Approximately 0.7% of the American population are in prison, and this group have a disproportionately high burden of disease. The prevalence of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) in prisoners is 2% and 15% respectively, compared with 0.5% and 1.3% in the rest of the US population. In general, 98% of prisoners will be released back into the community at some stage and since this group currently continue to acquire or transmit these infections at a high rate it is increasingly accepted that community based disease prevention and control strategies need to be extended to include the prison population.

Risk factors for the transmission of viral hepatitis are frequently reported by prisoners. In the US, 18% of jail inmates reported injecting drug use in the month before incarceration. Moreover, urine testing at entry indicated drug use was probably substantially under-reported. In a study on the prevalence of bloodborne viruses in prisoners in England, injecting drug use was reported by 24% of men (2). Other risk behaviours frequently reported by the prison population include unprotected sex with multiple partners and tattooing. Correctional employees are also particularly at risk from injuries caused by human bites and needles, as well as exposure to blood and body fluids.

For most prisoners, entry into prison provides a valuable opportunity to access healthcare. Since hepatitis A virus (HAV) and HBV infections can be prevented using highly effective and safe vaccines, transmission can be effectively reduced in the prison population by immunising prisoners. Transmission of HCV can be reduced by identifying risk behaviour and infection status, combined with harm- and risk-reduction counselling and substance abuse treatment. The burden of viral hepatitis related chronic liver disease can also be reduced through appropriate medical management. Similar recommendations have been made in the Hepatitis C Strategy for England published by the Department of Health (3, 4). Prison healthcare initiatives should also be extended to prevent HBV and HCV infections among correctional employees.

There are numerous challenges to the introduction of a comprehensive viral hepatitis prevention and control programme in the prison setting, such as budgetary and staffing constraints, lack of communication and security issues. Therefore, the report states/concludes that specific roles should be defined for all agencies involved and public health personnel at state and local levels should collaborate closely to facilitate the effective implementation of its recommendations.

Since 1995, the European network of HIV and hepatitis prevention in prison, funded by the European Commission, and based at the Wissenschaftliches Institut der Ärzte Deutschlands (WIAD, the Scientific Institute of the German Medical Association) in Bonn, has been collecting and comparing information on HIV/AIDS and hepatitis epidemiology and prevention in European prisons. For more information, email Caren Weilandt (caren.weilandt@wiad.de).