Academic journal article Bulletin of the World Health Organization

Hepatitis B Vaccination in Prisons. (Policy and Practice)

Academic journal article Bulletin of the World Health Organization

Hepatitis B Vaccination in Prisons. (Policy and Practice)

Article excerpt

Voir page 573 le resume en francais. En la pagina 573 figura un resumen en espanol.


Infection with hepatitis B virus is common among prison inmates (1, 2), mainly because many come from marginal sections of the population, such asintravenous drug users, with high rates of exposure to the virus. For example, Christensen (3) estimated the incidence of hepatitis B infections in Europe to be 2-10 per 100 000 population per year in the general population, compared with 10-20 per 100 population per year among cohorts of injecting drug users, and 1-3 per 100 population per year among prisoners with no history of injecting drug use. A stratified random survey of inmates in the New South Wales Corrections Health Service (CHS) also showed that 64% (85/132) of females and 40% (264/657) of males reported a history of injecting drug use within one year of imprisonment (4). Another study estimated that 60% of all fulltime prison inmates in New South Wales prisons had a recent history of injecting drug use (5). Similarly, a cross-sectional survey of 1205 prison inmates in Ireland indicated that 9% of the inmates were carriers of the hepatitis B surface antigen, while 43% had a history of injecting drug use (6).

The large pool of carders facilitates transmission of the virus in prison through high-risk activities, such as needle sharing and unprotected anal sex (2, 7), and approximately 30% of those with acute hepatitis B reported a history of incarceration (7). In addition to immunization programmes, there are complementary strategies for minimizing the risk of hepatitis B transmission in prisons, including education measures to encourage drug users to stop injecting and non-drug injectors not to take it up, the use of condoms, needle exchange programmes, and bleach programmes. This paper examines major facets of hepatitis B vaccination in prisons, as well as how such vaccination programmes may be complemented by the above strategies.

Management of hepatitis B vaccination programmes in prisons Eligibility criteria and modelling estimates

For two reasons, it is important to screen inmate populations for hepatitis B markers prior to vaccination. First, seroepidemiological studies indicate that drug injectors (who are over-represented in most prison settings) have widespread exposure to hepatitis B vires (8). Second, vaccination of individuals positive for hepatitis B antigen may lead to a false sense of security among such carriers, thereby increasing the risk that they will transmit the virus to others, which can lead to legal action. In countries where there is no effective vaccination for high-risk groups in the general community, it is probably sufficient to screen first with hepatitis B core antibody, and then screen Positives for hepatitis B surface antigen. Individuals who test negative for these markers should be vaccinated.

However, in countries like Australia, where effective community-based programmes are in place for injecting drug users, it is more cost-effective to screen additionally for the hepatitis B surface antibody, to exclude those with prior immunity. In New South Wales correctional facilities, we prescreen for all three primary markers to minimize a one-week delay associated with a two-stage screening process. Also, in this programme an eligible inmate for hepatitis B vaccination is defined as an inmate who is willing to be vaccinated against hepatitis B; who has negative primary serological markers for hepatitis B; and whose earliest date of release at the start of vaccination is later than the minimum period for completing vaccination.

One way to monitor a prison-based hepatitis B vaccination programme and estimate vaccine requirements is to develop models for hepatitis B vaccination in each programme. The role of modelling in planning includes ideation, prediction, identification, integration, systemization and coordination (9). Models have both representational and assessment purposes, providing the planner with a picture of possible solutions. …

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