1. TB control in Dutch prisons Ministry of Justice: J. Bastiani, MPH GGD Nederland: J. Doosje, MPH

2. TB screening in Dutch prisons: September 17, 2007 overview Introduction Medical Care in prisons TB control in the Netherlands TB screening programme in prisons 1994-2005 Conclusions, future perspective Acknowledgements

3. DJI organisation DJI is an agency of Min. of Justice DJI is the implementing agency Daily 16.000 persons detained Sectors: GW (prisons, house of detention) TBS (detention ‘in her Majesty’s pleasure’) DBV ( detention centres for illegals en refugees) JJI (youth detention) All with their own director and management

4. Medical Care in prison At 80 locations medical services Professionals: plm 450 nurses and 80 physiciens. Psychologist, psychiatrist, dentist and paramedics

5. Populatie kenmerken Tabel 1

6. Populatiekenmerken Tabel 2

7. Populatiekenmerken Tabel 3

8. Populatiekenmerken Tabel 4

9. Health characteristics Risk group for STD’s, hepatitis, Endemic risk areas > 40 % detained has serious addiction related problems > 50 % detained has one or more psychiatric disorders

10. TB screening in Dutch prisons: September 17, 2007

11. TB incidence in Dutch population 1972 – 2005* 1972: 2458 = 18/100.000 1987: 1192 = 8/100.000 1994: 1811 = 12/100.000 1996: 10.7/100.000 2005: 8.2/100.000 * Referentie.: Tuberculose in Nederland 2005, surveillance rapport over de tuberculosesituatie in Nederland, KNCV Tuberculosefonds, 2007

12. TB screening in Dutch prisons: September 17, 2007 * Referentie: Jaarverslag Tuberculose-onderzoek in Penitentiaire inrichtingen, 2007, GGD Flevoland en GGD Hart voor Brabant, W. Haddad

13. TB screening in Dutch prisons: September 17, 2007 TB prevalence in Dutch prisons 1994 – 2005* Number of PI’s included in programme: 57 277.000 screenings in 10 years, 240 TB cases In average 25 new cases per year Mean: prevalence 89/100.000 over the last 10 years Prevalence 52/100.000 in 2005 * Referentie: Jaarverslag Tuberculose-onderzoek in Penitentiaire inrichtingen, 2007, GGD Flevoland en GGD Hart voor Brabant, W. Haddad

14. TB screening in Dutch prisons: September 17, 2007 Number of TB cases in Dutch prisons in 2005

15. TB screening in Dutch prisons: September 17, 2007 ZN smear +/- direct versus culture

16. TB screening in Dutch prisons: September 17, 2007 Division by age in 2005

17. TB screening in Dutch prisons: September 17, 2007

19. Conclusions Decreasing incidence rate in the Netherlands Low prevalence of TB in prisons after 10 years Mobile Rontgen Units proven to be effective as screening instrument Continuing screening in following years Future perspective Improving screening instrument: –Efficiency: better data exchange and data match (adjusting of prevalence rate) ICT – national data base Set up research to define risk groups within prisons

20. TB screening in Dutch prisons: September 17, 2007 Optimise TB Control by using Mobile Röntgen Units!

21. TB screening in Dutch prisons: September 17, 2007 Acknowledgements GGD Hart voor Brabant, Wallid Haddad GGD Flevoland, Rene Jonker, Dick Fleury KNCV Tuberculosefonds DJI GGD Nederland