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Thursday June 28 5:29 PM ET

Hepatitis B Vaccination Recommended for Inmates

By Emma Patten-Hitt, PhD

ATLANTA (Reuters Health) - An outbreak of hepatitis B virus (HBV) infection among male inmates suggests that the virus spreads through risky behaviors such as sex and intravenous drug use, even in prison. It also highlights the need for HBV vaccination to be offered to inmates, the Centers for Disease Control and Prevention (news - web sites) (CDC) in Atlanta said on Thursday.

HBV is a liver infection that can be transmitted through unprotected sex, injection drug use and being exposed to infected blood. The infection can be chronic and lead to liver damage and cancer.

In an outbreak at a long-term state correctional facility in an undisclosed state, 11 patients who had been incarcerated for more than six months had acute (recent-onset) infection--indicating that transmission had occurred within the prison. An additional 10 inmates had previously unrecognized chronic hepatitis B infection.

The investigation started in May 2000, after a 34-year-old man who had been in the prison for more than 2 years developed jaundice, a yellowing of the skin that signals a liver problem.

The man reported having had unprotected sex with his cellmate. Testing of the cellmate confirmed that he, too, was infected with HBV.

Of 103 inmates who resided in the same dormitory, 97 consented to being tested for HBV infection. Of those, six had had been infected within the last six months, one was chronically infected, and 15 had had a previous infection that had subsided.

The researchers then tested about 1,000 inmates in other dormitories. Of those, five were identified with a previously undiagnosed HBV infection, 10 were chronically infected, and 178 had had a previous infection.

About half of the 907 inmates who a completed questionnaire reported participating in behaviors that could cause HBV. Twenty-one reported injecting drugs, 26 reported having sex with another man, 73 reported using another inmate's razor, and 429 reported receiving a tattoo.

``Sex with another man accounted for only 20% of the new infections in this investigation. However, this and other behaviors prohibited by the correctional facility (e.g. injecting drugs) probably are underreported by inmates,'' the researchers write in the June 29th issue of the CDC's Morbidity and Mortality Weekly Report.

``These findings support routine vaccination of inmates of correctional facilities,'' the CDC's Dr. Amy Khan told Reuters Health. She pointed out that only a handful of states offer hepatitis B vaccination to inmates.

But vaccination, Khan said, would provide ``an opportunity to prevent infection both during incarceration and before they go out into the community again.''

``A couple of barriers to administering routine HBV vaccine are cost and the difficulty of completing the three doses required to complete the series of vaccinations,'' she noted.

``But when vaccines are offered, the acceptance rate is about 70 to 80%--so that's high,'' she added. ``There are definite benefits to society, as well as to the prison system.''

SOURCE: Morbidity and Mortality Weekly Report 2001;50:529-532.

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.