Intended for healthcare professionals

Education And Debate

Tuberculosis in prisons in countries with high prevalence

BMJ 2000; 320 doi: (Published 12 February 2000) Cite this as: BMJ 2000;320:440
  1. Rudi Coninx, medical officer (,
  2. Dermot Maher, medical officerb,
  3. Reyes Hernán, visiting research scholarc,
  4. Malgosia Grzemska, medical officerb
  1. a Unit of Medicine and Community Health Care, International Committee of the Red Cross, 19 Avenue de la Paix, 1202 Geneva, Switzerland
  2. b Communicable Diseases Prevention and Control, World Health Organisation, 20 Avenue Appia, 1202 Geneva, Switzerland
  3. c Center for the Study of Society and Medicine, Columbia University, New York, 10032 NY, USA
  1. Correspondence to: R Coninx
  • Accepted 15 October 1999

On any day worldwide about 10 million people are incarcerated, in prisons, remand centres, police stations, jails, detention centres for asylum seekers, penal colonies, and prisoner of war camps. There is an increasing recognition that the high risk of tuberculosis in these settings poses a problem for those imprisoned and for the wider society. The issue now is what to do about what was until very recently “a forgotten plague.”1 The important general measures for tuberculosis control in prisons are improvement of prison conditions, particularly a reduction in overcrowding, improvement of nutrition and hygiene, and guaranteed access to improved prison health services.

Knowledge of the epidemiology of tuberculosis in prisons, appreciation of what makes control different from control in other settings, and understanding of the principles of tuberculosis control are all necessary for governmental and other agencies to contribute to the implementation of effective tuberculosis control programmes in prisons. We have focused here on countries with a high prevalence of tuberculosis, where the problem is most severe and the need for action most pressing, and on the specific measures necessary in the implementation of an effective prison tuberculosis programme.

Summary points

People incarcerated are at high risk for tuberculosis and case rates are among the highest ever recorded in any population

The specific features of prisons and of prisoners necessitate specific approaches to tuberculosis control that are different from those used in the general population

Guarantees are needed to ensure completion of treatment; and this requires political and administrative commitment

Prisons can also provide an opportunity for effective tuberculosis control, which may well lead to improved prison health care


The article is based on information from ongoing clinical work, follow up of ongoing prison programmes, and reports from prisons, supplemented by literature searches.

Epidemiology of tuberculosis in prisons

Prisons are closed institutions for prisoners during their …

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