1. Viral Hepatitis in Correctional Settings
National Hepatitis Coordinators’ Conference
San Antonio TX
January, 2003

2. Adult Correctional Population
~ 6.6 million adults in prison, jail, probation and parole
~ 3.1% of the adult US population
~ 1 in every 32 adults
~ 30% are incarcerated
Source: Bureau of Justice Statistics, Probation & Parole in 2001
(8/2002) NCJ

3. Adult Incarcerated Population
~1.9 million adults in prison or jail
Jail (630,000):
Local
Detained or <1year sentence
Prison (1,330,000)
State
Federal
Source: Bureau of Justice Statistics, Probation & Parole in 2001
(8/2002) NCJ

4. U.S. Adult Prison Population
1,600,000
1,330,000
1,400,000
1,200,000
1,000,000
739,980
800,000
600,000
315,974
400,000
166,123
196,429
The number of adults in the correctional population is growing.
Justice Policy Institute estimates U.S. has the world’s largest incarcerated population and highest incarceration rate.
U.S. represents almost 25% of the world’s prison population, but accounts for only 5% of the world’s population.
Imprisoned populations grew at a very fast rate during the 1990s.
In 1990, the U.S. jail and prison populations equaled 1,145,300 inmates.
In December 1999, there were an estimated 1,983,084 jail and prison inmates.
There will be approximately 2,073,969 jail and prison inmates by the end of this year.
129,453
173,706
212,953
200,000
57,070
68,735
81,959
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
Source: Justice Policy Institute of the U.S. Department of Justice Data

5. State and Federal Inmates and Population Disparities, 1999
2% Other
5% Other
12%
Black
13%
Hispanic
16%
Hispanic
46%
Black
71%
White
36%
White
State and Federal Inmates+
US Population
N=277,200,000
Source: Bureau of Justice Statistics, Prisoners in 2000,
August 2001 NCJ

6. Health in the Correctional System
Estelle v. Gamble (1976)
Security v. Healthcare
Short term v. Lifelong
Who Pays?

7. National Hepatitis Coordinators’ Conference
Prevention and Control of Infections with Hepatitis Viruses in Correctional Settings: New MMWR Recommendations
National Hepatitis Coordinators’ Conference
San Antonio TX
January, 2003

9. Offender Risk Behavior: Illicit Drug Use
3%-6% of juvenile offenders inject drugs
18% of jail inmates report IDU
Drug offenders in prison:
21% of sentenced State inmates
57% of Federal inmates
~ 80% of IDUs have been incarcerated

10. Risk Behaviors within Prisons
Needle sharing
Sexual activity
? Other percutaneous exposures

11. U.S. Viral Hepatitis Burden Among Released Inmates, 1997
Chronic
Infection
Affected prison and jail inmates
Noninmate population
with condition
Total US population with condition
Releasees with condition as % of US
HBV
34,000
(2%)
million (0.5%)
million
155,000
(12%-15%)
HCV
255,000 (15%)
2.7 million (1.3%) 3
million
1.3 million (39%)
Adapted from: NCCHC, Health Status of Soon-to-be Released Inmates

12. Incidence in Inmates
HBV infection: 1% - 3%
HCV infection: 0.1% - 1%

13. Prison HBV Outbreak Acute hepatitis B was reported in a prison
inmate. Case investigation determined:
8% acute HBV infection in dormitory of index
1.2% acute HBV infection overall in prison
3.8% newly infected at one-year follow-up

14. Prison: Opportunity for Prevention
Of reported acute hepatitis B cases, 29% have been incarcerated
Among IDUs with reported acute hepatitis B, 70% have been incarcerated
Source: Sentinel Counties Study of Viral Hepatitis

15. Prevention and Control of Viral Hepatitis in Correctional Settings
Recommendations
Prevention and Control of Viral Hepatitis
in Correctional Settings

16. Hepatitis A Vaccination
Juveniles:
In high prevalence areas
At risk for/from HAV infection
MSM, IDU, liver disease
No prevaccine serologic testing

17. Hepatitis A Vaccination
Adults:
At risk for/from HAV infection
MSM, IDU, liver disease
Vaccinate before release
Prevaccination testing if cost effective
Consider inmates >40 yrs old

18. Hepatitis B Vaccination of Incarcerated Persons
Recommended since 1982
Prevents infection outside and inside of facilities
Feasible and cost-effective
Challenges to implementation exist

19. Hepatitis B Vaccination: Juveniles
Since 1996 Massachusetts vaccinates:
Elementary school students
Adolescents
Juvenile detainees

20. Hampden County Jail, 1999 (n=463)
HBV Markers:
Hampden County Jail, 1999 (n=463)
HBsAb only
HBcAb/HBsAg
HBsAb OR
Source: Lincoln T, DePietro S, Keough K et al., unpublished data

21. Hepatitis B Vaccination
Deliver first dose of vaccine regardless of ability to deliver 3-dose series
First dose protects ~40% of people
Second dose protects ~75%
Create mechanisms to complete vaccination series
Tracking within the facility/system
Referrals into community health care

22. Hepatitis C Screening
All incoming inmates should receive a risk history assessment
Inmates at high risk for infection (primarily IDU) should be tested for anti-HCV

23. Hepatitis C Management
Evaluate anti-HCV positive inmates for chronic infection and liver disease
Evaluate and treat in consultation with an informed specialist
Make drug and alcohol abuse treatment programs available to facilitate antiviral treatment of substance abusers

24. Prison Hepatitis C Management
Incarceration facilitates sobriety
Incarceration provides stable environments
Inmates have been successfully treated for hepatitis C

25. Viral Hepatitis Education
Health curricula should include:
Risk factors for infection
Disease outcome information
Immunization information
Harm and risk reduction teaching
Substance abuse treatment
Community resources

26. Chronic Liver Disease Prevention
Inmates with chronic hepatitis B or C should receive:
Hepatitis A vaccination
Counseling on alcohol reduction
Information about hepatotoxic drugs
Information about aftercare

27. Internet Resources www.cdc.gov/hepatitis www.hepprograms.org
(webcast on hepatitis)