CDC Issues Recommendations Designed to Prevent Hepatitis Infections in Correctional Settings

The Centers for Disease Control and Prevention (CDC) today published recommendations designed to prevent and control viral hepatitis infections in correctional settings. Implementation of these recommendations can reduce transmission of hepatitis infections among adults at risk in both correctional facilities and the outside community. It’s estimated that 12 percent to 15 percent of all Americans with chronic hepatitis B virus (HBV) and 39 percent of those with hepatitis C virus (HCV) infections were released from a correctional facility during the previous year.

The report – which is published in the January 24 issue of CDC’s Morbidity and Mortality Weekly Report (MMWR), Recommendations and Reports Series – consolidates previous recommendations and adds new ones.

Individuals who spend time in jails, prisons and juvenile institutions have an increased risk of infectious disease, including high rates of infections with hepatitis B and hepatitis C virus. They also have high rates of certain risk behaviors, such as the use of injectable drugs, which expose them to infections with HBV and HCV.

The recommendations were developed following a meeting of experts convened by CDC in March, 2001. Corrections and public health professionals as well as experts in liver and infectious diseases reviewed existing and new research data of hepatitis infections in correctional facilities. The January 24 MMWR recommendations address incarcerated juveniles and adults, and covers topics including identification, reporting and investigation of cases of acute viral hepatitis; hepatitis A and hepatitis B immunization; testing to identify persons infected with chronic HBV and HCV infection, or immunity to infections; counseling to prevent HCV infections and it’s consequences; medical evaluation of inmates with HBV and HCV infection; and health education. The recommendations also address the protection of correctional officers form hepatitis infection.

“We believe these recommendations will provide a useful framework for the development of policies by corrections and public health agencies to prevent and control viral hepatitis among inmates of correctional facilities,” said Dr. Cindy Weinbaum, CDC epidemiologist and lead author of the report and recommendations.

The key CDC recommendations include:

All persons under correctional jurisdiction are at higher risk of a hepatitis infection, and should therefore be vaccinated against hepatitis B, unless they have been previously vaccinated or have been previously infected with hepatitis B and presumably are immune to reinfection;

Medical evaluation in a correctional facility should include a behavioral risk assessment and inmates with risk factors should be tested for HCV infection;

Inmates who test positive for HCV should be evaluated for chronic infection and the extent of liver disease;

Inmates with chronic hepatitis C should be evaluated for antiviral treatment, which should be considered based on criteria developed by each jurisdiction and incorporate current treatment guidelines;

Substance abuse treatment is recommended for persons with chronic hepatitis B or C infection to limit disease transmission, HCV re-infection, and progression of chronic liver disease;

Education regarding the prevention of viral hepatitis should be made part of health education programs for all correctional facility inmates.

For more information about hepatitis, visit CDC’s Web site at www.cdc.gov/hepatitis.

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