The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997

OBJECTIVES: This study developed national estimates of the burden of selected infectious diseases among correctional inmates and releases during 1997. METHODS: Data from surveys, surveillance, and other reports were synthesized to develop these estimates. RESULTS: During 1997, 20% to 26% of all people living with HIV in the United States, 29% to 43% of all those infected with the hepatitis C virus, and 40% of all those who had tuberculosis disease in that year passed through a correctional facility. CONCLUSIONS: Correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for infectious diseases. Such interventions stand to benefit not only inmates, their families, and partners, but also the public health of the communities to which inmates return.     

Compliance with universal precautions in correctional health care facilities

There were three main objectives of this cross-sectional study of Maryland State correctional health care workers. The first was to evaluate compliance with work practices designed to minimize exposure to blood and body fluids; the second, to identify correlates of compliance with universal precautions (UPs); and the third was to determine the relationship, if any, between compliance and exposures. Of 216 responding health care workers, 34% reported overall compliance across all 15 items on a compliance scale. Rates for specific items were particularly low for use of certain types of personal protective equipment, such as protective eyewear (53.5%), face mask (47.2%) and protective clothing (33.9%). Compliance rates were highest for glove use (93.2%) waste disposal (89.8%), and sharps disposal (80.8%). Compliance rates were generally not associated with demographic factors, except for age; younger workers were more likely to be compliant with safe work practices than were older workers (P < 0.05). Compliance was positively associated with several work-related variables, including perceived safety climate (i.e., management's commitment to infection control and the overall safety program) and job satisfaction, and was found to be inversely associated with security-related work constraints, job/task factors, adverse working conditions, workplace discrimination, and perceived work stress. Bloodborne exposures were not uncommon; 13.8% of all respondents had at least one bloodborne exposure within the previous 6 months, and compliance was inversely related to blood and body fluid exposures. This study identified several potentially modifiable correlates of compliance, including factors unique to the correctional setting. Infection-control interventional strategies specifically tailored to these health care workers may therefore be most effective in reducing the risk of bloodborne exposures.     

Gaps between HIV/AIDS policies and treatment in correctional facilities

In this article the authors examined correctional policy and its impact on the incidence of HIV/AIDS in prison population. Using data from the Florida Correctional System, they find that HIV/AIDS is still the leading cause of death. Improved treatment and care may have led to declines in AIDS-related mortality but the prison population continues to experience a much higher risk of mortality than he general population in spite of changes in the treatment and provision of care to infected patients. The dominance of HIV-related deaths indicates that treatment and voluntary testing policy have been ineffective. The authors argue that the persistence of HIV infections and AIDS-related deaths is largely attributable to continuing unequal distribution of health care resources between identified and unidentified HIV-infected inmates. Their analysis suggests that future changes in HIV/AIDS policy ib testing and treatment can contribute to improvement in health conditions of infected inmates.     

Detection and treatment of HIV and hepatitis virus infections in Swiss correctional facilities

OBJECTIVES: The aim of the study was to obtain an overview on diagnostic and therapeutic activities concerning hepatitis A, B, C virus and HIV in Swiss prisons. METHODS: A standardized questionnaire was sent to 91 prisons in the German and Italian speaking parts in October 2004; 41 institutions (45%) answered the questionnaire. RESULTS: In almost all prisons serological examinations were not done routinely, but were provided when demanded by inmates or recommended by the medical service. Vaccination against hepatitis A or B infection and initiation of antiviral therapy was possible in most institutions. CONCLUSIONS: Most of the prisons investigated offered diagnostic and antiviral treatment for hepatitis virus and HIV infections. A reported problem was the discontinuation of ongoing treatments or vaccination cycles after discharge. In some cases deficient funding was an obstacle.     

Influenza outbreaks at two correctional facilities -- Maine, March 2011

On March 8, 2011, the Maine Center for Disease Control and Prevention (Maine CDC) received a laboratory report of a positive influenza specimen from an intensive-care unit patient who was an inmate at a prison (facility A). That same day, the state medical examiner notified Maine CDC of an inmate death suspected to be have been caused by influenza at another, nearby prison (facility B). On March 9, Correctional Medical Services (CMS), which provides health services to both facilities, notified Maine CDC that additional inmates and staff members from both facilities were ill with influenza-like illness (ILI). CMS reported that influenza vaccination coverage among inmates was very low (<10%), and coverage among staff members was unknown but believed to be low. Maine CDC assisted CMS and the Maine Department of Corrections (DOC) in conducting an epidemiologic investigation to gather more information about the two cases, initiate case finding, and implement control measures, which included emphasizing respiratory hygiene and cough etiquette, closing both facilities to new admissions and transfers, and offering vaccination and antiviral drugs to inmates and staff members. This report describes the public health response and highlights the importance of collaboration between public health and corrections officials to identify quickly and mitigate communicable disease outbreaks in these settings, where influenza can spread rapidly in a large and concentrated population. Correctional facilities should strongly consider implementing the following measures during each influenza season: 1) offering influenza vaccination to all inmates and staff members, 2) conducting education on respiratory etiquette, and 3) making documentation regarding the vaccination status of inmates and staff members accessible.     

Treatment for latent TB in correctional facilities: a challenge for TB elimination

BACKGROUND: To eliminate tuberculosis (TB) in the United States, more information is needed on how to gain access to difficult-to-reach, high-risk populations to evaluate people who would benefit from treatment for latent TB infection (LTBI). METHODS: A field study was conducted of people at risk for co-infection with TB and the human immunodeficiency virus (HIV) and to demonstrate that treating LTBI in inmates is feasible. Inmates were tested for LTBI using the Mantoux tuberculin skin test (TST). Outcomes measured were skin test results and the start and completion of treatment for LTBI. RESULTS: In 49 correctional facilities in 12 states, 198102 inmates had a skin test read. The mean skin test positivity rate among inmates was 17.0%. Of those who had a known HIV test result, 14.5% tested HIV positive. Inmates with a positive TST were 4.2 times more likely than those with a negative TST to be HIV infected (95% confidence interval [CI]=3.9-4.4). Therapy for LTBI was completed in 55.9% of patients started on treatment. Patients who were HIV positive and started on a 12-month treatment regimen were less likely than HIV-negative patients (40.0% vs 68.1%, respectively) to complete treatment (odds ratio [OR]=0.24, 95% CI=0.20-0.28). Patients treated in jails were less likely than those treated in prisons (33.6% vs 57.7%, respectively) to complete treatment (OR=0.29, 95% CI=0.26-0.32). CONCLUSIONS: Correctional facilities offer a venue for identifying and treating high-risk individuals for LTBI. However, completing treatment is more problematic in jails than in prisons.     

Inmate exposure to secondhand smoke in correctional facilities and the impact of smoking restrictions

This study was undertaken to measure the passive smoking exposure of prisoners at three correctional facilities in the US and to evaluate the effectiveness of a ban on smoking in reducing these exposures at two of these facilities. The average weekly concentration of nicotine was measured in fixed locations within the correctional facilities using passive samplers. Samples were collected before and after a smoking ban was instituted, and after the policy was modified to allow smoking outdoors. Samples were collected in the living areas, near where inmates slept and watched TV, and in selected central facilities, including dining halls, visiting rooms, booking areas, and learning centers. Average weekly concentrations of nicotine were measured in 84 locations while smoking was allowed; changes in these concentrations were measured with 112 weekly samples 4 and 9 months after the policy restricting smoking was implemented The average concentrations of nicotine were high while smoking was allowed: most living and sleeping areas averaged 3-11 microg/m(3), but the gym that was used as a bunkroom averaged 25 microg/m(3); these values compare to an average of 2 microg/m(3) in the homes of smokers. The smoking ban significantly reduced nicotine concentrations in the living areas (P<0.01 at facility A and P<0.05 at facility B) to averages of 1.5-2.2 microg/m(3); all postban samples were less than 5 microg/m(3). In conclusion, secondhand smoke concentrations in correctional facilities can be quite high; however, policies banning smoking are effective in reducing, but not eliminating, these exposures.     

The prevalence and the risk behaviours associated with the transmission of hepatitis C virus in Australian correctional facilities

This study measured the prevalence and the risk factors associated with HCV antibody-positive prisoners. A total of 630 prisoners completed a questionnaire about risk behaviours associated with HCV transmission and were tested for HCV antibody from a blood test. Of these 362 (57.5%) prisoners were HCV antibody positive. A total of 436 (68.8%) prisoners reported ever injecting drugs and 332 reported injecting drugs in prison. HCV-positive prisoners were more likely to have injected drugs (OR 29.9) and to have injected drugs in prison during their current incarceration (OR 3.0). Tattooing was an independent risk factor for being HCV positive (OR 2.7). This is the first study conducted on prisoners that has identified having a tattoo in prison as a risk factor for HCV. Injecting drugs whilst in prison during this incarceration was also a risk factor for HCV. Our results show prisoners who injected drugs outside of prison continue to inject in prison but in a less safe manner.     

U.S. Supreme Court rules ADA applies to correctional facilities

In the Pennsylvania Department of Corrections v. Yeskey, the U.S. Supreme Court unanimously ruled that correctional facilities are subject to the provisions under the Americans with Disabilities Act (ADA); this ruling has broad implications for prisoners with HIV infection. When Ronald R. Yeskey was denied admission to a motivational boot camp program at the prison due to hypertension, he sued, claiming that his rights under the ADA had been violated. The Court rejected Pennsylvania's argument that eligibility and participation, as used in Title II of the ADA, imply voluntariness and, therefore, do not apply because inmates are being held against their will. The Court further rejected the argument that the ADA excluded prisoners because the act doesn't specifically mention them. This decision may aid in a case that is before the 11th Circuit Court regarding inmates with HIV having the right to equal access to services. Oral arguments on the 11th Circuit Court case will be heard on September 10, 1998.     

Results of a 29-state survey of tuberculosis in nursing homes and correctional facilities.

A survey of the 15,379 cases of tuberculosis reported to the Centers for Disease Control and Prevention by 29 State health departments in 1984 and 1985 revealed that 7.7 percent of the victims older than age 64 were living in a nursing home at the time of diagnosis and 1.8 percent between the ages of 15 and 64 were living in a correctional institution at the time of diagnosis. Incidence rates of tuberculosis for residents of nursing homes and for inmates of Federal and State prisons and local jails were estimated using denominators derived from institutional population counts provided by the National Center for Health Statistics and by the Department of Justice, Bureau of Justice Statistics, and Bureau of Prisons. The aggregate tuberculosis incidence rate for nursing home residents in the 29 States was 1.8 times higher than the rate seen in elderly persons who were living in the community (95 percent confidence interval on the relative risk 1.64, 2.02). The aggregate tuberculosis incidence rate for inmates in correctional facilities was 3.9 times higher than the rate for persons of a similar age who were not incarcerated (95 percent confidence interval on the relative risk 3.35, 4.49). Strengths and limitations of the design and implications of the first survey of tuberculosis incidence, in a large number of States, among residents of nursing homes and correctional facilities are discussed.