Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. The CDC issued new recommendations (available at http://www.cdc.gov/mmwr//preview/mmwrhtml/rr5201a1.htm) for controlling the spread of viral hepatitis in U.S. correctional facilities. The recommendations, published in the January 24, 2003 "Morbidity and Mortality Weekly Report," call for vaccination against hepatitis B for all inmates and vaccination against hepatitis A for at-risk inmates. Previous recommendations had called for vaccinating only long-term inmates. The report also recommends testing prisoners with a history of injection drug use (IDU) for hepatitis C.
The recommendations also provide guidelines for juvenile and adult correctional systems regarding identification and investigation of acute viral hepatitis; preexposure and postexposure immunization for hepatitis A and hepatitis B; hepatitis C screening, testing and prevention; health education; and release planning.
Incarcerated groups for whom hepatitis A vaccination is recommended:
The CDC recommends that for persons at risk, the vaccination series should be initiated as soon as possible after incarceration. Jails and prisons should implement tracking systems if not already in place, and should facilitate completion of the second vaccine dose for inmates who are released before the second dose is administered.
The CDC recommends that all adults who receive a medical evaluation in a correctional facility - jail or prison - should be given the hepatitis B vaccine (unless they have proof of completion of the vaccine series or serologic evidence of immunity). This includes inmates entering correctional facilities as well as those who are already incarcerated and have not been previously vaccinated.
For previously unvaccinated inmates with less than a six-month term, the vaccine series should be initiated and completed using a four-month schedule (zero, one-two, and four months).
Although administration of the complete vaccine series should be the goal of all immunization programs, the CDC notes that even a single dose confers protective levels of antibody, and the likelihood of completion of the vaccination series should not be a factor in offering it.
The CDC recommends that all inmates be asked questions about risk factors for HCV infection upon intake, and that all inmates reporting risk factors for HCV infection be tested. Risk factors include testing inmates who:
The CDC also recommends that inmates who test positive for HCV receive further medical evaluation to determine evidence of chronic infection and liver disease; be immunized against HAV and HBV if not previously vaccinated; and be evaluated for candidacy for antiviral therapy.
The CDC recommends that health education programs and curricula include:
Education can take different forms, including videos, brochures, and formal classroom presentations. However, repeated face-to-face sessions have been determined to be the most effective means of education.
* Nothing to disclose
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©1997,1998,1999,2000,2001,2002, 2003. The recently formed HIV Education Prison Project (HEPP) is a medical education program that targets a growing population, inmates in correctional facilities, that has been underserved in HIV care. It is part of the Brown University AIDS Program. Permission to use and reproduce portions of this newsletter is hereby granted provided that author and publication are fully credited and both copyright and permission notice appear with reprinted material. Inquiries may be directed to heppnews@brown.edu. Website: HIV Education Prison Project.
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