{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T03:00:40Z","timestamp":1788577240561,"version":"build-2803163510"},"reference-count":38,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,10,7]]},"abstract":"<jats:p>Prisoners have among the highest incidence of tuberculosis (TB) globally. However, the contribution of the prison environment on transmission is not well understood and structural characteristics have received little attention as effective epidemiological interventions in TB control. We evaluated architectural characteristics and estimated ventilation rates in 141 cells in three prisons in central west Brazil using steady-state exhaled carbon dioxide (CO<jats:sub>2<\/jats:sub>) levels. We used a modified Wells\u2013Riley equation to estimate the probability of infection for inmates sharing a cell with an infectious case and projected the impact of interventions, including early diagnosis and improved ventilation. Overall, prison cells were densely populated (mean 2.1 m<jats:sup>2<\/jats:sup> per occupant) and poorly ventilated, with only three cells meeting World Health Organization (WHO) standards for per-person ventilation (60 L\/s) applied in infection control settings. In the absence of interventions, projected mean risk of infection was 78.0% during a 6-month period. Decreasing time-to-diagnosis by 25% reduced transmission risk by 8.3%. Improving ventilation to WHO standards decreased transmission by 38.2%, whereas optimizing cross-ventilation reduced transmission by 64.4%. Prison environments promote high infection risk over short-time intervals. In this context, enhanced diagnostics have a limited impact on reducing transmission. Improving natural ventilation may be required to effectively control TB in prisons.<\/jats:p>","DOI":"10.4269\/ajtmh.15-0166","type":"journal-article","created":{"date-parts":[[2015,7,21]],"date-time":"2015-07-21T02:35:16Z","timestamp":1437446116000},"page":"739-746","source":"Crossref","is-referenced-by-count":60,"title":["The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons"],"prefix":"10.4269","volume":"93","author":[{"given":"Juliana","family":"Urrego","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert I.","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"da Silva Santos Carbone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dayse Sanchez Guimar\u00e3es","family":"Pai\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata Viebrantz Enne","family":"Sgarbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine W.","family":"Yeckel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason R.","family":"Andrews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Croda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Lancet","first-page":"1005","article-title":"Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990\u20132013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"Murray","year":"2014"},{"key":"ref2","series-title":"PLoS Med","first-page":"e1000381","article-title":"Tuberculosis incidence in prisons: a systematic review","volume":"7","author":"Baussano","year":"2010"},{"key":"ref3","series-title":"Am J Trop Med Hyg","first-page":"30","article-title":"Addressing institutional amplifiers in the dynamics and control of tuberculosis epidemics","volume":"84","author":"Basu","year":"2011"},{"key":"ref4","series-title":"BMC Public Health","first-page":"983","article-title":"X ray screening at entry and systematic screening for the control of tuberculosis in a highly endemic prison","volume":"13","author":"Sanchez","year":"2013"},{"key":"ref5","series-title":"Int J Tuberc Lung Dis","first-page":"1247","article-title":"Screening for tuberculosis on admission to highly endemic prisons? The case of Rio de Janeiro State prisons","volume":"13","author":"Sanchez","year":"2009"},{"key":"ref6","series-title":"PLoS Med","first-page":"e1001348","article-title":"Screening and rapid molecular diagnosis of tuberculosis in prisons in Russia and eastern Europe: a cost-effectiveness analysis","volume":"9","author":"Winetsky","year":"2012"},{"key":"ref7","series-title":"J Bras Pneumol","first-page":"646","article-title":"Tuberculin skin test: operational research in the state of Mato Grosso do Sul, Brazil","volume":"37","author":"Oliveira","year":"2011"},{"key":"ref8","series-title":"Am Rev Respir Dis","first-page":"511","article-title":"Infectiousness of air from a tuberculosis ward. Ultraviolet irradiation of infected air: comparative infectiousness of different patients","volume":"85","author":"Riley","year":"1962"},{"key":"ref9","series-title":"Am Rev Respir Dis","first-page":"302","article-title":"Airborne infection. Theoretical limits of protection achievable by building ventilation","volume":"144","author":"Nardell","year":"1991"},{"key":"ref10","series-title":"Risk Anal","first-page":"657","article-title":"Estimation of tuberculosis risk and incidence under upper room ultraviolet germicidal irradiation in a waiting room in a hypothetical scenario","volume":"21","author":"Ko","year":"2001"},{"key":"ref11","series-title":"Tuberculosis (Edinb)","first-page":"329","article-title":"Natural infection of guinea pigs exposed to patients with highly drug-resistant tuberculosis","volume":"91","author":"Dharmadhikari","year":"2011"},{"key":"ref12","series-title":"PLoS Med","first-page":"e68","article-title":"Natural ventilation for the prevention of airborne contagion","volume":"4","author":"Escombe","year":"2007"},{"key":"ref13","series-title":"PLoS Med","first-page":"e43","article-title":"Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmission","volume":"6","author":"Escombe","year":"2009"},{"key":"ref14","series-title":"WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households","author":"World Health Organization","year":"2009"},{"key":"ref15","series-title":"Natural Ventilation for Infection Control in Health-Care Settings","author":"World Health Organization","year":"2009"},{"key":"ref16","series-title":"World Prison Brief: Brazil","author":"International Centre for Prison Studies","year":"2013"},{"key":"ref17","series-title":"Rev Soc Bras Med Trop","first-page":"515","article-title":"Active and latent tuberculosis in prisoners in the central west region of Brazil","volume":"46","author":"Estevan","year":"2013"},{"key":"ref18","series-title":"Mem Inst Oswaldo Cruz","first-page":"909","article-title":"Tuberculosis in a southern Brazilian prison","volume":"107","author":"Kuhleis","year":"2012"},{"key":"ref19","series-title":"Rev Saude Publica","first-page":"119","article-title":"Tuberculosis and latent tuberculosis in prison inmates","volume":"46","author":"Nogueira","year":"2012"},{"key":"ref20","series-title":"Public Health","first-page":"976","article-title":"Development and evaluation of tuberculosis screening scores in Brazilian prisons","volume":"120","author":"Fournet","year":"2006"},{"key":"ref21","series-title":"Statistical Report: Analysis of the Prison System of Mato Grosso do Sul, Brazil","author":"Brazilian Ministry of Justice","year":"2012"},{"key":"ref22","series-title":"ASHRAE Trans","first-page":"12","article-title":"Occupant-generated CO2 as an indicator of ventilation rate","volume":"88","author":"Turiel","year":"1982"},{"key":"ref23","series-title":"ASHRAE Trans","first-page":"1","article-title":"Evaluating building IAQ and ventilation with indoor carbon dioxide","volume":"103","author":"Persily","year":"1997"},{"key":"ref24","series-title":"Am J Epidemiol","first-page":"556","article-title":"Modeling the role of public transportation in sustaining tuberculosis transmission in South Africa","volume":"177","author":"Andrews","year":"2013"},{"key":"ref25","series-title":"S Afr Med J","first-page":"809","article-title":"Tuberculosis in a South African prison: a transmission modelling analysis","volume":"101","author":"Johnstone-Robertson","year":"2011"},{"key":"ref26","series-title":"Indoor Air","first-page":"237","article-title":"Risk of indoor airborne infection transmission estimated from carbon dioxide concentration","volume":"13","author":"Rudnick","year":"2003"},{"key":"ref27","series-title":"PLoS Med","first-page":"e188","article-title":"The infectiousness of tuberculosis patients coinfected with HIV","volume":"5","author":"Escombe","year":"2008"},{"key":"ref28","series-title":"Lancet","first-page":"444","article-title":"Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli","volume":"353","author":"Behr","year":"1999"},{"key":"ref29","series-title":"BMC Infect Dis","first-page":"24","article-title":"Active and latent tuberculosis in Brazilian correctional facilities: a cross-sectional study","volume":"15","author":"Carbone","year":"2015"},{"key":"ref30","series-title":"Am Rev Respir Dis","first-page":"358","article-title":"Tuberculosis disseminators. A study of the variability of aerial infectivity of tuberculous patients","volume":"82","author":"Sultan","year":"1960"},{"key":"ref31","series-title":"Lancet Infect Dis","first-page":"359","article-title":"Tuberculosis and latent tuberculosis infection in close contacts of people with pulmonary tuberculosis in low-income and middle-income countries: a systematic review and meta-analysis","volume":"8","author":"Morrison","year":"2008"},{"key":"ref32","series-title":"Lancet","first-page":"212","article-title":"Proportion of tuberculosis transmission that takes place in households in a high-incidence area","volume":"363","author":"Verver","year":"2004"},{"key":"ref33","series-title":"BMC Infect Dis","first-page":"221","article-title":"Decreasing household contribution to TB transmission with age: a retrospective geographic analysis of young people in a South African township","volume":"14","author":"Middelkoop","year":"2014"},{"key":"ref34","series-title":"BMC Infect Dis","first-page":"300","article-title":"Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa","volume":"13","author":"Lygizos","year":"2013"},{"key":"ref35","series-title":"Annu Rev Energy Environ","first-page":"567","article-title":"Indoor air quality factors in designing a healthy building","volume":"25","author":"Spengler","year":"2000"},{"key":"ref36","series-title":"Build Environ","first-page":"559","article-title":"Natural ventilation for reducing airborne infection in hospitals","volume":"45","author":"Qian","year":"2010"},{"key":"ref37","series-title":"Int J Infect Dis","first-page":"e510","article-title":"Super-spreaders in infectious diseases","volume":"15","author":"Stein","year":"2011"},{"key":"ref38","series-title":"Am J Physiol Heart Circ Physiol","first-page":"H424","article-title":"Effect of paced breathing on ventilatory and cardiovascular variability parameters during short-term investigations of autonomic function","volume":"290","author":"Pinna","year":"2006"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/93\/4\/article-p739.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/93\/4\/article-p739.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/93\/4\/article-p739.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T19:02:08Z","timestamp":1723057328000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/93\/4\/article-p739.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,7]]},"references-count":38,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.15-0166","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10,7]]}}}