What I would have said if I had

What I would have said if I had been there! Views on the TB situation in prisons from Anders in Sweden

The point • TB prevalence and spread in prison settings is a serious medical problem! • TB is a social disease and the situation is also a social problem! But don’t forget…. I base this on the following….

Sweden 1910 TB Incidense > 400/100. 000 Sweden 2010 OK – a bit exorbitant but… TB incidense 4/100. 000

TB associated death & incidence Sweden 1910 - 2000 Introduction of antituberculosis drugs Mortality

Conclusion • Adequate medical measures such as antibiotic treatment, high standard health care and tip-top diagnostics did only sweep away the last remains of the TB epidemic in Sweden

…and the main reason TB disappeared (almost!) from Sweden during the 20 th century is – I believe • Increased standards of living • Better hygiene • Clean water • Better food etc

…and thus – in the closed society of a prison… Russian custody 1995 TB incidense in Russian prisons 1995 > 4000/100. 000 Swedish custody 2008 Number of new TB cases in Swedish custodies and prisons 2008 = 0.

The prison system in Russia has (especially during the 1990’s) been a “TB pump” in the Russian society. The prison system can not be blamed for the TB prevalence among the newly enrolled inmates but it is possible to reduce the number of cases with reactivated TB or those infected inside the institutions…

…and if they succeed with that the Russian prison system can work as a vacuum cleaner for TB in the society! And that journey has already begun…!

…look at this data… Tuberculosis rates (new cases) in the penitentiary system Russia • Russia Arkhangelsk (from A Marjandishev ) An impressive reduction much (I believe) due to improved living conditions inside the Russian prisons the last 15 years

The most cost-effective way to reduce burden of TB in (for instance) Russian prisons is (in my opinion) to • find strategies and methods for rapid identification of infected inmates + to take preventive measures for reducing the risk of further transmission from the infected individual to his inmates inside the institutions • reduce the inmates vulnerability to infection by supporting measures for improving hygiene and living conditions inside the prisons

So… If You get $ 10. 000 Don’t by x-ray-machines buy food or more space or clothes

And… I wish you all good luck with the meeting and we all acknowledge the importance of active and extensive medical interventions but doctors…!!! Don’t forget the social aspects of this challenge!