Global burden of chronic hepatitis B virus infection in prison

Statement of the problem

Despite a vaccine against hepatitis B virus (HBV) being available since 1982, the prevalence of chronic HBV infection among adults in sub-Saharan Africa and east Asia is estimated to be 5–10%. A high rate of chronic infections is also found in the Amazon and the southern parts of eastern and central Europe. In the Middle East and the Indian subcontinent, the prevalence is of 2–5%. Less than 1% of the population of western Europe and north America is chronically infected.

Given the high prevalence of infections, such as HIV, HBV and hepatitis C virus (HCV) among inmates, particularly those with a history of injection drug use, prison is considered a reservoir facilitating these infections. The prevalence of hepatitis B surface antigen (HBsAg) in prisoners in west and central Africa is very high (23.5%). High levels of chronic HBV infection were also reported in east and southern Africa (5.7%) and in eastern Europe and central Asia (10.4%).

Purpose

The purpose of this review was to analyse the most recent data on HBV prevalence and vaccination in prisons.

Methodology

Relevant studies were searched for on the PubMed database. The Centres for Disease Control and Prevention (CDC) has highlighted the importance of HBV blood screening and subsequent anti-HBV vaccination in the prison population. The vaccination was recommended for all inmates and represents an opportunity to prevent HBV infection in people at high risk. In these subjects, an accelerated hepatitis B immunization schedule may result in a rapid seroconversion and in early short-term protection.

Conclusion and significance

Although hepatitis B vaccination of inmates has been recommended since the vaccine first became available in 1982, only some states vaccinate inmates routinely. Therefore, it is necessary to have a collaboration between public health officials, clinicians and correctional authorities to implement a vaccination programme.