HBV screening and accelerated vaccination in prison (2018)
The hepatitis B virus (HBV) vaccine, available since 1982, has shown high efficacy in the prevention of HBV infection (95%), as well as in the prevention of chronic liver disease, cirrhosis and HBV-related hepatocellular carcinoma. Several studies show that HBV infection in inmates has ranged from 1.4% to 23.5%. This project was relevant in relation to the Global Health Sector Strategy (GHSS) on viral hepatitis, which called for elimination of viral hepatitis as a major public health threat by 2030 (i.e. 90% reduction in incidence and 65% in mortality).
The main objective of this study was to evaluate the increase in pre-exposure prophylaxis by favouring access to anti-HBV accelerated vaccination in the population present in detention facilities in the Tuscany region.
In this study, a doctor and cultural mediators from the International Organization for Migration (IOM) were involved in order to facilitate the diffusion of some messages concerning HBV infection and vaccination. The implementation was regional (local).
The results of this study were as follows: Of 17 detention facilities in the Tuscany region, 15 were enrolled in the study. Training on HBV infection and on its ways of transmission was carried out in 10 institutes. Institutes with a higher number of prisoners were favoured in order to facilitate the dissemination of information. The peer educators that participated in the training were selected by a multidisciplinary group of staff from justice, health and education institutes. A total of 138 inmates were involved, predominantly of Italian, Moroccan and Albanian nationalities. On 28 February 2017, these institutions had 3068 detainees. Of the 1075 subjects screened for HBV serum markers, 730 (67.9%) were susceptible to infection and needed to be vaccinated. Of those 730, 596 agreed to be vaccinated (82%), 27 (2.5%) had isolated anti-HBc antibodies, 20 (1.9%) were infected with HBV (HBsAg+), 127 (11.8%) had previous HBV infection (anti-HBs+, anti-HBc+ and HBsAg−), and 171 had been previously vaccinated. Five hundred and fifty-five inmates (95.1%) received the first vaccine dose, and 404 (83%) received the third dose at day 21.
The evidence of impact is represented by the high prevalence of third-dose subjects. This indicates that accelerated vaccination may be a useful choice for ensuring short-term protection in most people. In fact, the results of the study confirm very high levels of coverage, taking into account both the entire enrolled population and the new prisoners. The monitoring system was represented by clinical medical records for the registration of screening and vaccination. The exported file (containing the “anonymized” data) was sent from the system to the Regional Health Agency of Tuscany via a secure channel (SSL).
With regards to sustainability, the accelerated anti-HBV vaccination programme, initiated as part of the project action, has attracted a great deal of interest from clinicians who work in Tuscany’s custodial institutes. As a result, some procedures have been implemented in these institutions to regulate the application of an accelerated anti-HBV vaccine schedule.
This project addresses the needs of key populations in an equitable manner, because it extends the vaccination programmes in migrant populations, often not subject to compulsory vaccination in their countries. The use of an accelerated anti-HBV vaccine schedule can reduce the spread of the HBV infection in populations at greater risk of infection. The potential limitations of this study were both the study funding period and the annual turnover of inmates, of 36%.
