Hepatitis B vaccination for inmates

Correctional settings provide a unique opportunity to offer hepatitis B vaccination to a substantial number of high-risk adults who are willing to be vaccinated and who would not otherwise have access to the preventive medicine, according to a new Brown University study of inmates within the Rhode Island Department of Corrections.

Ninety-three percent of inmates studied from June to August 2002 said they would agree to receive the hepatitis B vaccine while incarcerated. Those who said they would not accept vaccination were either undecided or mistrusting of the government and/or prison.

“Implementation of routine hepatitis B vaccination in jails and prisons could substantially decrease hepatitis B transmission by preventing disease in large cohorts of those most at risk,” said Snigdha Vallabhaneni, study author and third-year student in the Brown Medical School. Vallabhaneni’s paper is in press in the journal Preventive Medicine and available online at www.sciencedirect.com/science/journal/00917435. “Such programs would help protect the health of incarcerated persons and the communities to which they return.”

Researchers interviewed 153 male and female inmates selected randomly from the daily roster of the Rhode Island Department of Corrections, which performs 15,000 intakes each year and has an average daily population of 3,000.

Hepatitis B continues to be a substantial problem in this country despite the existence of a safe and effective vaccine for more than two decades, said the researchers. The disease is caused by a virus that attacks the liver and causes lifelong infection, cirrhosis of the liver, liver cancer, liver failure, and death. An estimated 78,000 people were newly infected in 2001 and 1.2 million Americans now have chronic hepatitis B, according to the Centers for Disease Control and Prevention (CDC).

Since 1982, the CDC has recommended hepatitis B vaccination for high-risk adults including healthcare workers, injection drug users, men who have sex with men, and people with multiple sexual partners. Men and women who are incarcerated report a higher prevalence of high-risk behaviors than the general population. In this study, 29 percent of all participants were determined to be at risk for hepatitis B infection based on the list of risk factors.

Outside the prison system, many of the study participants said they do not have access to regular healthcare and therefore may not have the opportunity to take the hepatitis B vaccine series. One-third of those studied used the emergency room as their main source of medical care, said Vallabhaneni.

However the median sentence length is three years in Rhode Island, allowing enough time to complete the hepatitis B vaccination series of three injections while incarcerated, according to Vallabhaneni.

At the time of the study, there was no routine vaccination program for men at the Rhode Island Department of Corrections, although women were routinely offered hepatitis B vaccination. Since that time, routine vaccination has been expanded to the men’s division, making the state one of only a few in the nation that offer hepatitis B vaccinations to their inmates.

The study was supported by the National Institutes of Health Center for AIDS Research, the Center for Disease Control, and the Brown Medical School Research Fellowship. Vallabhaneni conducted the research in conjunction with other members of the Brown Medical School, Lifespan Department of Medical Computing, and The Miriam Hospital. They include Grace Macalino, Steven E. Reinert, Beth Scwartzapfel, Francis A. Wolf, and Josiah D. Rich.

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