High hepatitis B rates in prisons are preventable

Rates of hepatitis B virus infection are high in state correctional facilities. However, most inmates appear to be willing to undergo vaccination, which would prevent infections during incarceration and reduce the spread of hepatitis B in the community after their release.

These conclusions come from two reports by the Centers for Disease Control and Prevention, published in the Morbidity and Mortality Weekly Report.

In the first article, Dr. K. Arnold, at the Georgia Division of Public Health, and associates monitored reports of hepatitis B virus infections among Georgia inmates and identified 57 new cases between January 2001 and June 2002.

Forty-one cases were acquired while in prison.

In the prison setting, hepatitis B is contracted most often through unsafe practices such as tattooing or sex contacts.

Arnold's group also conducted a survey at four facilities during prisoner intake in February and March of 2003. Consenting inmates underwent testing for hepatitis B, and all were offered vaccination.

Ninety percent consented to testing. Among these 498 prisoners, recent hepatitis B infection was detected in three, chronic infection in four, and evidence of resolved infections was seen in 64. Seventy-eight percent consented to vaccination.

The finding that most of those tested were susceptible to infection and willing to be vaccinated suggests that "vaccination efforts in correctional facilities might effectively capture susceptible, high-risk populations," Arnold's team writes.

However, most state correctional systems do not have hepatitis B vaccination programs.

In the second report, Dr. Cindy Weinbaum, with the CDC's Division of Viral Hepatitis, and colleagues demonstrate the feasibility of hepatitis B vaccination programs for inmates.

The researchers assessed the success of a Texas Department of Criminal Justice program implemented in May of 2000, by auditing charts in February 2002 of 426 inmates considered to be eligible for vaccination.

The team found that the vaccine had been offered to 84 percent of prison inmates and 65 percent of jail inmates. Acceptance rates were 72 percent and 85 percent, respectively.

However, "in December 2002, the hepatitis B vaccination program was suspended because of a lack of funds," Weinbaum's group notes.

"The CDC started recommending hepatitis B virus vaccination for inmates in 1982," Weinbaum told Reuters Health. "The barrier to implementation of such programs in correctional systems really seems to be funding, not inmates' willingness to participate."

SOURCE: Morbidity and Mortality Weekly Report, August 6, 2004.