by John E. Dannenberg
The national Centers for Disease Control and Prevention (CDC) has issued an updated report providing guidelines and recommendations for juvenile and adult correctional facilities to help identify, immunize against and prevent acute viral hepatitis disease. In its 36 page January, 24, 2003 Recommendations and Reports (MMWR 2003, Vol. 52, No. RR-1), a team of medical specialists in viral hepatitis from the National Center for Infectious Diseases offered this resource guide to correctional health care providers.
Varying by state, 16 to 41 percent of prisoners are already infected with Hepatitis-C, one million of whom are being discharged annually. CDC now recommends at least testing all those with an IV drug use history [approximately 80% of Hep-C infected prisoners have this history], so that those who were not even aware of their latent disease might be able both to take precautions against further spread as well as begin early treatment.
But a battle between costs, legal liability and ethics rages in several states regarding responsibility of prisons to control this epidemic. Arguably, federal laws requiring treatment of seriously ill prisoners might favor the chances of their getting medical help while incarcerated, versus when back outside. While full treatment can cure half the Hep-C cases, the cost of a year's treatment is $25,000. CDC states that 39% of the three million Americans infected with Hep-C will pass through jails and prisons each year, thus making correctional facilities an ideal staging ground to intercept the epidemic.
After discussing the unique risk factors associated with prison populations, the report discusses the nature of each of Hep A, B, and C infection, including incidence of each type as related to behavioral risk factors (e.g., drug injection, sexual transmission and tattooing).
A major chapter is devoted to prevention and control (including disease detection and management) specific to each type of hepatitis, differentiating between them by symptoms and testing.
Next, a prevention rationale is presented, resulting in detailed health program recommendations in both juvenile and adult prisons for each of Hep A, B, and C. These six chapters give specific plans for dosages of pre-exposure vaccinations (types A and B only; none exists for Hep C), for post-exposure vaccinations, and for chronic disease treatment.
Prevention and control of hepatitis disease among prison staff is discussed, including precautions regarding simultaneous exposure to HIV and TB.
This highly technical report is plainly aimed at medical professionals and not lay prisoners. But it is so important to all prisoners' ultimate welfare, because of their epidemic rate of hepatitis infection, that it should be recommended by concerned prisoners/advisory councils to every correctional facility's health care department.
CDC's MMWR reports are available free electronically at http://www.edc.gov/mmwr. The instant report is also available online at www.prisonsucks.com. Hard copies may be ordered from Superintendent of Documents, US Govt. Printing Office, Washington, DC, 20402 (202-512-1800). MMWR is published by the Epidemiology Program Office, CDC, US Dept. of Health and Human Services, Atlanta, GA, 30333. See: MMWR 2003; 52 (No. RR-1): 1-36; The Philadelphia Enquirer.
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