms, and that the introduction of a blood test for TB is being considered: “The Prison Service have engaged in preliminary discussions with the HSE with regard to the possible use of blood tests in this regard”.