Observational Study
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World J Exp Med. Mar 20, 2024; 14(1): 87551
Published online Mar 20, 2024. doi: 10.5493/wjem.v14.i1.87551
Prevalence and features of SARS-CoV-2 infection in prisons in Tuscany
Cristina Stasi, Martina Pacifici, Caterina Milli, Francesco Profili, Caterina Silvestri, Fabio Voller
Cristina Stasi, Martina Pacifici, Caterina Milli, Francesco Profili, Caterina Silvestri, Fabio Voller, Epidemiology Unit, Regional Health Agency of Tuscany, Florence 50141, Italy
Cristina Stasi, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena 53100, Italy
Author contributions: Stasi C interpreted the data, wrote the paper, and revised the manuscript critically for important intellectual content; Pacifici M analyzed and interpreted the data; Milli C collected the data; Profili F recorded the research data and revised statistical analysis; Silvestri C and Voller F conceived and designed the study and revised the manuscript critically for important intellectual content.
Institutional review board statement: The study was performed in accordance with the Declaration of Helsinki (revised in Edinburgh, 2000). According to the Italian legislation on data confidentiality, the dataset used is not openly available (Decree No. 196/2003).
Informed consent statement: No identifiable human data were used for this study.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cristina Stasi, MD, PhD, Research Scientist, Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi, 1, Florence 50141, Italy. cristina.stasi@ars.toscana.it
Received: August 21, 2023
Peer-review started: August 21, 2023
First decision: November 28, 2023
Revised: December 18, 2023
Accepted: December 26, 2023
Article in press: December 26, 2023
Published online: March 20, 2024
Processing time: 211 Days and 2.7 Hours
Abstract
BACKGROUND

Prisons can be a reservoir for infectious diseases, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), due to the very intimate nature of the living spaces and the large number of people forced to share them.

AIM

To investigate the SARS-CoV-2 epidemiology in prisons, this study evaluated the infection incidence rate in prisoners who underwent nasopharyngeal swabs.

METHODS

This is an observational cohort study. Data collection included information on prisoners who underwent nasopharyngeal swab testing for SARS-CoV-2 and the results. Nasopharyngeal swab tests for SARS-CoV-2 were performed between 15 February 2021 and 31 May 2021 for prisoners with symptoms and all new arrivals to the facility. Another section included information on the diagnosis of the disease according to the International Classification of Diseases, Ninth Revision, and Clinical Modification.

RESULTS

Up until the 31 May 2021, 79.2% of the prisoner cohort (n = 1744) agreed to a nasopharyngeal swab test (n = 1381). Of these, 1288 were negative (93.3%) and 85 were positive (6.2%). A significant association [relative risk (RR)] was found only for the risk of SARS-CoV-2 infection among foreigners compared to Italians [RR = 2.4, 95% confidence interval (CI): 1.2-4.8]. A positive association with SARS-CoV-2 infection was also found for inmates with at least one nervous system disorder (RR = 4, 95%CI: 1.8-9.1). The SARS-CoV-2 incidence rate among prisoners is significantly lower than in the general population in Tuscany (standardized incidence ratio 0.7, 95%CI: 0.6-0.9).

CONCLUSION

In the prisoner cohort, screening and rapid access to health care for the immigrant population were critical to limiting virus transmission and subsequent morbidity and mortality in this vulnerable population.

Keywords: SARS-CoV-2; Epidemiology; Prison; Prevalence; Foreigners; Swab tests

Core Tip: Prisons can be a reservoir for infectious diseases. Based on this premise, this study evaluated the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in prisons. A significant association was found in the risk of SARS-CoV-2 infection in foreigners compared to Italians, in particular those with at least one nervous system disorder. The SARS-CoV-2 incidence rate in prisoners is significantly lower than in the general population in Tuscany. In the prisoner cohort, screening and rapid access to health care for the immigrant population were critical to limiting virus transmission and subsequent morbidity and mortality in this vulnerable population.