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Prevention and Control of Infections with Hepatitis Viruses in Correctional Settings
Jules Levin
  MMWR (Morbidity and Mortality weekly Report) January 24, 2003
Following this summary of the CDC recommendations regarding hepatitis in correctional settings is a new article commenting on this CDC paper which appeared in the Philadelphia Inquirer newspaper. The CDC just issued recommendations regarding Hepatitis C in prisons. The CDC should also issue recommendations regarding Hepatitis C in communities, and provide funding to implement these programs. It's estimated that 30% of HIV-infected individuals have hepatitis C and 60-90% of individuals who acquired HIV through IV drug use have HCV/HIV coinfection. Public funding is required for desperately needed programs including: testing and counseling, patient and provider education, public awareness, patient support programs, and access to care, treatment & diagnostic testing.
Here is the link to the full report and following are excerpts from the CDC recommendations: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm
The CDC recommends:
1. The high prevalence of chronic HBV and HCV infections and risk factors for their transmission make prevention and control of these infections high priorities for correctional health programs. In addition, because a substantial proportion of releasees to the community continue to acquire or transmit these infections at a high rate, correctional efforts should become part of prevention and control efforts in the broader community.
2. CDC's national strategy to prevent HCV infection includes 1) prevention of transmission during high-risk activities (e.g., injection-drug use and unprotected sex with multiple partners) through risk-reduction counseling, testing, and appropriate medical management of infected persons.
3. Testing populations with high proportions of IDUs is an efficient strategy for identifying HCV-positive persons.
4. Anti-HCV testing is recommended to identify infected persons.
5. Health education directed toward prevention of viral hepatitis includes information related to the disease, routes of transmission, risk factors for infection, methods of prevention, disease outcomes, and treatment options.
6. Comprehensive release planning: Persons with chronic hepatitis B or chronic hepatitis C can benefit from 1) counseling regarding ways to reduce further liver damage, 2) referrals to substance-abuse--treatment and other IDU programs if indicated, and 3) medical referrals to specialists for future treatment.
7. Testing populations with high proportions of IDUs is an efficient strategy for identifying HCV-positive persons.
8. Management of HCV Infection: HCV-positive persons benefit from evaluation for the presence and severity of chronic liver disease. Antiviral therapy is recommended for persons with persistently elevated ALT levels, detectable HCV RNA, and a liver biopsy that indicates either portal or bridging fibrosis or moderate degrees of inflammation and necrosis.
9. The feasibility of including viral hepatitis prevention activities in existing prevention programs has been demonstrated. However, the challenges to integration of a comprehensive viral hepatitis prevention and control program in correctional health settings are substantial. They include budgetary and staffing constraints, priorities that compete with preventive health care, and lack of communication among correctional health, public health, and private health-care systems.
10. The recommendations for prevention and control of viral hepatitis that follow are adapted to the correctional setting. The objective of these recommendations is to reduce transmission of hepatitis virus infections both during and after incarceration. Implementation of these recommendations can 1) reduce transmission of HAV infection in the community by immunizing incarcerated persons at highest risk for infection; 2) eliminate transmission of HBV infection among the inmate population through immunization; 3) reduce the number of new HCV infections by testing, harm- and risk-reduction counseling, and substance-abuse treatment and prevention; 4) reduce the burden of viral hepatitis-related chronic liver disease through appropriate medical management; and 5) prevent HBV and HCV infections among correctional employees.
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