Management in Custody

It is not possible to tell if a detainee is a carrier. Nevertheless, the risk of acquiring infection even from an infected and sick individual is low, unless the individual has carried out mouth-to-mouth resuscitation. Any staff member who believes he or she has been placed at risk should report to the occupational health department (or equivalent) or the nearest emergency department at the earliest opportunity for vaccination.

If the detainee has performed mouth-to-mouth resuscitation, prophylactic antibiotics should be given before receiving vaccination. Rifampicin, ciprofloxacin, and ceftriaxone can be used; however, ciprofloxacin has numerous advantages (66). Only a single dose of 500 mg (adults and children older than 12 years) is needed and has fewer side effects and contraindications than rifampicin. Ceftriaxone has to be given by injection and is therefore best avoided in the custodial setting. If the staff member is pregnant, advice should be sought from a consultant obstetrician, because ciprofloxacin is not recommended (67).

For anyone dealing regularly with illegal immigrants (especially from the Middle East or Sub-Saharan Africa) (e.g., immigration services, custody staff at designated stations, medical personnel, and interpreters), should consider being vaccinated with ACWY Vax. A single injection provides protection for 3 years. Detainees suspected of disease should be sent directly to the hospital.

7.3. Tuberculosis

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