An outbreak of coronavirus disease began in a large penitentiary complex in Brazil on April 1, 2020. By June 12, there were 1,057 confirmed cases among inmates and staff. Nine patients were hospitalized, and 3 died. Mean serial interval was ≈2.5 days; reproduction number range was 1.0–2.3.

Objectives To assess SARS-CoV-2 prevalence and health outcomes among inmates over 60 years of age during a COVID-19 outbreak in a major penitentiary complex in the Federal District, Brazil. Methods A mass test campaign was performed on May 13, 2020, with the use of antibody-detection rapid tests for asymptomatic inmates and RT-PCR for symptomatic. Those with negative results were retested on June 16. Inmates were interviewed for the characterization of background health conditions and the presence of symptoms. Results A total of 159 inmates were evaluated. In the first mass testing, we found that 79.9% (127/159) had been infected and 53.5% (68/127) of those reported symptoms. There were 17 new cases after the second testing, meaning 90.6% (144/159) of inmates had some positive result. Comorbidities were present in 67.3%; two hospitalizations and no COVID-related deaths were recorded. Conclusion More than 90% of inmates over the age of 60 were infected with SARS-CoV-2 during the outbreak. Periodic health monitoring, active case finding and early care for symptomatic patients were the main actions that contributed to positive post-infection outcomes. Such measures must be considered as essential components for the surveillance of COVID-19 in environments with limited capacity to promote social distance, such as penitentiary institutions.

No abstract

Purpose This study aims to estimate the overall SARS-CoV-2 seroprevalence and evaluate the accuracy of an antibody rapid test compared to a reference serological assay during a COVID-19 outbreak in a prison complex housing over 13,000 prisoners in Brasília. Design/methodology/approach The authors obtained a randomized, stratified representative sample of each prison unit and conducted a repeated serosurvey among prisoners between June and July 2020, using a lateral-flow immunochromatographic assay (LFIA). Samples were also retested using a chemiluminescence enzyme immunoassay (CLIA) to compare SARS-CoV-2 seroprevalence and 21-days incidence, as well as to estimate the overall infection fatality rate (IFR) and determine the diagnostic accuracy of the LFIA test. Findings This study identified 485 eligible individuals and enrolled 460 participants. Baseline and 21-days follow-up seroprevalence were estimated at 52.0% (95% CI 44.9–59.0) and 56.7% (95% CI 48.2–65.3) with LFIA; and 80.7% (95% CI 74.1–87.3) and 81.1% (95% CI 74.4–87.8) with CLIA, with an overall IFR of 0.02%. There were 78.2% (95% CI 66.7–89.7) symptomatic individuals among the positive cases. Sensitivity and specificity of LFIA were estimated at 43.4% and 83.3% for IgM; 46.5% and 91.5% for IgG; and 59.1% and 77.3% for combined tests. Originality/value The authors found high seroprevalence of anti-SARS-CoV-2 antibodies within the prison complex. The occurrence of asymptomatic infection highlights the importance of periodic mass testing in addition to case-finding of symptomatic individuals; however, the field performance of LFIA tests should be validated. This study recommends that vaccination strategies consider the inclusion of prisoners and prison staff in priority groups.