REPORTING ON TUBERCULOSIS (TB)

With incidents of the disease on the rise, you should know what symptoms to look out for and how to respond

The number of tuberculosis (TB) cases within the prison system has increased steadily in recent times. This article aims to make you aware of what TB is, the symptoms to look for and how to reduce the risk of further infection of others. It is important to note that I have no medical qualifications – this is purely an article to raise awareness.

WHAT IS TB?

TB is a bacterial infection that is spread by airborne droplets from the coughs and sneezes of an infected person. It is well known as an infection of the lungs, but it can also infect other parts of the body, such as the bones, brain and lymph nodes.

Although TB is a serious condition, it can be cured when treated correctly.

SYMPTOMS

• Coughing – a cough that lasts more than 3 weeks or coughing up blood or phlegm.
• Weight loss – this may be slow at first, but it gets faster as the disease progresses.
• Fever – a high temperature or chills.
• Night sweats – episodes of excessive sweating during the night.
• Fatigue – a feeling of tiredness or exhaustion.
• Loss of appetite – a reduced interest in food.
• Swollen glands – in the neck, armpits or groin.
• Pain – in the chest, bones, joints, sides or when passing urine.
• Other symptoms – headache, sickness, vomiting, constipation, dark or cloudy urine, or rashes.

While one, some or all the above symptoms develop gradually, it is possible for an individual to show no symptoms; this is known as latent TB, which is not infectious.

If a prisoner or colleague has a persistent cough that gets progressively worse over a period of three weeks or more, you must inform your healthcare staff.

If TB is detected early, it is easier to treat, and further spread is limited.

If a prisoner is diagnosed, healthcare staff will need to know the details of individuals who have been in prolonged and close contact with him/her, as they may need to be tested for TB. This may be limited to individuals who share a cell/communal area with someone who has TB in their lungs and is infectious. The local UK Health Security Agency (UKHSA) team and prison healthcare staff will conduct a risk assessment and determine who needs to be tested to limit the spread of infection.

• Prisons should be aware that contact tracing may need to be carried out for prisoners who have been transferred/ released, or to identify potential staff contacts from other prisons (when staff from other prisons have been used for bed watches, for example). Every effort should be made to identify potential contacts as soon as possible to limit onward transmission.
• Any individual who is diagnosed with TB will be discussed with local healthcare officials.

RISK REDUCTION

• All prisoners suspected of having TB should be isolated in line with UKHSA advice while diagnosis by the healthcare professionals is completed.
• If a prisoner is diagnosed with infectious TB, they will need to be isolated for at least the first two weeks of treatment.
• Prison officers accompanying individuals with infectious TB to hospital should ensure they have appropriate personal protective equipment (PPE), as advised by healthcare staff.
• The risk of tasks such as bed watches should be discussed with healthcare personnel. When using FFP3 masks, the prison should ensure that these are fit-tested in line with instructions. If battery-powered respiratory protection equipment is used, this should be done in line with training provided by the local HSF Team (or other identified approved trainers).
• UKHSA may decide to arrange and chair an incident management team meeting or outbreak control team meeting to support the management of an incident or outbreak of TB.
• Where TB is suspected but not yet confirmed, PPE should be worn as a precautionary measure, in line with TB guidelines.
• Support TB screening by reassuring individuals and motivating people to get checked. In some specialised areas or situations, organised X-ray screening of high-risk groups can help ensure early detection of TB. Currently, screening is not available in all areas.

SUPPORTING TREATMENT:

• TB is a curable disease provided that TB medication is taken as instructed and for the entire course.
• A prisoner diagnosed with TB will be prescribed specialist treatment.
• It is essential to supervise individuals to ensure that they take their medication. Ensuring individuals take a full course of TB treatment is the most challenging obstacle to TB control.

JACKIE MARSHALL
NATIONAL EXECUTIVE COMMITTEE