Hepatitis B Virus Infection in US Correctional Facilities: A Review of Diagnosis, Management, and Public Health Implications

Abstract

Among the blood-borne chronic viral infections, hepatitis B virus (HBV) infection is one that is not only treatable but also preventable by provision of vaccination. Despite the availability of HBV vaccine for the last 15 years, more than 1.25 million individuals in the USA have chronic HBV infection, and about 5,000 die each year from HBV-related complications. From a societal perspective, access to treatment of chronic viral infections, like HIV and viral hepatitis, is highly cost-effective and has lasting benefits by reducing risk behaviors, morbidity, mortality, as well as disease transmission in the community. Individuals in correctional facilities are specially predisposed to such chronic viral infections because of their high-risk behaviors. The explosion of incarceration in the USA over the last few decades and the disproportionate burden of morbidity and mortality from chronic infections among the incarcerated have put incredible strains on an overcrowded system that was not originally designed to provide comprehensive medical care for chronic illnesses. Recently, there has been a call to address medical care for individuals with chronic medical conditions in correctional settings, including those with infectious diseases. The economic and public health burden of chronic hepatitis B and its sequelae, including cirrhosis and hepatocellular carcinoma, is felt most prominently in managed care settings with limited budgets, like correctional facilities. Prevalence of HBV infection among the incarcerated in the USA is fivefold that of the general population. We present a review of diagnosis, prevention, and the recently streamlined treatment guidelines for management of HBV infection in correctional settings, and discuss the implications and public health impact of these measures.

Epidemiology and Treatment of Hepatitis B in Prisoners

“…Routes of transmission include sharing needles and other drug injection paraphernalia, sexual activity, sharing tattoo paraphernalia, sharing razors or toothbrushes, and fights involving breaks in skin and bleeding [4, 18]. Thus, risk factors for HBV transmission include: sharing personal items such as toothbrushes, razors and injecting equipment, use of contaminated drug injecting equipment, sex, tattooing or piercing, needle or sharps injuries, and failure to adhere to standard precautions in medical environment [19].…”

Background paper to the revised recommendation for hepatitis B vaccination of persons at particular risk and for hepatitis B postexposure prophylaxis in Germany

“…Prevalence of acute or previous hepatitis B was 34.8% in prison inmates Gupta et al [19] Review, US In the US, prevalence of hepatitis B is five times higher in prison inmates than in the general population Khan [20] Serological cross-sectional study (n=1124), US At study entry, active or previous hepatitis B was diagnosed in 20.5% of prison inmates. Acute or chronic hepatitis B was present in 1%, while 18.5% had previous hepatitis B infection Psychiatric inpatients Velinga et al [21] Review (n>8000), Europe, US, and others…”

“…F Indication group 2: Persons at increased risk of non-occupational exposure.Examples: Persons living together with HBsAg carriers [11,12,13], persons at high risk of acquiring hepatitis B by sexual contact [11,14,15], people who inject drugs [14,16,17], prison inmates [18,19,20], psychiatric inpatients [21,22]. F Indication group 3: Persons at increased risk of occupational exposure.Examples: Health care personnel (HCP) at risk of exposure (including trainees, laboratory personnel, cleaning personnel) [23,24,25], first aiders [26,27], police officers [29], personnel of facilities where an increased prevalence of HBV-infected persons is likely to be present (e.g., correctional facilities, asylum seeker shelters, homes for the handicapped) [18,19,20,27,28,29].…”

Mahkûmlarda Hepatit A, Hepatit B, Hepatit C ve HIV İnfeksiyonu Göstergelerinin Taranması

“…Benzer şekilde kronik HBV'li bireylerin %40'ından fazlası ve akut HBV'li olguların yaklaşık %30'u Amerika'da tutuklulardır. Amerika Hastalık Koruma ve Önleme Merkezi (CDC) akut HBV'li hastaların %5.6'sının inkübasyon döneminde tutuklu olduklarını bildirmiştir (16). Amerika'da tutuklu olanlarda HBV seroprevalansının tutuklu olmayanlardan 10 kat fazla olduğu bildirilmektedir (16 HCV seroprevalansı tüm dünyada genel popülasyona göre tutuklularda %2-58 arasında değişmektedir.…”

“…Amerika Hastalık Koruma ve Önleme Merkezi (CDC) akut HBV'li hastaların %5.6'sının inkübasyon döneminde tutuklu olduklarını bildirmiştir (16). Amerika'da tutuklu olanlarda HBV seroprevalansının tutuklu olmayanlardan 10 kat fazla olduğu bildirilmektedir (16 HCV seroprevalansı tüm dünyada genel popülasyona göre tutuklularda %2-58 arasında değişmektedir. Amerika'da bu oran 20 kat daha fazladır %12-35 tutuklu kronik hepatit C hastasıdır (12).…”