1. J Infect Dev Ctries. 2013 Jun 15;7(6):453-67. doi: 10.3855/jidc.2965.

Molecular epidemiology of HIV, HBV, HCV, and HTLV-1/2 in drug abuser inmates in central Javan prisons, Indonesia. Prasetyo AA, Dirgahayu P, Sari Y, Hudiyono H, Kageyama S. Faculty of Medicine, Sebelas Maret University, Jl. Ir. Sutami 36A, Surakarta, Indonesia. afie.agp.la@gmail.com. INTRODUCTION: This study was conducted to determine the current molecular prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and human T lymphotropic virus-1/2 (HTLV-1/2) circulating among drug abuser inmates incarcerated in prisons located in Central Java, Indonesia. METHODOLOGY: Socio-epidemiological data and blood specimens were collected from 375 drug abuser inmates in four prisons. The blood samples were analyzed with serological and molecular testing for HIV, HBV, HCV, HDV, and HTLV-1/2. RESULTS: The seroprevalence of HIV, HBsAg, HCV, HDV, and HTLV-1/2 in drug abuser inmates was 4.8% (18/375), 3.2% (12/375), 34.1% (128/375), 0% (0/375), and 3.7% (14/375), respectively. No co-infections of HIV and HBV were found. Co-infections of HIV/HCV, HIV/HTLV-1/2, HBV/HCV, HBV/HTLV-1/2, and HCV/HTLV-1/2 were prevalent at rates of 4% (15/375), 1.3% (5/375), 1.1% (4/375), 0.3% (1/375), and 2.1% (8/375), respectively. The HIV/HCV co-infection rate was significantly higher in injection drug users (IDUs) compared to non-IDUs. Triple co-infection of HIV/HCV/HTLV-1/2 was found only in three IDUs (0.8%). HIV CRF01_AE was found to be circulating in the inmates. HBV genotype B3 predominated, followed by C1. Subtypes adw and adr were found. HCV genotype 1a predominated among HCV-infected inmates, followed by 1c, 3k, 3a, 4a, and 1b. All HTLV-1 isolates shared 100% homology with HTLV-1 isolated in Japan, while all of the HTLV-2 isolates were subtype 2a. CONCLUSION: Drug abuser inmates in prisons may offer a unique community to bridge prevention and control of human blood-borne virus infection to the general community. PMID: 23771289 [PubMed - in process] 2. ScientificWorldJournal. 2013 Apr 22;2013:735761. doi: 10.1155/2013/735761. Print 2013.

Risk Prison and Hepatitis B Virus Infection among Inmates with History of Drug Injection in Isfahan, Iran. Dana D, Zary N, Peyman A, Behrooz A. Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Objectives. Hepatitis B virus (HBV) is a health problem among injection drug users (IDUs) in prison. The aim of this study is to evaluate the association of factors of incarceration with HBV infection in prisoners with history of drug injection in Isfahan, Iran. Methods. In a cross-sectional study, all IDUs inmates were enrolled. Sociodemographic characteristics and associated risk factors were obtained. Blood samples were collected and serological markers for HBV were analyzed. For data analysis, odds ratio and logistic regression were used. Results. Of the IDUs inmates, 970 subjects participated in the study. History of imprisonment (OR: 1.82, 95% CI: 1.28-2.57), multiple incarceration (OR: 1.43, 95% CI: 1.01-2.02), and total duration of imprisonment (OR: 2.70, 95% CI: 1.94-3.74) were significantly associated with prevalence of HBV among IDUs inmates. Multivariate analysis of associated factors showed that only total duration of incarceration is significantly associated with HBV infection. Conclusion. In conclusion, according to our results, multiple and duration of incarcerations will be considered as important risk factors of HBV infection in IDUs inmates. This fact makes it important to set some screening and prevention programs in prisons to decrease the risk of being infected and prevent the transmission of these diseases. PMCID: PMC3655682 PMID: 23737725 [PubMed - in process] 3. J Infect Public Health. 2013 Jun;6(3):186-95. doi: 10.1016/j.jiph.2012.12.003. Epub 2013 Feb 27. Hepatitis C, hepatitis B and HIV infection among Egyptian prisoners: Seroprevalence, risk factors and related chronic liver diseases. Mohamed HI, Saad ZM, Abd-Elreheem EM, Abd-Elghany WM, Mohamed MS, Abd Elnaeem EA, Seedhom AE. Department of Tropical Medicine, Minia University, Egypt. Electronic address: halaibrahem@yahoo.com. BACKGROUND AND AIM: Prisons in Egypt do not currently screen for blood-borne viruses, and there are no statistics concerning the prevalence of hepatitis C

virus, hepatitis B virus or human immunodeficiency virus among prisoners. This study was performed to detect the prevalence of antibodies against hepatitis C, hepatitis B core and human immunodeficiency virus among Egyptian prisoners. METHODS: The study was conducted in an Egyptian prison. The prisoners voluntarily completed a risk factor questionnaire and provided blood specimens for testing for antibodies against hepatitis C virus, hepatitis B virus core antigen and human immunodeficiency virus. Positive results were confirmed by the detecting HCV RNA via polymerase chain reaction. Multivariate regression analysis was performed to determine the factors that were independently associated with positive HCV serology. RESULTS: Five hundred resident prisoners were screened. The prevalence of hepatitis C virus antibodies was 15.8% (79/500), and viremia was confirmed by PCR in 77.2% (61/79) of the antibody-positive prisoners. The prevalence of antibodies to hepatitis B core antigen was 9.8% (49/500), and 1.2% (6/500) of prisoners were dually infected with HBV and HCV. Antibodies to human immunodeficiency virus were not detected in any of the prisoners. The best predictor for hepatitis C and hepatitis B infection was a history of intravenous drug use (P<0.011 for HBV and P<0.001 for HCV), a period of >10 years spent in prison (P<0.052 for HBV and P<0.021 for HCV) and shared toiletries (P<0.059 for HBV and P<0.002 for HCV). CONCLUSION: Hepatitis C and hepatitis B virus infections constitute an important public health problem in prisons. Public health strategies to prevent morbidity and mortality from these infections should include hepatitis B vaccination, HCV testing, counseling and medical management of infected prisoners. Copyright 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved. PMID: 23668463 [PubMed - in process] 4. Med J Aust. 2013 Apr 15;198(7):376-9. A cross-sectional study of susceptibility to vaccine-preventable diseases among prison entrants in New South Wales. Larney S, Monkley DL, Indig D, Hampton SE. University of New South Wales, Sydney, NSW. s.larney@unsw.edu.au OBJECTIVES: To determine the prevalence of susceptibility to measles, mumps, rubella, varicella and hepatitis B virus (HBV) among New South Wales prison entrants and to compare results for prison entrants with those of a community sample. DESIGN AND SETTING: Between 11 October 2010 and 24 October 2010, new entrants at seven adult correctional centres completed a cross-sectional survey and provided

a venous blood sample. PARTICIPANTS: All adults entering the correctional centres were eligible to participate, with 211 completing the survey (response rate 68%). MAIN OUTCOME MEASURES: Serological evidence of immunity to measles, mumps, rubella, varicella and HBV. Prison data were compared with community data obtained from the 2007 Australian National Serosurveillance Program. RESULTS: Over half of the participants (106/204, 52%) were susceptible to HBV, followed by susceptibility to mumps (82/198, 41%), rubella (33/209, 16%), measles (27/203, 13%) and varicella (19/198, 10%). Having no history of drug injection was a significant predictor of susceptibility to measles, mumps and HBV. Prison entrants were significantly less likely than people in the community to be susceptible to varicella (10% versus 18%; risk ratio [RR], 1.9; 95% CI, 1.1-3.2) and HBV (52% versus 65%; RR, 1.3; 95% CI, 1.1-1.5). CONCLUSIONS: Prison entrants are susceptible to a number of vaccine-preventable diseases. We recommend a cost-benefit analysis of implementing routine vaccination for measles, mumps, rubella and varicella and an exploration of options for improving uptake of HBV vaccination. PMID: 23581958 [PubMed - indexed for MEDLINE] 5. Rev Soc Bras Med Trop. 2013 Jan-Feb;46(1):24-9. Epidemiology of the viral hepatitis B and C in female prisoners of Metropolitan Regional Prison Complex in the State of Gois, Central Brazil. Barros LA, Pessoni GC, Teles SA, de Souza SM, de Matos MA, Martins RM, Del-Rios NH, de Matos MA, Carneiro MA. Instituto de Patologia Tropical e Sade Pblica, Universidade Federal de Gois, Goinia, GO, Brasil. INTRODUCTION: Little information regarding hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among Brazilian female prisoners exists. This study investigated the prevalence and risk factors associated with HBV and HCV infections and identified viral genotypes among female prisoners in Gois, Central Brazil. METHODS: Women incarcerated in the largest prison in the State of Gois were invited to participate in the study. All female prisoners were interviewed and tested for the detection of hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), against hepatitis B core antigen (anti-HBc), and antibody against HCV (anti-HCV) by ELISA. HBsAg and anti-HCV positive samples were tested for HBV DNA and HCV RNA and genotyped, respectively. RESULTS: Participants (n = 148; 98.6%) completed the study with an overall HBV prevalence of 18.9%. Age >30 years, a low education level, sex with a sexually transmitted diseases carrier, and a male sexual partner serving in the same

penitentiary were associated with HBV infections. Only 24% of the women were anti-HBs positive suggesting previous HBV vaccination. Nine female prisoners (6.1%) were anti-HCV positive. Age >40 years, injecting drug use and length of incarceration were statistically associated with anti-HCV antibodies. Five samples were HCV RNA positive and classified as genotypes 1 (subtypes 1a; n = 3 and 1b; n = 1) and 3 (subtype 3a; n = 1). The HBsAg-reactive sample was HBV DNA positive and genotype A. CONCLUSIONS: These findings highlight the necessity of public policies to control hepatitis B and C infections and emphasize the importance of hepatitis B vaccination in prison environments. PMID: 23563821 [PubMed - in process] 6. Eur Rev Med Pharmacol Sci. 2012 Dec;16(15):2142-6. Blood born viral infections, sexually transmitted diseases and latent tuberculosis in italian prisons: a preliminary report of a large multicenter study. Sagnelli E, Starnini G, Sagnelli C, Monarca R, Zumbo G, Pontali E, Gabbuti A, Carbonara S, Iardino R, Armignacco O, Babudieri S; Simspe Group. Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy. evangelista.sagnelli@unina2.it BACKGROUND: Recent screenings of inmates for Hepatitis C virus (HCV), Hepatitis B virus (HBV), human immunodeficiency virus (HIV), Syphilis and Latent Tuberculosis (LTB) did not provide sufficient information to improve healthcare strategies. AIM: To obtain valuable information on the endemicity of the above mentioned Infections in prisons of Italy. MATERIALS AND METHODS: A screening based on a peer-to-peer communication, followed by a month of blood sampling on a voluntary basis was performed to detect antibody to 4 of the 5 above mentioned infections and detect LTB by PPD (purified protein derivative) Skin Test. The present analysis regards data obtained in 9 of the 20 prisons. RESULTS: The percentage of patients who accepted the screening varied between jails (37.3-95.2%, median 62.2), but it was higher than 10.0-20.5% obtained in the same 9 prisons using traditional methods before our intervention. The participation to the screening reached 65.3% for HBV, 64.6% for HCV, 67.4%for HIV, 55.7% for TPHA (Treponema Pallidum Hemagglutination Assay) and 42.8% for LTB. HBsAg was detected in 4.4% of 2265 subjects, anti-HCV in 22.8% of 2241, anti-HIV in 3.8% of 2339 and TPHA in 2.1% of 1932; PPD Skin Test was positive in 17.2% of 1486 subjects. The screening identified 183 subjects with an unknown infection, 56 italian and 127 foreigners to be evaluated for clinical decisions: 35 with HBV chronic infection, 34 with HCV chronic infection, 3 anti-HIV

positive, 14 with syphilis and 97 with LTB. CONCLUSIONS: The new approach to the screening, based on a peer-to-peer communication followed by blood sampling on a voluntary basis provided valuable information to improve the healthcare system in each single prison. PMID: 23280032 [PubMed - indexed for MEDLINE] 7. J Gastroenterol Hepatol. 2013 Feb;28(2):314-22. doi: 10.1111/jgh.12063. Hepatitis B virus exposure and vaccination in a cohort of people who inject drugs: what has been the impact of targeted free vaccination? Winter RJ, Dietze PM, Gouillou M, Hellard ME, Robinson P, Aitken CK. Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia. rwinter@burnet.edu.au BACKGROUND AND AIM: Forty percent of new hepatitis B virus (HBV) infections in Australia occur in people who inject drugs (PWID); long-term infection carries the risk of serious liver disease. HBV incidence among Australian PWID has not been measured since the advent of targeted (2001) and adolescent school-based "catch-up" (1998) vaccination programs. We measured HBV incidence and prevalence in a cohort of PWID in Melbourne, Australia and examined demographic and behavioral correlates of exposure and vaccination. METHODS: Community-recruited PWID were surveyed about blood-borne virus risk behaviors and their sera tested for HBV markers approximately three-monthly over three years. Incidence was assessed using prospectively collected data. A cross-sectional design was used to examine prevalence of HBV exposure and vaccination at baseline. Poisson regression was used to identify correlates of HBV exposure and vaccination. RESULTS: At baseline, 33.1% of participants (114/344) had been vaccinated against HBV, 40.4% (139/344) had been exposed (previously or currently infected), and 26.5% (91/344) were susceptible. HBV incidence was 15.7 per 100 person-years. Independent associations with HBV exposure included female gender, South-East Asian ethnicity, drug treatment in the past three months, injecting in prison, and prior exposure to hepatitis C virus. Independent associations with vaccination included being 25 years old, reporting HBV vaccination, and never having been to prison. CONCLUSIONS: HBV infection continues at high incidence among Australian PWID despite the introduction of free vaccination programs. Innovative methods are needed to encourage PWID to complete HBV vaccination. 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

PMID: 23190264 [PubMed - in process] 8. Hepat Mon. 2012 Jul;12(7):442-7. Epub 2012 Jul 30. Prevalence and Risk Factors of HIV, Syphilis, Hepatitis B and C Among Female Prisoners in Isfahan, Iran. Nokhodian Z, Yazdani MR, Yaran M, Shoaei P, Mirian M, Ataei B, Babak A, Ataie M. Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran. BACKGROUND: Female prisoners are at risk of acquiring sexually transmitted infections (STIs). There has been no previous study regarding the epidemiological status of STIs among female prisoners in Isfahan, central Iran. OBJECTIVES: The aim of this study was to investigate the prevalence and risk factors of the aforementioned infections among women incarcerated in the central prison, Isfahan, to determine appropriate prevention measures. PATIENTS AND METHODS: In a cross-sectional study, all of the 163 women incarcerated in the central prison, Isfahan in 2009, were voluntarily enrolled by the census method. After completing a checklist consisting of demographic, social, and risk factors, a 5ml blood sample was taken from each individual. The sera were analyzed for markers of the hepatitis B virus (HBV; HBsAg, HBsAb, HBcAb), hepatitis C virus (HCV; HCV antibodies), human immunodeficiency virus (HIV; HIV antibodies), and syphilis (RPR). Confirmatory tests were performed on HCV antibody-positive cases. RESULTS: The mean age of the participants in the study was 34.54 11.2 years old, 94.3% of these women were Iranian, and many of them had only a primary level of education. The prevalence of HBsAg, HBcAb, HBsAb, and HCV antibodies were; 1.2%, 7.4%, 12.9% and 7.4% respectively. No positive RPR or HIV antibodies were detected. CONCLUSIONS: A significant relationship was seen between the HCV antibody, drug injection and illegal sex in the women, and also between HBc-Ab and drug injection. Regular screening, educational programs, and facilitation of access to suitable treatment care should be widely implemented in the prison population. Testing for immunity against HBV should be considered on admission, and afterwards vaccination of all prisoners and an appropriate preventative approach should be applied. PMCID: PMC3437455 PMID: 23008724 [PubMed] 9. Can J Public Health. 2012 May-Jun;103(3):207-12.

Tattooing and risk of hepatitis B: a systematic review and meta-analysis. Jafari S, Buxton JA, Afshar K, Copes R, Baharlou S. School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC. OBJECTIVE: The objective of this systematic review and meta-analysis is to assess the association between tattooing and the risk of transmission of hepatitis B virus. METHODS: A systematic search of MEDLINE, EMBASE, PubMed, Database of Abstracts of Reviews of Effects, ACP Journal Club and BIOSIS Previews was performed up to March 2011. RESULTS: Forty-two observational studies were included in this systematic review, of which 31 were included in the meta-analysis. Pooled odds ratios (95% confidence intervals) of the association of tattooing and hepatitis B infection was 1.48 (1.30-1.68) when all studies were included in the analysis. Subgroup analysis shows the strongest association between tattooing and risk of hepatitis B among populations involved in high-risk behaviours (OR = 1.64, 95% CI: 1.32-2.03). CONCLUSION: Findings of the current systematic review and meta-analysis indicate that tattooing is associated with hepatitis B transmission in all subgroups. A population health approach that emphasizes universal hepatitis B immunization, education of young adults who are more likely to get tattoos, and education of prison inmates (who have the highest background rate of hepatitis B infection), along with enforcement of guidelines and safer tattooing practices in prison, are fundamental in prevention of transmission of hepatitis B. PMID: 22905640 [PubMed - indexed for MEDLINE] 10. Harm Reduct J. 2012 Jul 9;9(1):24. doi: 10.1186/1477-7517-9-24. Partnering with law enforcement to deliver good public health: the experience of the HIV/AIDS Asia regional program. Sharma M, Chatterjee A. Technical Support Unit, HIV/AIDS Asia Regional Program, Bangkok, Thailand. mukta.sharma8@gmail.com. In the South-East Asia region, the drug control and supply reduction agenda is of high political importance. A multitude of law enforcement agencies are engaged in this work. Nationwide campaigns such as the "Strike- Hard" campaign in China or the "war on drugs" in Thailand dominate the landscape. Viet Nam's response to

drug use has historically focused on deterrence through punishment and supply-side measures. This policy environment is further complicated by lack of evidence-based drug dependence treatment in several settings. The public health consequences of this approach have been extremely serious, with some of the highest documented prevalence of preventable blood-borne viral infections, including HIV, and hepatitis B and C. The wider socioeconomic consequences of this have been borne by families, communities and the governments themselves.The HIV/AIDS Asia Regional Program (HAARP) aims to stop the spread of HIV associated with drug use in South-East Asia and parts of southern China. HAARP works across five countries (Cambodia, China Burma, Laos, Viet Nam) chiefly through the Ministries of Health and Social Affairs, National Drug Control Agencies, and Public Security sectors, including prisons. HAARP has also engaged with UN agencies and a wide range of civil society organisations, including organisations of people who use drugs, to ensure their meaningful involvement in matters that directly affect them. We describe the experience of HAARP in implementing a large-scale harm reduction programme in the Sub-Mekong Region. HAARP chose to direct its efforts in three main areas: supporting an enabling environment for effective harm reduction policies, building core capacity among national health and law enforcement agencies, and supporting "universal access" goals by making effective, high-coverage services available to injecting drug users and their partners.The activities supported by HAARP are humble yet important steps. However, a much higher political-level dialogue is needed. The current huge gap of human rights standards in drug control practices also needs to be bridged immediately. Public health that embraces a rights-based approach must be given its fair share of policy space, budget and influence. PMCID: PMC3504507 PMID: 22769065 [PubMed] 11. Public Health Rep. 2012 Jul-Aug;127(4):407-21. Prevalence, distribution, and correlates of hepatitis C virus infection among homeless adults in Los Angeles. Gelberg L, Robertson MJ, Arangua L, Leake BD, Sumner G, Moe A, Andersen RM, Morgenstern H, Nyamathi A. University of California at Los Angeles, David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA 90024, USA. lgelberg@mednet.ucla.edu OBJECTIVE: We documented the prevalence, distribution, and correlates of hepatitis C virus (HCV) infection among urban homeless adults. METHODS: We sampled a community-based probability sample of 534 homeless adults from 41 shelters and meal programs in the Skid Row area of downtown Los Angeles,

California. Participants were interviewed and tested for HCV, hepatitis B, and HIV. Outcomes included prevalence, distribution, and correlates of HCV infection; awareness of HCV positivity; and HCV counseling and treatment history. RESULTS: Overall, 26.7% of the sample tested HCV-positive and 4.0% tested HIV-positive. In logistic regression analysis, independent predictors of HCV infection for the total sample included older age, less education, prison history, and single- and multiple-drug injection. Among lifetime drug injectors, independent predictors of HCV infection included older age, prison history, and no history of intranasal cocaine use. Among reported non-injectors, predictors of HCV infection included older age, less education, use of non-injection drugs, and three or more tattoos. Sexual behaviors and snorting or smoking drugs had no independent relationship with HCV infection. Among HCV-infected adults, nearly half (46.1%) were unaware of their infection. CONCLUSIONS: Despite the high prevalence of HCV infection, nearly half of the cases were hidden and few had ever received any HCV-related treatment. While injection drug use was the strongest independent predictor, patterns of injection drug use, non-injection drug use, prison stays, and multiple tattoos were also independent predictors of HCV. Findings suggest that urgent interventions are needed to screen, counsel, and treat urban homeless adults for HCV infection. PMCID: PMC3366378 [Available on 2013/7/1] PMID: 22753984 [PubMed - indexed for MEDLINE] 12. Curr Opin HIV AIDS. 2012 Jul;7(4):345-53. doi: 10.1097/COH.0b013e328354bd44. Tuberculosis and HIV in people who inject drugs: evidence for action for tuberculosis, HIV, prison and harm reduction services. Getahun H, Gunneberg C, Sculier D, Verster A, Raviglione M. Stop TB Department, WHO, Geneva, Switzerland. getahunh@who.int PURPOSE OF REVIEW: To provide a comprehensive summary of the prevention, diagnosis and treatment of HIV-related tuberculosis (TB) in people who inject drugs (PWIDs), and recommend actions to enhance the clinical and programmatic responses to the epidemic. RECENT FINDINGS: People who live with HIV and inject drugs have a 2-6-fold increased risk of developing TB compared with noninjectors, and commonly have comorbidities with hepatitis B (HBV) and C viral (HCV) infection. Among PWIDs who develop TB, at least one in three will also have HIV and two out of three will have HCV antibodies. They are also at increased risk of criminalization and incarceration. The risk of TB disease in prisons is on average 23 times higher than the level in the general population. Key recent developments to address HIV-related TB among PWIDs include the use of simplified symptom-based algorithm to provide isoniazid-preventive therapy, molecular DNA detection methods for

Mycobacterium tuberculosis and the immediate provision of antiretroviral therapy within the first 2 weeks of initiation of anti-TB treatment. SUMMARY: Addressing the challenge posed by HIV-associated TB among PWIDs requires a systematic and integrated response to viral hepatitis and incarceration-related health issues, in addition to ensuring HIV and TB prevention, diagnosis and treatment as core components of harm reduction services. Regionally tailored measures, taking into consideration the epidemiology of these comorbidities, the policy and programmatic environment, and the infrastructure of the health system are needed. PMID: 22678489 [PubMed - indexed for MEDLINE] 13. Subst Use Misuse. 2012 Jun-Jul;47(8-9):910-22. doi: 10.3109/10826084.2012.663281. Harm reduction--from a conceptual framework to practical experience: the example of Germany. Michels II, Stver H. Office of the Federal Drug Commissioner, Federal Ministry of Health, Berlin, Germany. ingoilja.michels@giz.de Drug demand reduction programs must be integrated into a comprehensive strategy aiming at preventing drug misuse, facilitating access to counseling, to treatment of dependence, and to rehabilitation; and establishing effective measures to reduce the adverse health and social consequences of drug misuse. The continuous and even rising spread of HIV/AIDS and other infectious diseases (e.g., hepatitis B and C) among injecting drug users is alarming. Although, in many countries the prevalence of HIV infections is decreasing due to the implementation of effective harm reduction measures, such as syringe exchange and opiate substitution treatment (OST), in other countries infections are on the rise. The lessons learnt indicate that only a comprehensive, evidence-based approach in prevention, treatment, care, and support is promising in combating the devastating effects of drug dependence. PMID: 22676562 [PubMed - indexed for MEDLINE] 14. Hepat Mon. 2012 Jan;12(1):23-31. doi: 10.5812/kowsar.1735143X.806. Epub 2012 Jan 20. Factors Correlated With Hepatitis C and B Virus Infections Among Injecting Drug

Users in Tehran, IR Iran. Amin-Esmaeili M, Rahimi-Movaghar A, Razaghi EM, Baghestani AR, Jafari S. Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, IR Iran. BACKGROUND: In Iran, the number of injecting drug users (IDUs) has increased in recent years. The rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections among IDUs are reportedly high. OBJECTIVES: The purpose of this study was to assess factors correlated with HCV and HBV infections among IDUs in Tehran. PATIENTS AND METHODS: A cross-sectional study included 899 IDUs recruited from the community, drug treatment centers, and drop-in-centers. The study involved interviews conducted using an adapted version of the WHO Drug Injection Study Phase II (Version 2b) questionnaire and blood testing for the HCV antibody, hepatitis B surface antigen, and hepatitis B core antibody. A logistic regression model was used to identify independent factors correlated with HCV and HBV infections. RESULTS: HCV infection was found to be primarily associated with female gender [odds ratio (OR) 5.0, 95% confidence interval (CI) 2.0-10.0)], unmarried status (OR 2.9, 95% CI 1.9-4.4), drug use for more than 10 years (OR 2.7, 95% CI 1.8-3.9), drug injection frequency of more than once per day (OR 2.6, 95% CI 1.6-4.2), history of imprisonment (OR 2.5, 95% CI 1.6-4.0)], and a history of shared injection needles in prison (OR 2.3, 95% CI 1.5-3.6). HBV infection was mainly correlated with a history of imprisonment (OR 1.9, 95% CI 1.4-2.7) and drug use for more than 10 years (OR 1.4, 95% CI 1.1-1.9). CONCLUSIONS: Because a considerable number of IDUs in Iran are receiving reduction services, tailoring services for prevention of hepatitis infection are necessary. PMCID: PMC3298872 PMID: 22451840 [PubMed] 15. Ir J Med Sci. 2012 Dec;181(4):541-8. doi: 10.1007/s11845-012-0814-9. Epub 2012 Mar 20. The natural history of injecting drug use: a 25-year longitudinal study of a cohort of injecting drug users in inner city Dublin. O'Kelly FD, O'Kelly CM. Department of Primary Care and Public Health, Trinity College Dublin, Dublin, Ireland. feokelly@tcd.ie

BACKGROUND: Injecting drug use is associated with increased morbidity and mortality. This is the first longitudinal study of a community-based population of injecting drug users (IDUs) in the Republic of Ireland. AIM: To establish the natural history of IDUs in a deprived Dublin community. METHODS: Eighty-two IDUs (heroin) were recruited over the summer months of 1985. The prevalence of drug use in this district electoral area was established in 1985 and followed-up over a 25-year period with two formal interviews in 1995 and 2010. RESULTS: It is a descriptive study of a cohort of IDUs established in 1985 prior to human immunodeficiency virus (HIV) testing being available. The majority of the cohort recruited included single, unemployed males aged 20 to 29 years, who had served a prison sentence. Fifty-one (63 %) of the cohort had died by 2010, of which 26 were attributed to HIV disease. The mean age of death was 35.9 years of age (standard deviation 4.1 years). Fifty-two (63 %) of the cohort tested positive for HIV and 58 (71 %) for hepatitis B between 1985 and 2010. The median survival time for those with a positive HIV status was 17 years (95 % CI 14.0-20.0) and for those with a positive hepatitis C status, 21 years (95 % CI 15.5-26.5). CONCLUSIONS: The lifestyle of IDUs, as demonstrated by the experience of this cohort, has hazardous consequences resulting in high levels of morbidity and mortality. A relatively stable picture of HIV associated with IDUs is now emerging in Ireland, as is the case throughout most of the EU. HIV is a more manageable chronic disease, posing challenges for primary care in its treatment of former and existing IDUs who are ageing and now have other chronic diseases. PMID: 22430070 [PubMed - indexed for MEDLINE] 16. Int J Tuberc Lung Dis. 2012 May;16(5):633-8. doi: 10.5588/ijtld.11.0504. Epub 2012 Mar 8. Latent tuberculosis infection treatment for prison inmates: a randomised controlled trial. Chan PC, Yang CH, Chang LY, Wang KF, Lu BY, Lu CY, Shao PL, Hsueh PR, Fang CT, Huang LM. Centers for Disease Control, Taipei, Taiwan. SETTING: A prison in northern Taiwan. OBJECTIVE: To compare safety and the completion rate of the 4-month daily rifampicin regimen (4R) vs. the standard 6-month daily isoniazid regimen (6H) for latent tuberculosis infection (LTBI) in prison inmates. DESIGN: This was an open-label randomised trial among human immunodeficiency virus negative male inmates. Inmates without active tuberculosis (TB) who tested

positive for both the tuberculin skin test and QuantiFERON-TB Gold In-Tube were eligible, but those with baseline glutamic pyruvic transaminase (GPT) levels 120 U/l, bilirubin levels 2.4 U/l or a platelet count < 150 k/mm(3) were excluded. The primary endpoint was any adverse event that resulted in discontinuation of LTBI treatment. RESULTS: Participants (n = 373; 14% hepatitis B surface antigen positive, 21% anti-hepatitis C virus [HCV] positive) were randomised (stratified by hepatitis B virus, HCV status and 2-year prison term) to receive either 4R or 6H under directly observed treatment. The 4R group (n = 190) was less likely to experience an adverse event leading to discontinuation of treatment (2% vs. 12%, P < 0.001 for all adverse events; 0% vs. 8%, P < 0.001 for hepatotoxicity), and more likely to complete LTBI treatment (86% vs. 78%, P = 0.041), compared with the 6H group (n = 183). CONCLUSIONS: 4R is safer and has a higher completion rate than 6H as treatment for LTBI among male prison inmates. PMID: 22410137 [PubMed - indexed for MEDLINE] 17. Presse Med. 2012 Jul;41(7-8):e375-85. doi: 10.1016/j.lpm.2011.12.015. Epub 2012 Mar 2. [Risk reduction and drug use in detention: study about the detainees of Liancourt Penitentiary]. [Article in French] Sannier O, Verfaillie F, Lavielle D. UCSA du Centre Pnitentiaire de Liancourt, Liancourt, France. olivier.sannier@gmail.com BACKGROUND: The prison population is drug users. Recent debates around the provision of devices to reduce the risks associated with drug use (syringe exchange programs and snort kit) lead us to question local practices of the prison population. METHOD: An anonymous questionnaire was offered to the prison population of the Liancourt penitentiary. The questions addressed the use of drugs before and during incarceration, knowledge of HIV and B and C hepatitis status, taking an opiate substitution treatment and advice on the implementation of syringe exchange programs and snort kit. RESULTS: A percentage of 54.4 of the prisoners responded to the questionnaire. An amount of 60.1 % of respondents consumed at least one drug before incarceration and 43.6 % of respondents consumed at least one drug during their incarceration. Cannabis was the most consumed drug before and during incarceration. Barely half of respondents reported knowing their HIV and hepatitis B and C status. Over 10 %

of respondents said they were interesting in establishing needle exchange programs or snort kit. DISCUSSION: The prison concentrate drug users and is not a repressive tool of efficient risk reduction. The strategies implemented by the medical unit of Liancourt prison require adaptations that warrant development of health resources. Then, only new tools to reduce risks associated with drug use can be established. Copyright 2012 Elsevier Masson SAS. All rights reserved. PMID: 22386285 [PubMed - indexed for MEDLINE] 18. Vaccine. 2012 Mar 2;30(11):1965-71. doi: 10.1016/j.vaccine.2012.01.020. Epub 2012 Jan 18. Hepatitis B vaccination coverage and uptake in prisons across England and Wales 2003-2010: a retrospective ecological study. Beck CR, Cloke R, O'Moore , Puleston R. Clinical Sciences Building, Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Nottingham NG5 1PB, United Kingdom. OBJECTIVE: To describe the custodial hepatitis B vaccination programme performance and examine these data by geographical region and prison category. DESIGN: Retrospective ecological study. DATA SOURCE: Health Protection Agency (HPA) published data. SETTING: Custodial primary healthcare providers located in prisons across England and Wales. PARTICIPANTS: 147 prisons which reported vaccination data between July 2003 and April 2010 to the HPA Prison Infection Prevention team. MAIN OUTCOME MEASURES: Hepatitis B vaccination coverage (July 2003 to April 2010) and uptake (December 2007 to April 2010). RESULTS: Median hepatitis B vaccination coverage was 22% (interquartile range [IQR] 5-49%) and uptake was 36% (IQR 16-59%). Vaccination coverage varied significantly between July 2003 and November 2007 compared to December 2007 and April 2010 (median 12% [IQR 2-31%] versus median 48% [IQR 26-67%], MannWhitney W=14,689,158.0, p<0.001). There was significant variation between vaccination coverage (Kruskal-Wallis H=613.44, DF=9, p<0.001) and uptake (Kruskal-Wallis H=247.99, DF=9, p<0.001) across the HPA regions. Compared to England and Wales, estimated population median vaccination coverage was significantly (p0.05) lower

in three regions and one prison category and higher in four regions and seven prison categories; estimated population median vaccination uptake was significantly lower in three regions and three prison categories and higher in two regions and four prison categories. CONCLUSION: Prisoners are a vulnerable group with a high prevalence of hepatitis B infection and the custodial setting plays an important role in the delivery of hepatitis B vaccination to this hard to reach group. This study suggests that variation in hepatitis B vaccination coverage and uptake may exist by geographical region and prison category. Further research is required to confirm and identify possible explanations for our findings. Copyright 2012 Elsevier Ltd. All rights reserved. PMID: 22265944 [PubMed - indexed for MEDLINE] 19. Med Trop (Mars). 2011 Oct;71(5):464-7. [Prevalence and risk factors associated with infection by human immunodeficiency virus, hepatitis B virus, syphilis and bacillary pulmonary tuberculosis in prisons in Burkina Faso]. [Article in French] Diendr EA, Tino H, Bognounou R, Oudraogo DD, Simpor J, Oudraogo-Traor R, Drabo J. Service de Mdecine Interne, CHU Yalgado Oudraogo, Ouagadougou, Burkina Faso. ericarno@hotmail.fr This purpose of this study was to determine prevalences and risk factors associated with infection by human immunodeficiency virus, hepatitis B Virus, syphilis and bacillary pulmonary tuberculosis in prisons in Burkina Faso. From February 20 to March 20, 2009, 300 prisoners over 18 years of age held in Ouagadougou were selected to take part in this descriptive and analytical cross-sectional study. Sociodemographic data, confinement information (number, motive and prison time), medical history, substance addiction (alcohol, tobacco, drug), and the other risk behaviors (sexual relations, type of partners, sharing of toiletries or razor) were compiled for each prisoner. Serological tests were performed to detect anti-HIV antibodies, Hbs antigen, and anti-treponema antibody. In prisoners presenting signs of tuberculosis, BAAR detection was performed by direct examination of sputum. Men represented 95% of the study population. Median age was of 30.1 +/- 8.9 years (range, 18 and 63). The prevalences of HIV infection, Hbs antigen and positive syphilitic serology were 5%, 27.3% and 5.7% respectively. Four prisoners (1.3%) had bacillary pulmonary tuberculosis. Two prisoners reported homosexual intercourse and 44 reported drug

abuse. Sharing of toiletries and razor blades was reported by 18.7% and 20% of the prisoners respectively. Immediate measures are needed reduce the spread of these infections in prisons in Africa. PMID: 22235618 [PubMed - indexed for MEDLINE] 20. J Correct Health Care. 2012 Jan;18(1):29-44. doi: 10.1177/1078345811421466. Epub 2011 Dec 29. Compliance with bloodborne pathogen standards at eight correctional facilities. Lehman EJ, Huy JM, Viet SM, Gomaa A. Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA. ELehman@cdc.gov This study had three objectives: (a) to examine compliance with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens (BBPs) Standard at eight correctional facilities, (b) to identify potential barriers to compliance, and (c) to discuss steps to address these barriers. Eight facilities of different sizes and locations were visited to examine employer adherence to 15 selected BBP risk reduction activities. Facility compliance was less than 50% for four activities: updating exposure control plans, implementing use of appropriate safer medical devices, soliciting employee input on selection of safer devices, and training medical staff when such devices are implemented. Inconsistent compliance may be due to difficulties in applying the standards in the correctional health care work setting. Any BBP training and health communication activities targeted to correctional health care workers should be tailored to the correctional facility setting. PMID: 22209817 [PubMed - indexed for MEDLINE] 21. Epidemiol Prev. 2011 Sep-Dec;35(5-6):297-306. [The health conditions of prison inmates in Tuscany]. [Article in Italian] Voller F, Silvestri C, Orsini C, Aversa L, Da Fr M, Cipriani F. Agenzia regionale di Sanit della Toscana, Firenze. OBJECTIVE: Investigation of health conditions of prison inmates in Tuscany

(Italy) compared with non-institutionalized population and literature data. DESIGN: Cross-sectional descriptive study of a sample recruited for a prospective cohort study. SETTING E PARTICIPANTS: Prison inmates detained in Tuscany on June 15th 2009. Istat data concerning the survey "Aspects of daily life" 2006-2009 has been used for comparison. MAIN OUTCOME MEASURES: The measures used for the analysis are prevalence data by age classes and odds ratios obtained through a logistic regression model. Outcome variables are: broad disease groups, in particular infectious and parasitic diseases and psychic disorders. RESULTS: Prison inmates from Northern Africa and Eastern Europe are 40% of the population studied. A high consumption of tobacco is observed, with 70.6% of regular smokers among prisoners vs 33.2% among free citizens. Digestive system diseases are the most frequent diseases (25.1%), followed by infectious and parasitic diseases (15.7%). Among digestive disease,more than half are teeth and oral cavity pathologies that affect 13.7% of prisoners.Other frequently reported disease groups were diseases of the bone-muscular and connective systems (11.0%), of the circulatory system (10.8%), endocrine and metabolic systems (9.2%), traumatisms and poisonings (6.8%), respiratory system diseases (5.9%), and nervous system diseases (4.9%). The prevalence of ischemic heart diseases, diabetes, obesity and esophagitis, gastritis and gastro-duodenal ulcers is significantly higher among prisoners than in the general population. The most frequent infectious and parasitic diseases are Hepatitis C Virus (HCV) infection with a prevalence of 9.0%, Hepatitis B Virus (HBV) infection (2.2%), and Human Immunodeficiency Virus (HIV) infection (1.4%). Hepatitis C, HIV and hepatitis A have a higher prevalence among inmates of Italian nationality, while syphilis is more common among prisoners from Eastern Europe (1.2%). The prevalence of psychic disorders among prison inmates is 33.3% (vs 11.6% in the general population), while it decreases to 29.3% if we exclude the population detained in the Psychiatric Prison. CONCLUSIONS: According to previous national and international studies, the cohort is more affected than the general population by physical and psychic disorders, partly associated to the prison inmate's country of origin. PMID: 22166776 [PubMed - indexed for MEDLINE] 22. J Urban Health. 2012 Feb;89(1):108-16. doi: 10.1007/s11524-011-9626-x. Prevalence and correlates of HCV, HVB, and HIV infection among prison inmates and staff, Hungary. Tres B, Barcsay E, Tarjn A, Horvth G, Dencs A, Hettmann A, Cspai MM, Gyori Z, Rusvai E, Takcs M. National Center for Epidemiology, Budapest, Hungary.

The aim of this national, multicenter, cross-sectional study was to assess the prevalence of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency viruses (HIV) among prisoners, and to identify related risk behaviors including injection drug use. Overall, 4,894 inmates from 20 prisons were enrolled. To have a comparison group, prison staff were also asked to take part. Altogether, 1,553 of the 4,894 inmates from seven prisons completed a questionnaire on risk behaviors. According to the survey, 1.5%, 4.9%, and 0.04% of the prisoners were tested positive for HBsAg, anti-HCV and anti-HIV, respectively. These prevalence data are among the lowest reported from prisons worldwide, although comparable to the Central European data. The prevalence of HBV, HCV, and HIV in the Hungarian prison staff was low (0.38%, 0.47%, and 0%, respectively). The rate of HCV infection was significantly higher among inmates who have ever injected drugs (22.5%) than among inmates who reported they had never injected drugs (1.1%). This first prevalence study of illegal drug injection-related viral infections among Hungarian prisoners points out that ever injecting drugs is the main reason for HCV infection among inmates. The opportunity to reach drug users infected with HCV for treatment underlines the importance of screening programs for blood-borne viruses in prisons. PMCID: PMC3284587 PMID: 22143408 [PubMed - indexed for MEDLINE] 23. Drug Alcohol Depend. 2012 Jun 1;123(1-3):269-72. doi: 10.1016/j.drugalcdep.2011.11.009. Epub 2011 Dec 3. Non-injection drug use and hepatitis C among drug treatment clients in west central Mexico. Campollo O, Roman S, Panduro A, Hernandez G, Diaz-Barriga L, Balanzario MC, Cunningham JK. Center of Studies on Alcohol and Addictions, CUCS, Universidad de Guadalajara, Hospital Civil de Guadalajara, Hospital 278, Guadalajara, Jal. 44280, Mexico. renaceboy@hotmail. BACKGROUND: Research on hepatitis C virus (HCV) prevalence among non-injecting drug treatment clients in the United States, Europe and Asia indicate substantial differences by place. To date, little or no research on HCV and non-injection drug use (NIDU) has been conducted in Mexico. METHODS: We examined the prevalence of HCV, hepatitis B virus (HBV), and HIV among non-injecting drug users (NIDUs) in community-based drug treatment (N=122) and NIDUs in a prison-based drug treatment program (N=30), both located in west central Mexico. RESULTS: Among the community clients, prevalence was 4.1% (95% confidence

interval [CI]: 1.8-9.2) for HCV, 5.7% for HBV (95% CI: 2.8-11.4), and 1.6% for HIV (95% CI: 0.4-5.8). Among the in-prison clients, prevalence was 40.0% (95% CI: 24.6-57.7) for HCV, 20.0% for HBV (95% CI: 9.5-37.3), and 6.7% for HIV (95% CI: 1.9-21.3). None of the clients were aware of being infected. CONCLUSION: The HCV prevalence found for the NIDU community treatment clients ranks among the lower HCV estimates published for NIDUs in treatment to date. The prevalence found for the in-prison clients ranks among the higher, raising a concern of possible elevated HCV infection among NIDUs in the west central Mexico prison--one compounded by the finding that none of this study's clients knew they were HCV positive. Copyright 2011 Elsevier Ireland Ltd. All rights reserved. PMID: 22138538 [PubMed - indexed for MEDLINE] 24. Hepat Mon. 2011 Jan;11(1):19-22. Incarceration is a major risk factor for blood-borne infection among intravenous drug users: Incarceration and blood borne infection among intravenous drug users. Mir-Nasseri MM, Mohammadkhani A, Tavakkoli H, Ansari E, Poustchi H. Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. BACKGROUND: There is a strong association between hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection which are mainly transmitted by contamination with blood via intravenous drug abuse (IVDU) or sexual contact. OBJECTIVES: To determine the prevalence of these infections and the risk factors associated with them among prisoner and non-prisoner IVDUs in Tehran, Iran. PATIENTS AND METHODS: This cross-sectional study was performed in two jails and three drug rehabilitation centers between 2001 and 2002 in Tehran. HBsAg and HBcAb were checked using highly specific third generation enzyme immunoassays (DIA.PRO, Italy, specificity >99%, and Radim, Italy, specificity 99.7%, respectively). HCVAb was detected using ELISA (DIA.PRO, Italy) with both sensitivity and specificity >98%. HIVAb test (DRG Diagnostics kit, Germany) was performed for 459 of the 468 IDU subjects. RESULTS: 392 prisoners and 135 individual attending drug rehabilitation centers were approached. Of the 518 subjects studied, 464 (89.5%) were male, 386 (74.5%) were prisoners and 132 (25.5%) were non-prisoners. In this study, HBsAg, HCVAb and HIVAb were positive in 19 (3.7%), 359 (69.5%) and 70 (15.5%) of subjects, respectively. These tests were positive in 17 (4.5%), 311 (80.5%) and 63 (17%) among prisoners and 2 (1.5%), 48 (36.5%) and 7 (7.8%) in non-prisoners, respectively. Multiple logistic regression analysis revealed that independent

factors related to co-infection of HCV and HIV infection were imprisonment (p<0.001. OR: 7.5) and using common syringe (p=0.03, OR: 4.5). CONCLUSIONS: Our findings strongly suggest that drug injection inside prison carries is a risk for HIV infection and that HIV infection among IDUs is likely to be bridged to the broader population through sexual contact without using effective prevention programs. PMCID: PMC3206659 PMID: 22087111 [PubMed] 25. Rev Med Chir Soc Med Nat Iasi. 2011 Jul-Sep;115(3):736-41. [Characteristics of hepatitis C virus (HCV) infection in closed communities]. [Article in Romanian] Nazare C, Girleanu I, Cojocariu-Salloum C, Trifan A. Universitii de Medicin i Farmacie "Gr.T. Popa" Iai, Penitenciarul Bacu. AIM: To determine the prevalence of HCV in closed communities and the relations between risk behavior and HCV infection. MATERIAL AND METHODS: The persons deprived of personal freedom selected for this study have filled out an epidemio logical questionnaire including identity and epidemiological data (detention history, evaluation of the risk factors), as well as a written consent. All the subjects were tested for the presence of anti-HCV antibodies. RESULTS: This study included 326 of the total of 500 persons deprived of personal freedoms at the Bacau Correctional Facility The prevalence of hepatitis B and C was 15.34 %, and that of HCV 5.21%, higher than in the general population. Risk factors associated with HCV in closed communities were injected drugs, homosexuality, and tattooing. CONCLUSIONS: The results confirm that the population in correctional facilities is at high risk for infection with hepatitis viruses (both B and C), the modes of disease transmission being already known. PMID: 22046780 [PubMed - indexed for MEDLINE] 26. Rev Soc Bras Med Trop. 2011 Oct;44(5):652; author reply 653. Accelerated vaccination against HBV infection is an important strategy for the control of HBV infection in prisons.

Alavian SM. Comment on Rev Soc Bras Med Trop. 2010 Sep-Oct;43(5):512-5. PMID: 22031090 [PubMed - indexed for MEDLINE] 27. Rev Med Chir Soc Med Nat Iasi. 2011 Apr-Jun;115(2):325-30. [Prevalence of chronic hepatitis B virus (HBV) infection in closed communities and risk behaviour]. [Article in Romanian] Nazare C, Grleanu I, Cojocariu-Salloum C, Trifan A. Universitii de Medicin i Farmacie Gr. T. Popa Iai, Penitenciarul Bacu. AIM: To determine the prevalence of chronic hepatitis B virus infection in closed communities and the relations between the risk behavior and VHB infection. MATERIAL AND METHODS: In this study we included persons deprived of personal freedom at Bacau Correctional Facility. The subjects filled out a questionnaire, which contained identification and epidemiologic data (detention history, evaluation of the risk factors), as well as an informed consent. All subjects were tested for HBsAg. RESULTS: According to the performed tests, the general prevalence of hepatitis B and C in this correctional facility was 15.34%, with a prevalence of hepatitis B of 10.74%. Although these figures show a higher prevalence in this population than within the general population, they are lower than the figures reported in correctional facilities from other countries. CONCLUSIONS: The results confirm the fact that the population in correctional facilities is at high risk for hepatitis B infection, the ways of disease transmission being already known (infected blood, injected drugs, tattooing, homosexual relationships). PMID: 21870718 [PubMed - indexed for MEDLINE] 28. Sex Transm Dis. 2011 Jul;38(7):634-9. doi: 10.1097/OLQ.0b013e31820bc86c. Sexually transmitted infections and hepatitis in men with a history of incarceration. Sosman J, Macgowan R, Margolis A, Gaydos CA, Eldridge G, Moss S, Flanigan T, Iqbal K, Belcher L; Project START Biologics Study Group.

Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA. jms@medicine.wisc.edu BACKGROUND: Men entering correctional facilities have high rates of human immunodeficiency virus, sexually transmitted infections (STI), and hepatitis. Many prisons offer screening, treatment, and vaccination services; however, little is known about the rates of these infections in men after release to the community. METHODS: Young men were recruited from prisons in Mississippi, Rhode Island, and Wisconsin as part of a human immunodeficiency virus/STI/hepatitis intervention study. Participants were offered screening for Neisseria gonorrhoeae (GC), Chlamydia trachomatis, trichomoniasis, syphilis, hepatitis B (HBV) and C (HCV) 6 months after release. Logistic regression was performed to identify associations with prevalent infections. RESULTS: Of 248 eligible men, 178 (71.8%) participated. Their mean age was 22.5 years, and 92% reported multiple lifetime incarcerations. At 6-month postrelease, 79% reported unprotected vaginal or anal sex, and 26% tested positive for 1 or more infections (GC, 1%; C. trachomatis, 12%; trichomoniasis, 8%; syphilis, 0%; HCV, 6%; HBV, 1%). Of all, 55% were susceptible to HBV infection. Active STI (GC, C. trachomatis, or trichomoniasis) was associated with less education (odds ratios [OR], 2.25; P < 0.05). HCV infection was associated with injection drug use (OR, 69.70; P < 0.05) and being white (OR, 7.54; P < 0.05). HBV susceptibility was associated with older age (OR, 3.02; P < 0.05), more education (OR, 2.39; P < 0.05), or incarceration in Mississippi (OR, 6.69; P < 0.05) or Rhode Island (OR, 2.84; P < 0.05). CONCLUSIONS: Effective screening and prevention programs are needed for this population before and after release from custody to prevent acquisition and further transmission of these infections. PMID: 21844713 [PubMed - indexed for MEDLINE] 29. BMC Public Health. 2011 May 19;11:351. doi: 10.1186/1471-2458-11-351. A hepatitis A, B, C and HIV prevalence and risk factor study in ever injecting and non-injecting drug users in Luxembourg associated with HAV and HBV immunisations. Removille N, Origer A, Couffignal S, Vaillant M, Schmit JC, Lair ML. Centre de Recherche Public de la Sant, Luxembourg. nathalie.removille@crp-sante.lu BACKGROUND: In Luxembourg, viral hepatitis and HIV infection data in problem drug users (PDUs) are primarily based on self-reporting. Our study aimed to determine

the prevalence of HAV, HBV, HCV and HIV infections in ever injecting (IDUs) and non-injecting drug users (nIDUs) including inherent risk factors analysis for IDUs. Secondary objectives were immunisation against HAV and HBV, referral to care and treatment facilities as well as reduction in risk behaviour. METHODS: A nationwide, cross-sectional multi-site survey, involving 5 in-, 8 out-treatment and 2 prison centres, included both an assisted questionnaire (n = 368) and serological detection of HIV and Hepatitis A, B, C (n = 334). A response rate of 31% resulted in the participation of 310 IDUs and 58 nIDUs. Risk factors such as drug use, sexual behaviour, imprisonment, protection and health knowledge (HAV, HBV status and immunisations, HCV, HIV), piercing/tattoo and use of social and medical services were studied by means of chi2 and logistic models. RESULTS: Seroprevalence results for IDUs were 81.3% (218/268, 95%CI=[76.6; 86.0]) for HCV, 29.1% (74/254, 95%CI=[25.5;34.7 ]) for HBV (acute/chronic infection or past cured infection), 2.5% (5/202, 95%CI=[0.3; 4.6]) for HIV-1 and 57.1% (108/189, 95%CI=[50.0; 64.1]) for HAV (cured infections or past vaccinations). Seroprevalence results for nIDUs were 19.1% (9/47, 95%CI=[7.9;30.3]) for HCV, 8.9% (4/45, 95%CI=[0.6;17.2]) for HBV (acute/chronic infection or past cured infection), 4.8% (2/42, 95%CI=[-1.7;11.3]) for HIV-1 and 65.9% (27/41, 95%CI=[51.4;80.4]) for HAV. Prisoners showed the highest rates for all infections. Age, imprisonment and setting of recruitment were statistically associated with HCV seropositivity. Age, speedball career and nationality were significantly associated with HBV seropositivity. Only 56% of the participants in outpatient centres collected their serology results and 43 doses of vaccine against HAV and/or HBV were administered. CONCLUSIONS: Despite the existing national risk-reduction strategies implemented since 1993, high prevalence of HCV and HBV infections in injecting drug users is observed. Our study showed that implementing risk-prevention strategies, including immunisation remains difficult with PDUs. Improvement should be looked for by the provision of field healthcare structures providing tests with immediate results, advice, immunisation or treatment if appropriate. PMCID: PMC3123592 PMID: 21595969 [PubMed - indexed for MEDLINE] 30. Int J Prison Health. 2010 Jun;6(1):5-17. Sources of heterogeneity in hepatitis B virus (HBV) seroprevalence estimates from U.S. adult incarcerated populations: A systematic review and meta-regression analysis. Harzke AJ, Goodman KJ, Mullen PD, Baillargeon J. Division of Correctional Managed Care and the Department of Preventive Medicine and Community Health at the University of Texas Medical Branch, Galveston, TX, USA.

HBV seroprevalence estimates from U.S. incarcerated populations are relatively high. However, the usefulness of these estimates for guiding HBV-related correctional healthcare policy is limited by wide variation in estimates across studies and little understanding of the sources of this variation. The authors systematically reviewed studies indexed from 1975-2005, meeting pre-specified criteria and reporting HBV seroprevalence estimates from U.S. adult incarcerated populations. Using meta-regression techniques, the authors investigated report type, geographical region, serum collection year, facility type, serum source, sampling procedures, sample characteristics, and measurement procedures as potential study-level sources of heterogeneity in prevalence estimates for common HBV seromarkers. In bivariable meta-regression analyses, mean age 31 years was strongly associated with increased HBsAg prevalence (POR=2.6), and serum collection year before 1991 was strongly associated with increased prevalence of any positive marker (POR=2.0). Other moderate-to-strong associations were observed, but these were considered less certain because of small numbers of observations, influence of single studies, or potential confounding. Potential sources of heterogeneity should be considered when comparing HBV seroprevalence estimates in adult U.S. incarcerated populations and when developing HBV screening and vaccination protocols in correctional settings. PMCID: PMC3089417 PMID: 21556292 [PubMed] 31. J Public Health (Oxf). 2011 Jun;33(2):197-204. doi: 10.1093/pubmed/fdr011. Epub 2011 Feb 23. Hepatitis C and B testing in English prisons is low but increasing. Kirwan P, Evans B; Sentinel Surveillance of Hepatitis Testing Study Group, Brant L. Health Protection Agency Centre for Infections, London, UK. BACKGROUND: Prisons are important settings for blood-borne virus control because of the high prevalence of hepatitis C and B viral infections (HCV and HBV), and behaviours associated with transmission among prisoners. METHODS: Data from sentinel laboratories in England were used to identify testing for hepatitis C (anti-HCV) and hepatitis B [hepatitis B surface antigen (HBsAg) and anti-hepatitis B core antigen (HBc)] among male and female prisoners between 2005 and 2008. RESULTS: Between 2005 and 2008, 10 723 prisoners from 39 prisons in England were tested for anti-HCV, anti-HBc and/or HBsAg. Overall, 24.2% prisoners tested positive for anti-HCV. Anti-HCV testing increased 47% over 4 years (P < 0.001), whilst the proportion testing positive decreased significantly from 26% in 2005

to 23% in 2008 ((2)= 10.0, df = 3, P = 0.030). In total, 13.9% people tested positive for anti-HBc. Of 5151 people tested for anti-HBc, 4433 were also tested for HBsAg; of these 2.4% were HBsAg positive. HBsAg testing increased 35% between 2005 and 2008, with no significant change in the proportion testing positive. Between 2005 and 2008, 2.4% (CI: 2.32-2.43%) of the prison population (24 prisons) were estimated to have been tested for anti-HCV. CONCLUSIONS: Although hepatitis testing has increased, only a small proportion of the prison population were tested. More testing is required to identify infected prisoners and refer them for appropriate treatment. PMID: 21345883 [PubMed - indexed for MEDLINE] 32. J Correct Health Care. 2011 Jan;17(1):69-76. doi: 10.1177/1078345810385916. Implementing opt-out programs at Los Angeles county jail: a gateway to novel research and interventions. Malek M, Bazazi AR, Cox G, Rival G, Baillargeon J, Miranda A, Rich JD. Infection Control and Epidemiology Unit, Medical Services Bureau, Los Angeles County Sheriff's Department, Los Angeles, CA, USA. mamalek@lasd.org Routine opt-out screening and vaccination programs are effective methods for improving public health in correctional populations. Jail-based rapid testing for HIV, hepatitis B and C, tuberculosis, syphilis, gonorrhea, and chlamydia can improve urban health by increasing diagnosis and linkage to care for infectious diseases. In addition, jail-based vaccination programs would significantly benefit community health and lower costs associated with tertiary level care. The paucity of ethical and rigorous scientific research among incarcerated populations excludes these marginalized members of society from potential advancements in correctional medicine and public health. Routine opt-out testing programs would not only benefit the health of the correctional population but also serve as platforms for future research. Trials measuring the efficacy of new rapid tests, screening methods, novel vaccine delivery systems, or accelerated vaccine regimens would be greatly beneficial. PMCID: PMC3154702 PMID: 21278322 [PubMed - indexed for MEDLINE] 33. Eur J Clin Microbiol Infect Dis. 2011 Jul;30(7):857-62. doi: 10.1007/s10096-011-1166-5. Epub 2011 Jan 28. Hepatitis C and B prevalence in Spanish prisons.

Saiz de la Hoya P, Marco A, Garca-Guerrero J, Rivera A; Prevalhep study group. Collaborators: de la Hoya Saiz P, Marco A, Garca-Guerrero J, Rivera A, Bedia M, Castro JM, Faraco I, Hoyos C, Isaach MD, De Juan J, Lpez-Palacios G, Mallo A, Martnez-Prez J, Moreno R, Planella R, Pozo E, Quionero J, Sternberg F, Teixido N, Vasallo L. Servicios Mdicos, Centro Penitenciario Fontcalent, 03113, Alicante, Spain. pabloshz@coma.es Purpose The Prevalhep study seeks to determine the prevalence of factors associated with the hepatitis C (HCV) and B (HBV) virus in Spanish prisoners. Methods This was an observational, cross-sectional study which randomly selected 18 Spanish prisons to participate, with 21 prisoners per centre. Results There were 378 prisoners selected, 370 of whom had serological HCV and 342 had HBV data. The HCV population was predominantly male (91.6%), middle age (66.7% 40 years of age), of Spanish origin (60.5%), with a history of injection drug use (IDU; 23.2%), in prison <5 years (71.2%) and having entered prison after 2006 (51.9%). The prevalence of HCV was 22.7% (n = 84; 95% CI, 18.3-27.1) and HBV was 2.6% (n = 9; 95% CI, 0.2-4.9%). Of the patients with HCV, 40.5% were co-infected with HIV, 0.3% co-infected with HBV, and 1.5% with triple virus co-infection (HBV + HCV + HIV). The three markers of HB had been measured in 99 inmates: 32.1% had post-vaccination immunity (antiHBS+) and 30.4% contact status with HBV (HBcAb + and/or HBsAg+), while 37.5% were susceptible to HB. Conclusions The prevalence of HBV and HCV has decreased in the Spanish prison population, probably as a result of decrease in IDU transmission, and an increase in immigrant prisoner population that does not have this risk behaviour. PMID: 21274586 [PubMed - indexed for MEDLINE] 34. Dig Liver Dis. 2011 Aug;43(8):589-95. doi: 10.1016/j.dld.2010.12.004. Epub 2011 Jan 21. Recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B and C in special population groups (migrants, intravenous drug users and prison inmates). Almasio PL, Babudieri S, Barbarini G, Brunetto M, Conte D, Dentico P, Gaeta GB, Leonardi C, Levrero M, Mazzotta F, Morrone A, Nosotti L, Prati D, Rapicetta M, Sagnelli E, Scotto G, Starnini G. Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Italy. The global spread of hepatitis B virus (HBV) and hepatitis C virus (HCV), their high chronicity rates and their progression to cirrhosis and hepatocellular

carcinoma, are major public health problems. Research and intervention programmes for special population groups are needed in order to assess their infection risk and set up suitable prevention and control strategies. Aim of this paper is to give health care professionals information on HBV and HCV infections amongst migrants, drug users and prison inmates. The manuscript is an official Position Paper on behalf of the following Scientific Societies: Italian Association for the Study of the Liver (A.I.S.F.), Italian Society of Infectious and Tropical Diseases (S.I.M.I.T.), Italian Federation Department's Operators and Addiction Services (FederSerD), Italian Prison Medicine and Healthcare Society (S.I.M.S.Pe.). The considered population groups, having a high prevalence HBV and HCV infections, require specific interventions. In this context, the expression "special population" refers to specific vulnerable groups at risk of social exclusion, such as migrants, prison inmates, and intravenous drug users. When dealing with special population groups, social, environmental and clinical factors should be considered when selecting candidates for therapy as indicated by national and international guidelines. Copyright 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. PMID: 21256097 [PubMed - indexed for MEDLINE] 35. Iran Red Crescent Med J. 2011 Jan;13(1):42-6. Epub 2011 Jan 1. Seroprevalence of HIV, HBV and HCV in Persons Referred to Hamadan Behavioral Counseling Center, West of Iran. Keramat F, Eini P, Majzoobi MM. Department of Infectious Diseases, Hamadan University of Medical Sciences, Hamadan, Iran. BACKGROUND: Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are three important prevalent infections all over the world. The aim of this study was to determine seroprevalence of HIV, HBV and HCV infections and high risk behaviors in persons who referred to the behavioral counseling center of Hamadan, west of Iran. METHODS: This was a cross-sectional study which was done on 379 persons who referred to the behavioral counseling center of Hamadan. All persons after obtaining the informed consent were tested for serologic markers including HBs Ag, HCV-Ab and HIV-Ab by ELISA and western blot methods. RESULTS: Of the 379 persons, 71.5 % (271 cases) were male and 28.5% (108 cases) were female. HIV infection was reported in 4% (15) of persons. HBV and HCV infections were reported in 2.9% (11 cases) and 35.6% (135 cases), respectively. The most common high risk behaviors were injection drug user and history of

prison with 52.5% (199 cases) and 40.4% (153 cases), respectively. CONCLUSION: According to the results, injection drug users and prisoners are at the highest risk for HCV, HIV and HBV infections. PMCID: PMC3407584 PMID: 22946017 [PubMed] 36. BMC Public Health. 2010 Dec 21;10:777. doi: 10.1186/1471-2458-10-777. HIV and hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis. Gough E, Kempf MC, Graham L, Manzanero M, Hook EW, Bartolucci A, Chamot E. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. BACKGROUND: High Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population. METHODS: The authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations. RESULTS: Thirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race. CONCLUSIONS: Although important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups. PMCID: PMC3016391 PMID: 21176146 [PubMed - indexed for MEDLINE]

37. Int J Drug Policy. 2011 Mar;22(2):145-52. doi: 10.1016/j.drugpo.2010.10.006. Epub 2010 Dec 10. Prevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities. Nasir A, Todd CS, Stanekzai MR, Bautista CT, Botros BA, Scott PT, Strathdee SA, Tjaden J. International Rescue Committee, Kabul, Afghanistan. BACKGROUND: HIV amongst injecting drug users (IDUs) has been described in Kabul but little data exists for other Afghan cities. We assessed HIV, hepatitis B virus (HBV), and C virus (HCV) prevalence and associated risk behaviours amongst IDUs in Hirat, Jalalabad, and Mazar-i-Sharif, Afghanistan. METHODS: Consented participants reporting injecting drugs within the previous 6 months completed interviewer-administered questionnaires and testing for HIV, hepatitis C antibody (HCV Ab), and hepatitis B surface antigen (HBsAg). Logistic regression was used to determine characteristics associated with each infection. RESULTS: Of 623 participants, most (98.7%) were male. Prevalence of HIV, HCV, and HBV was 1.8% (95% CI: 0.88-3.2), 36.0% (95% CI: 33-41), and 5.8% (95% CI: 3.9-7.6), respectively. All HIV cases and highest HCV prevalence were detected in Hirat; HBV prevalence was highest in Jalalabad. Amongst male IDUs, 62.9% had been imprisoned, of whom 17.2% (n=66) injected in prison. High risk behaviours were common; 30.2% reported needle sharing in the last 6 months, 23.1% reported sex with another male, and 50.4% reported paying females for sex. Behaviours varied significantly by site; generally, Hirat participants reported fewer sexual risk behaviours. Sex with other males was negatively associated with both HBV and HCV in multivariate logistic regression analysis; no injecting behaviours were associated with both HBV and HCV. CONCLUSIONS: Whilst HIV prevalence is low, HCV prevalence and high risk behaviours were common in these populations. Regional variations should be considered in programming to prevent transmission of HIV and viral hepatitis amongst IDUs in Afghanistan. Copyright 2010 Elsevier B.V. All rights reserved. PMID: 21146392 [PubMed - indexed for MEDLINE] 38. J Infect. 2011 Jan;62(1):59-66. doi: 10.1016/j.jinf.2010.10.011. Epub 2010 Nov 16. Hepatitis A, B, C and HIV infections among Finnish female prisoners--young females a risk group.

Viitanen P, Vartiainen H, Aarnio J, von Gruenewaldt V, Hakamki S, Lintonen T, Mattila AK, Wuolijoki T, Joukamaa M. Prison Health Services, Vanajantie 10 B, Hmeenlinna, Finland. paivi.viitanen@om.fi OBJECTIVES: Previous prison studies have shown that the female gender is associated with higher hepatitis C prevalence. However, there are few prison studies of gender differences concerning the risk factors of hepatitis C infections. We studied the prevalence of hepatitis and HIV infections and the risk factors among Finnish female prisoners. METHODS: The material consisted of 88 females and 300 male prisoners as controls. RESULTS: The prevalence of hepatitis C virus antibodies was 52%, hepatitis B surface antigen 0%, hepatitis A virus antibodies 38% and HIV antibodies 1% among women, and 44%, 0.7%, 4% and 0.7% respectively among men. Among women, 71% of the age group 16-24 had HCV. There was no significant association between gender and HCV. Women were more commonly sharing syringes/needles and had unsafe sexual habits. Among women, HCV was associated only with IDU and syringe/needle sharing whereas among men also with tattoos, cumulative years in prison and age. CONCLUSIONS: Especially young females had a high prevalence of HCV. The study showed that the risk factors are differentiated by gender. This should be taken into account when assessing earlier studies which mainly concentrate on men. Copyright 2010 The British Infection Association. Published by Elsevier Ltd. All rights reserved. PMID: 21087630 [PubMed - indexed for MEDLINE] 39. Rev Soc Bras Med Trop. 2010 Sep-Oct;43(5):512-5. Seroprevalence of hepatitis B virus infection and associated factors among prison inmates in state of Mato Grosso do Sul, Brazil. Stief AC, Martins RM, Andrade SM, Pompilio MA, Fernandes SM, Murat PG, Mousquer GJ, Teles SA, Camolez GR, Francisco RB, Motta-Castro AR. Department of Biochemistry and Pharmacy, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil. Comment in Rev Soc Bras Med Trop. 2011 Oct;44(5):652; author reply 653. INTRODUCTION: This study aimed to estimate the prevalence of HBV infection and

associated factors among prison inmates in Campo Grande, MS. METHODS: A total of 408 individuals were interviewed regarding sociodemographic characteristics, associated factors and HBV vaccination using a standardized questionnaire. Blood samples were collected from all participants and serological markers for HBV were detected by enzyme-linked immunosorbent assay. Hepatitis B surface antigen (HBsAg) and/or antibodies against hepatitis B core antigen (anti-HBc) positive samples were tested for HBV-DNA by polymerase chain reaction. RESULTS: The overall prevalence of HBV infection was 17.9% (95%CI: 14.4-22.0). The HBsAg carrier rate was 0.5%; 56 (13.7%) individuals had been infected and developed natural immunity and 15 (3.7%) were positive for anti-HBc only. Ninety eight (24%) prisoners had only anti-HBs, suggesting that they had low vaccine coverage. An occult HBV infection rate of 0% was verified among anti-HBc-positive individuals. Multivariate analysis of associated factors showed that age > 35 years-old, low schooling level and illicit drug use are significantly associated with HBV infection. CONCLUSIONS: Analysis of the data showed HBV infection prevalence similar or slightly lower than that reported in other of Brazilian prisons. Independent predictors of HBV infection in this population include older age, low schooling level and illicit drug use. PMID: 21085860 [PubMed - indexed for MEDLINE] 40. J Public Health (Oxf). 2011 Jun;33(2):193-6. doi: 10.1093/pubmed/fdq083. Epub 2010 Oct 21. Hepatitis B transmission event in an English prison and the importance of immunization. Viswanathan U, Beaumont A, O'Moore E, Ramsay M, Tedder R, Ijaz S, Balogun K, Kirwan P. Public Health, NHS, Walsall WS2 7JL, UK. Immunization against hepatitis B virus (HBV) is recommended for all sentenced prisoners and all new entrants to prison in the UK. In November 2008, acute hepatitis B was confirmed serologically in a 27-year-old man (Case 1) who had been incarcerated since February 2007. The cell mate of Case 1, a 26-year-old man was an established HBV carrier. A home-made tattoo gun was confiscated from their prison cell. In the absence of other clearly identifiable risk behaviours, tattooing was deemed to be a possible route of HBV transmission. Transmission of hepatitis B in a prison setting is a real concern and this report highlights the importance of immunizing prisoners against hepatitis B and should encourage health professionals to communicate the benefits of immunization to inmates to increase vaccine uptake.

PMID: 20965882 [PubMed - indexed for MEDLINE] 41. Trop Med Int Health. 2010 Dec;15(12):1491-8. doi: 10.1111/j.1365-3156.2010.02655.x. Epub 2010 Oct 18. Human immunodeficiency virus, hepatitis B and hepatitis C in an Indonesian prison: prevalence, risk factors and implications of HIV screening. Nelwan EJ, Van Crevel R, Alisjahbana B, Indrati AK, Dwiyana RF, Nuralam N, Pohan HT, Jaya I, Meheus A, Van Der Ven A. Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia. erninelwan@hotmail.com OBJECTIVE: To determine the prevalence and behavioural correlates of HIV, HBV and HCV infections among Indonesian prisoners and to examine the impact of voluntary counselling and testing for all incoming prisoners on access to antiretroviral treatment (ART). METHODS: In a non-anonymous survey in an Indonesian prison for drug-related offences, all incoming prisoners and symptomatic resident prisoners were counselled and offered testing for HIV, hepatitis B and C. RESULTS: Screening was performed in 679 incoming prisoners, of whom 639 (94.1%) agreed to be tested, revealing a seroprevalence of 7.2% (95% CI 5.2-9.2) for HIV, 5.8% (95% CI 3.9-7.6) for HBsAg and 18.6% (95% CI 15.5-21.6) for HCV. Of 57 resident prisoners tested, 29.8% were HIV-positive. HIV infection was strongly associated with injecting drug use (IDU; P<0.001), but not with a history of unsafe sex. Screening of incoming prisoners was responsible for diagnosing and treating HIV in 73.0%, respectively, and 68.0% of HIV-positive individuals. CONCLUSIONS: HIV and HCV are highly prevalent among incoming Indonesian prisoners and almost entirely explained by IDU. Our study is the first to show that voluntary HIV counselling and testing during the intake process in prison may greatly improve access to ART in a developing country. 2010 Blackwell Publishing Ltd. PMID: 20955370 [PubMed - indexed for MEDLINE] 42. Cent Eur J Public Health. 2010 Jun;18(2):104-9. Seroprevalence of blood-borne infections and population sizes estimates in a population of injecting drug users in Croatia. Kolari B, Stajduhar D, Gajnik D, Rukavina T, Wiessing L.

Public Health, Social Medicine and Gerontology Service, Zagreb County Institute of Public Health, Zagreb, Croatia. branko.kolaric@gmail.com Similar to some other Central European countries, Croatia has low HIV prevalence among injecting drug users (IDUs) but high hepatitis C (HCV) prevalence. This may indicate different patterns of risk behaviour in this region than in other parts of Europe. The main objectives of this study were to assess the seroprevalence of HIV and hepatitis B and C and related risk factors among IDUs in the three largest Croatian cities (Zagreb, Split, Rijeka) and within the national prison system, as well as to apply a multiplier-method population size estimation of IDUs in Zagreb, Split and Rijeka. Recruitment sites were selected in collaboration with the local public health institutes, NGOs, Centers for treatment municipalities and the judiciary system. Participants were recruited during September and October 2007. Trained peer-recruiters were used to recruit IDU participants at treatment and harm reduction centres as well as pre-identified social, commercial and street based venues. Participants completed the study questionnaire and provided venous blood samples for HIV, hepatitis B and hepatitis C testing. The study included 601 participants, of whom 121 were recruited in Split, 130 in Zagreb, 150 in Rijeka and 200 in the prison system. The prevalence of positive anti-HCV tests was 65% in Split, 51% in Zagreb, 29% in Rijeka and 44% in the prisons. The prevalence of anti-HBcAg was 31% in Split, 13% in Zagreb, 9% in Rijeka and 24% in prison. No case of HIV infection was found. The estimated IDUs population sizes were 2,805 for Zagreb area, 3,347 for Split and 1,370 for Rijeka area, however confidence intervals were very large, indicating the need for larger samples. A high frequency of positive markers on hepatitis B virus and C virus in the population of injecting drug users in Croatia has been confirmed with this research, as well as a low prevalence of HIV infection. This may be related to relatively low levels of injecting risk behaviour and injecting frequency although it is not possible to make strong conclusions on risk behaviour, as participants were mostly recruited in harm reduction programmes. This research should be followed by targeted activities for reducing risks of infectious diseases among injecting drug users in the Republic of Croatia and future research at the national level. PMID: 20939261 [PubMed - indexed for MEDLINE] 43. Addiction. 2010 Jul;105(7):1311-2. doi: 10.1111/j.1360-0443.2010.02968.x. Universal hepatitis B virus vaccination in French prisons: breaking down the last barriers. Carrieri MP, Rey D, Michel L. Comment on

Addiction. 2010 Feb;105(2):216-23. PMID: 20642514 [PubMed - indexed for MEDLINE] 44. Health Psychol. 2010 May;29(3):317-23. doi: 10.1037/a0019283. Completion and subject loss within an intensive hepatitis vaccination intervention among homeless adults: the role of risk factors, demographics, and psychosocial variables. Stein JA, Nyamathi AM. Department of Psychology, University of California-Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. jastein@ucla.edu OBJECTIVE: Unprotected sexual behavior, needle sharing, and a prison history are major correlates of hepatitis B Virus (HBV). These risk factors are common among homeless people who also have elevated rates of HBV. We examine whether these behaviors were associated with completion or loss to follow-up of the most intensive and successful condition of a 3-arm HBV vaccination intervention. Significant results would imply that those most in need are the least compliant. Contributions of baseline demographics, physical health, psychosocial variables, and health beliefs were also assessed. DESIGN: Three-hundred thirty-one adults from Los Angeles' Skid Row were assigned to nurse-case-managed sessions with hepatitis education, incentives, and tracking. Successive predictive structural equation models assessed the amount of variance accounted for by the risk variables, demographics, and the health-related variables. MAIN OUTCOME MEASURES: (1) Completion of 3 injections by 6 months; and (2) loss to a 6-month follow-up questionnaire. RESULTS: The 3 risk factors explained 2% of the variance in completion and 1% of the variance in loss. Adding the other variables increased the variance explained to 14% for completion and 13% for loss. African American ethnicity, positive coping, social support, poorer health, no prison history, and greater efficacy significantly predicted completion. White ethnicity, less social support, better health, and less intention to complete predicted participant loss. CONCLUSION: The program was not strongly rejected differentially as a function of preexisting hepatitis B risk behaviors. Programs designed for homeless people should include malleable psychosocial and health belief model variables. These aspects of the lives of homeless people provide leverage points for future interventions. (c) 2010 APA, all rights reserved.

PMCID: PMC3314590 PMID: 20496986 [PubMed - indexed for MEDLINE] 45. Sex Health. 2010 Jun;7(2):170-6. doi: 10.1071/SH09138. Sexual practices and dental dam use among women prisoners--a mixed methods study. Yap L, Richters J, Butler T, Schneider K, Kirkwood K, Donovan B. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia. l.yap@unsw.edu.au BACKGROUND: Dental dams have been distributed to women prisoners for protection against HIV and other sexually transmissible infections (STIs) in some Canadian and Australian prisons for over a decade. However, we do not know whether they serve any useful public health purpose. OBJECTIVE: To determine how dental dams are used in women's prisons in New South Wales (NSW), Australia. METHOD: Using quantitative and qualitative methods, we investigated women's sexual practices with a focus on how dental dams are used in NSW prisons. RESULTS: Although 71 of the 199 (36%) women reported having had sex with another inmate, with oral sex involved in most encounters, only eight (4%) had ever used a dental dam. The main sources of STI transmission risk among women prisoners were oral sex, manual sex and sharing dildos. Furthermore, sharing razors could also allow the transmission of blood-borne viruses, which could occur during sex in the presence of cuts or menstrual fluid. The high rates of hepatitis B and C among incarcerated women compound this risk. CONCLUSION: Dental dams are not widely used by women prisoners and we question their utility in women's prisons. Oral sex is an important risk factor for acquisition of herpes simplex virus type 1, but most women in NSW prisons (89%) are already infected. Condoms and latex gloves may have more use. Condoms could be used as a barrier on shared dildos and sex toys, while latex gloves could be used to protect cut and grazed hands from vaginal and menstrual fluids. PMID: 20465982 [PubMed - indexed for MEDLINE] 46. J Fam Pract. 2010 Apr;59(4 Suppl):S43-50. Reports from today's health care environment on the implementation of screening, diagnosis, and treatment recommendations. Kim WR, Valdiserri RO, Wright LN, Manos MM, Do ST. Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

PMID: 20398590 [PubMed - indexed for MEDLINE] 47. Med Pr. 2010;61(1):15-22. [Is healthcare personnel the only professional group exposed tothe risk of occupational HBV, HCV or HIV infections?]. [Article in Polish] Krawczyk P, Biakowska J, Dworniak D, Kamerys J, Szosland D, Jabkowski M. Katedra Chorb Zakanych, Klinika Chorb Zakanych i Chorb Watroby, Uniwersytet Medyczny, d. BACKGROUND: Our paper presents the problem of exposure to potentially infectious material among health care workers, and also in police officers, prison guards, cleaning service personnel and ordinary citizens. MATERIALS AND METHOD: In the study period, 200 patients were admitted to the Infectious Diseases Clinic after exposure to potentially infectious materials in order to evaluate the risk of HBV, HCV and HIV infections and initiate post exposure prophylaxis. HBsAg, a-HCV and a-HIV were carried out on the day of admission, a-HBs was measured in patients who had been vaccinated against hepatitis B virus. Clinical evaluation of HBV, HCV, HIV infections was performed in the source patients' plasma. RESULTS: The study population consisted of 93 health-care workers (63 nurses, 25 physicians, and 5 medical students), 30 policemen, 23 prison guards, 42 cleaning service workers employed in health-care centers. The remaining 12 patients were inhabitants of the od region who had not been occupationally exposed to potentially infectious material. CONCLUSIONS: Although "safe needles" are in use, exposure among health care personnel still occurs. The problem of occupational exposure among police officers and prison guards is highly underestimated. The lack of control over the vaccination against hepatitis B virus in groups not related with health care creates the risk of new infections. PMID: 20437885 [PubMed - indexed for MEDLINE] 48. J Epidemiol. 2010;20(3):231-6. Epub 2010 Apr 20. Prevalence and determinants of hepatitis B antigenemia in 15,007 inmates in Taiwan. Lin CF, Twu SJ, Chen PH, Cheng JS, Wang JD.

Department of Internal Medicine, Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan. BACKGROUND: The goal of this study was to determine the prevalence and risk factors for horizontal transmission of hepatitis B infection due to intravenous drug abuse (IVDA), tattooing, blood transfusion, and combinations of these risk factors. METHODS: All people detained in 19 prisons were invited to participate. Subjects underwent a physical examination and completed a questionnaire. Blood samples were collected and screened for hepatitis B surface antigen and Venereal Disease Research Laboratory (VDRL) reactivity. RESULTS: A total of 16 204 prisoners were invited to participate. The response rate was 92.6% and the mean age was 29.73 years. The overall prevalence of HBsAg positivity was 21.7%. Among 3333 subjects with a history of blood transfusion, the carrier rate was 23.19%. Among the 3071 subjects with a history of IVDA and the 6908 subjects with tattoos, the carrier rate was 26.4% and 29.3%, respectively. IVDA appeared to be the strongest risk factor among the 3, with an adjusted odds ratio (AOR) of 1.54 (95% confidence interval, 1.27-1.86), followed by tattooing (1.40, 1.23-1.55), and blood transfusion (1.27, 1.05-1.61). When blood transfusion was combined with either of the other 2 risk factors, the risk increased multiplicatively, and the combination of the 3 factors increased the AOR to 2.76 (2.20-3.47). The prevalence of a positive VDRL test result was 1.01%. CONCLUSIONS: The prevalence of HBV antigenemia in prisoners was high and was associated with BT, IVDA, and tattooing. A national vaccination program against HBV should be considered for prisoners and other people with these risk factors. PMID: 20431237 [PubMed - indexed for MEDLINE] 49. Hepat Mon. 2010 Spring;10(2):101-4. Epub 2010 Jun 1. Seroprevalence study of hepatitis C and Hepatitis B virus among hospitalized intravenous drug users in Ahvaz, Iran (2002-2006). Alavi SM, Behdad F. Infectious and Tropical Disease Research Center Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. alavil329dr@yahoo.com BACKGROUND AND AIMS: Viral hepatitis is a serious complication among intravenous drug users (IDUs). The objectives of this study were to determine the seroprevalence of hepatitis B and C viruses (HBV and HCV), and associated risk factors among IDUs at a teaching hospital in Ahvaz, southwest Iran.

METHODS: Medical records of 333 IDUs hospitalized from 2002 to 2006 at Razi Hospital, which is affiliated to Ahvaz Jundishapur University of Medical Sciences, were reviewed. Cases meeting the criteria for a diagnosis of viral hepatitis infection were included in this study. Patients' characteristics, clinical and laboratory findings were extracted. Data of cases with hepatitis virus infection (HVI), called the HVI group and without HVI, called the NHVI group, were compared, using the chi-square test for qualitative variables and the t-test for quantitative variables. Differences with a P < 0.05 were considered significant. RESULTS: Out of a total of 333 IDUs, 115 (34.5%), mostly male, with a mean age of 24.86.2 had HVI. More than 65% had a history of imprisonment. The mean duration of IDU was 4.51.6 years for the HVI group and 1.80.4 years for the NHVI group (P < 0.05). 85% of the HVI group and 45% of the NHVI group shared injection equipment (P < 0.05). 103 patients (30.9%) had HCV and 12 (3.6%) had HBV infection. There was a significant difference in age, duration of drug abuse, time spent in prison, sharing injection equipment, history of surgery, blood transfusion, packs of cigarettes per year and human immunodeficiency virus (HIV) co-infection between the two groups (P < 0.05). CONCLUSIONS: HVI in IDU population is a prevalent complication, and is associated with heavy smoking (high number of packs of cigarettes per year), sharing injection equipment, long duration of drug usage, long duration of prison stay, HIV co-infection, history of surgery, blood and blood products transfusion. Older age, longer duration of IDU and imprisonment put the cases at higher risk of acquiring HCV in comparison to HBV. PMCID: PMC3270351 PMID: 22312381 [PubMed] 50. J Infect Dev Ctries. 2010 Mar 29;4(3):144-9. Prevalence of antibodies to human immunodeficiency virus (HIV), hepatitis B and hepatitis C and risk factors in prisoners in Lebanon. Mahfoud Z, Kassak K, Kreidieh K, Shamra S, Ramia S. Departments of Epidemiology, Faculty of Health Sciences, American University of Beirut, Lebanon. zm15@aub.edu.lb BACKGROUND: People admitted to correctional facilities often have a history of risky behaviours which frequently lead to transmission of blood-borne viruses, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Our aim was to determine the prevalence of HIV, HBV and HCV infections among prisoners in Lebanon. METHODOLOGY: Conducted between August 2007 and February 2008 in Roumieh Prison,

Lebanon, the study included a total of 580 male prisoners aged 16 and above who were randomly selected from four prison blocks. Peripheral blood was collected by a finger prick, blotted onto high-quality filter paper, dried and later eluted to be tested for markers of HIV, HBV and HCV infections. RESULTS: A significantly higher seroprevalence of HBV (2.4%) and HCV (3.4%) was found among prisoners compared to the seroprevalence of these virus infections reported in the general Lebanese population (< 1% for HBV and HCV). Only one of the 580 prisoners tested (0.17%) was confirmed as anti-HIV-positive. The majority (89%) of anti-HCV-positive prisoners had a history of previous imprisonment and were injecting drug users (IDUs). Tattooing was also associated with HCV transmission: all nine anti-HCV-positive prisoners had tattoos compared to only 60% who were anti-HCV-negative. Only HCV genotypes 1 and 3 were detected. CONCLUSIONS: We provide evidence for an outbreak of HCV and HBV occurring in Roumieh prison. In addition to vaccinating prisoners against HBV, collaborations should develop between the prison's administration, academic institutions, and community-based organizations to provide HCV prevention services within the prisons. PMID: 20351454 [PubMed - indexed for MEDLINE] 51. Epidemiol Infect. 2010 Nov;138(11):1610-20. doi: 10.1017/S0950268810000476. Epub 2010 Mar 5. Viral hepatitis B, C and HIV infection in Croatian prisons. Burek V, Horvat J, Butorac K, Mikuli R. University Hospital for Infectious Diseases, Zagreb, Croatia. vitomir.burek@zg.htnet.hr Incarcerated persons comprise about 0.4% of the Croatian population, of whom 25-30% misuse drugs. We attempted to determine the structure of the prison population, prevalence of HBV, HCV, HIV markers, co-infections with HBV, HCV and HIV and acute HBV, HCV and HIV infection. In total, 25.9% of prisoners were positive for some markers for viral hepatitis (HBV 11.3%, HCV 8.3%, HBV/HCV 6.3%). Prevalence of HBV infection in intravenous drug users (IDUs) was 26.2% (highly promiscuous group 20.4%, individuals with psychiatric diseases and personality disorders 16.0%). HCV infection in IDUs was 52.0% and 4.9% in the highly promiscuous group. HBV/HCV co-infection was registered in 34.9% of prisoners positive for HBV markers (203/582). Acute HBV infection was detected in 0.5%, and HCV in 1.2%. Only 0.15% (5/3348) of prisoners were anti-HIV positive. It appears that individuals with psychiatric diseases and personality disorders could be an additional risk population for these viral infections.

PMID: 20202285 [PubMed - indexed for MEDLINE] 52. Acta Med Croatica. 2009 Dec;63(5):447-50. [Prevalence of hepatitis B and C among prison population in Croatia]. [Article in Croatian] Burek V, Horvat J, Susi E, Mikuli R. Department of Clinical Immunology, Dr Fran Mihaljevi University Hospital for Infectious Diseases, Zagreb, Croatia. In 2007, incarcerated persons accounted for 0.41% (approximately 16,500) of the Croatian population. In the heterogeneous structure of the prison population in Croatia, some 25%-30% of the prisoners are drug abusers. In this study, we intended to determine precisely the structure of the prison population in Croatia and the prevalence of HBV and HCV markers in this population. It is well known that HBV and HCV infection can spread within prisons, and therefore we tried to determine the rate of acute HBV and HCV infection among prisoners in Croatian prisons. In total, 25.7% of prisoners were positive for some viral hepatitis markers (HBV 11.3%, HCV 8.3%, and HBV/HCV 6.3%). The rate of HBV infection was very high among intravenous drug users (26.2%) and relatively high among highly promiscuous individuals (19.9%). HCV infection was most prevalent among intravenous drug users (50.2%) and relatively high among highly promiscuous individuals (7.5%). HBV/HCV coinfection was recorded in 23.5% of prisoners. Acute infection with HBV was detected in 0.3% and with HCV in 1.2% of the study population. One fourth of all prisoners had contact with HBV, HCV, or both viruses. It is evident that both hepatitis virus infections (HCV more and HBV less) are spreading within prisons among prisoners. The opportunity of screening, testing, vaccination, treatment and education of high-risk individuals while they are in the controlled environment of a correctional facility is a good policy for both individuals and the community. PMID: 20198906 [PubMed - indexed for MEDLINE] 53. Int J Infect Dis. 2010 Sep;14 Suppl 3:e60-6. doi: 10.1016/j.ijid.2009.11.012. Epub 2010 Mar 1. Risk factors and prevalence of tuberculosis, human immunodeficiency virus, syphilis, hepatitis B virus, and hepatitis C virus among prisoners in Pakistan. Kazi AM, Shah SA, Jenkins CA, Shepherd BE, Vermund SH.

Departments of Preventive Medicine, Biostatistics and Pediatrics, Vanderbilt University Institute for Global Health, 2215 Garland Ave., Nashville, TN 37232-0242, USA. mominkazi@gmail.com OBJECTIVE: The objective of this study was to evaluate the burden of sexual- and injection drug use-related infections in male prisoners in Karachi, Pakistan. METHODS: We administered a structured questionnaire in a cross-sectional survey of 365 randomly selected imprisoned men. We analyzed blood for the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) by ELISA, and for syphilis by rapid plasma reagin with Treponema pallidum hemagglutination assay confirmation. Subjects with possible tuberculosis (World Health Organization criteria) provided sputum samples for an acid-fast bacillus smear and culture. RESULTS: The prevalence of tuberculosis was 2.2% (95% CI 0.71-3.8%). Of 357 of the randomly selected prisoners (eight refused to give blood), 2.0% (95% CI 0.6-3.4) were HIV-infected; syphilis was confirmed in 8.9% (95% CI 6.0-11.8%), HBV in 5.9% (95% CI 3.5-8.3%), and HCV in 15.2% (95% CI 11.7-18.8). By self-report, 59.2% had used any illicit drugs, among whom 11.8% (95% CI 8.5-15.0) had injected drugs. The median length of stay in the prison had been 3.2 (range 1-72) months. CONCLUSIONS: All four infections were prevalent among the prisoners in Pakistan. Prisons are excellent venues for infectious disease screening and intervention given the conditions of poverty and drug addiction. Collaboration with community-based health providers is vital for post-discharge planning. Copyright 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. PMCID: PMC2905608 PMID: 20189863 [PubMed - indexed for MEDLINE] 54. Addiction. 2010 Feb;105(2):189-90. doi: 10.1111/j.1360-0443.2009.02781.x. Hepatitis B vaccination in prisons: a much-needed targeted universal intervention. Farrell M, Strang J, Stver H. PMID: 20078472 [PubMed - indexed for MEDLINE] 55. Hepat Mon. 2010 Winter;10(1):26-30. Epub 2010 Mar 1. Evaluation of the Prevalence of Hepatitis B, Hepatitis C, and HIV in Inmates with Drug-Related Convictions in Birjand, Iran in 2008.

Azarkar Z, Sharifzadeh G. Department of Infectious Disease, Birjand University Medical Sciences, Birjand, Iran. BACKGROUND AND AIMS: Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are common infections among prisoners. Addicted prisoners are at a higher risk than the normal population for contracting these diseases. Many studies have reported higher prevalence rates of HBV, HCV, and HIV in prisoners. Because of this problem, this study was conducted to evaluate the serologic prevalence of these three diseases in prisoners convicted of drug-related crimes. METHODS: A descriptive cross-sectional study was conducted on a random sample of prisoners with drug charges who were inmates in a prison in Birjand, Iran. Information was collected via questionnaire after obtaining prisoners' informed consent and blood samples were tested for hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV), and antibodies to HIV (anti-HIV). The results were analyzed by chi-square tests. RESULTS: In this study, 358 prisoners were selected. 80.2% of prisoners were male, and 19.8% were female. The average age was 34.712 years. 39.1% were addicted to drugs, 54.2% were smokers, and 19.3% had tattoos. 8.4% had had extramarital intercourse, and 16.8% had had a sexually transmitted disease (STD) in past. HBsAg, anti-HCV, and anti- HIV prevalence in these samples were 6.1%, 8.1%, and 0%, respectively.The prevalence rate of HBV in the addicted prisoners was 4.3%, and the rate in non-addicted prisoners was 7.3% (P = 0.24).The prevalence of HCV in addicted prisoners was 15.7%, and the prevalence in non-addicted prisoners was 3.2%; this difference was significant (P < 0.001).Furthermore, a significant difference between the prevalence of HBV and extramarital intercourse was noted (P < 0.005).A significant difference between HCV and transfusion, history of STDs, addiction, and tattooing was noted. CONCLUSIONS: The survey showed that HCV, HBV, and HIV prevalence rates in prisoners were 8.1%, 6.1%, 0%, respectively. The prevalence rates of HCV and HBV in addicted prisoners were 15.7% and 4.3 %, respectively. Studies performed in Iran and other countries have shown that the prevalence rates of HBV, HCV, and HIV in addicted prisoners were higher than the rates in non-addicted prisoners. These results indicate that HBV, HCV, and HIV are significant problems in prisons, and efforts to reduce the risk of these infections, such as education and vaccination, should be considered. PMCID: PMC3270341 PMID: 22308122 [PubMed] 56. Trans Am Clin Climatol Assoc. 2009;120:73-83.

HIV and infectious disease care in jails and prisons: breaking down the walls with the help of academic medicine. Flanigan TP, Zaller N, Taylor L, Beckwith C, Kuester L, Rich J, Carpenter CC. The Warren Alpert Medical School of Brown University and TheMiriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA. tflanigan@lifespan.org Health care within correctional facilities has traditionally been marginalized from excellence in academic medicine. The armamentarium of a medical school, which includes excellence in research, teaching and clinical care, can be successfully applied to the correctional setting both in the United States and internationally. At any one time, there are over 2 million people incarcerated in the US who are disproportionately poor and from communities of color. Rates of human immunodeficiency virus (HIV) and hepatitis C virus infection (HCV) in prisons are 5 and 17-28-times higher than in the general population, respectively. The correctional setting provides an excellent opportunity to screen for and treat sexually transmitted infections (STIs), HIV, HCV, chronic hepatitis B virus (HBV) infections and tuberculosis (TB) and to develop effective prevention programs. PMCID: PMC2744543 PMID: 19768164 [PubMed - indexed for MEDLINE] 57. J Infect Dev Ctries. 2009 Aug 30;3(7):539-47. Human immunonodeficiency virus, hepatitis B virus and hepatitis C virus: sero-prevalence, co-infection and risk factors among prison inmates in Nasarawa State, Nigeria. Adoga MP, Banwat EB, Forbi JC, Nimzing L, Pam CR, Gyar SD, Agabi YA, Agwale SM. Virology Department, Innovative Biotech Ltd, 1 Abdu Abubakar Street, GRA, P.O.Box 30, Keffi, Nigeria. madoga@innovativebiotechng.com BACKGROUND: Published data on HIV, HBV, and HCV in correctional facilities in Nigeria is scarce. We set out to establish the seroprevalence, co-infection, and risk factors for these infections for the first time among prison inmates in Nasarawa State, Nigeria. METHODOLOGY: In a cross-sectional study conducted between April and May, 2007, blood samples were collected from 300 male prisoners of a mean age of 29.2 years, in the state's four medium-security prisons (overall population: 587). Prior to the study, ethical clearance and informed consent were obtained and structured

questionnaires were administered. Samples were analyzed for HIV, HBsAg, and HCV using anti-HIV 1+2-EIA-avicenna, Shantest-HBsAg ELISA, and anti-HCV-EIAavicenna, respectively. Specimens initially reactive for HIV were retested with vironostika microelisa. Data were analyzed using SPSS version 13.0. P values < or = 0.05 were considered significant. RESULTS: Of the 300 subjects, 54 (18.0 %), 69 (23.0 %), and 37 (12.3 %) tested positive for HIV, HBV, and HCV, respectively. Co-infections were eight (2.7 %) for HIV/HBV and two (0.7 %) for HBV/HCV. Those aged 21-26 years were more likely to be infected with HIV and HBV, while those aged 33-38 years had the highest HCV infection. Associated risk factors included duration in prison, previous incarceration (for HIV, HBV and HCV), intra-prison anal sex, multiple sex partners (for HIV and HBV), ignorance of transmission modes, blood transfusion, and alcohol consumption (for HBV and HCV). No inmate injected drugs. CONCLUSIONS: The overall outcome represents the need for prison-focused intervention initiatives in Nigeria. Injected drug use is an unlikely major transmission mode among Nigerian inmates. PMID: 19762972 [PubMed - indexed for MEDLINE] 58. Am J Gastroenterol. 2009 Jun;104(6):1412-9. doi: 10.1038/ajg.2009.106. Epub 2009 Apr 21. Chronic liver disease mortality among male prison inmates in Texas, 1989-2003. Harzke AJ, Baillargeon J, Paar DP, Pulvino J, Murray OJ. Correctional Managed Care Division, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA. ajharzke@utmb.edu OBJECTIVES: Alcohol abuse and chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major etiologic factors for chronic liver disease/cirrhosis (CLD) in the United States. These CLD risk factors are highly prevalent in US adult incarcerated populations, but CLD-related mortality data from these populations are lacking. The primary objective of this study was to assess CLD-related mortality over time and across categories of race-ethnicity from 1989 through 2003 among male inmates in the Texas state prison system. The secondary objective was to examine patterns of recorded underlying, intervening, and contributing causes of death for CLD-related deaths. METHODS: Prisoner decedent data were linked with Texas Vital Statistics multiple-cause-of-death data. Deaths were considered CLD-related if CLD or common sequelae were recorded as the underlying, intervening, or contributing causes of death. CLD-related crude annual death rates, 5-year average annual death rates, and average annual percentage changes were estimated. RESULTS: Among male Texas prisoners from 1989 to 2003, CLD-related deaths

accounted for 16% of deaths (688/4,316). CLD-related crude annual death rates were high and increased over the study period by an average of 4.5% annually, with similar rate increases across categories of race-ethnicity. CLD-related average annual death rates were higher among Hispanic prisoners than among black prisoners in each 5-year period, and were higher than those for white prisoners in the 1994-1998 and 1999-2003 periods. HBV or HCV was identified as a causal factor in more than a third (34%) of CLD-related deaths. CONCLUSIONS: From 1989 to 2003, CLD-related death rates among male Texas prisoners were high and increased over time, particularly among Hispanics. Targeted prevention, screening, and treatment of CLD risk factors, especially HCV, and early detection and treatment of CLD should be considered as priorities of the US prison healthcare systems. PMCID: PMC2856927 PMID: 19491854 [PubMed - indexed for MEDLINE] 59. AIDS Behav. 2011 Feb;15(2):340-6. doi: 10.1007/s10461-009-9570-x. Epub 2009 May 20. Impact of prison status on HIV-related risk behaviors. Hudson AL, Nyamathi A, Bhattacharya D, Marlow E, Shoptaw S, Marfisee M, Leake B. School of Nursing, University of California-Los Angeles, CA 90095, USA. Baseline data were collected to evaluate the effectiveness of interventions on completion of the hepatitis A and B vaccine series among 664 sheltered and street-based homeless adults who were: (a) homeless; (b) recently (<1 year) discharged from prison; (c) discharged 1 year or more; and (d) never incarcerated. Group differences at baseline were assessed for socio-demographic characteristics, drug and alcohol use, sexual activity, mental health and public assistance. More than one-third of homeless persons (38%) reported prison time and 16% of the sample had been recently discharged from prison. Almost half of persons who were discharged from prison at least 1 year ago reported daily use of drugs and alcohol over the past 6 months compared to about 1 in 5 among those who were recently released from prison. As risk for HCV and HIV co-infection continues among homeless ex-offenders, HIV/HCV prevention efforts are needed for this population. PMCID: PMC2945614 PMID: 19455412 [PubMed - indexed for MEDLINE] 60. Ann Epidemiol. 2009 Aug;19(8):582-9. doi: 10.1016/j.annepidem.2009.03.009. Epub

2009 May 13. HCV-related mortality among male prison inmates in Texas, 1994-2003. Harzke AJ, Baillargeon JG, Kelley MF, Diamond PM, Goodman KJ, Paar DP. Department of Preventive Medicine and Community Health and the Correctional Managed Care Division, University of Texas Medical Branch, Galveston, Texas 77555, USA. ajharzke@utmb.edu PURPOSE: The prevalence of hepatitis C virus (HCV) infection is high among adult incarcerated populations, but HCV-related mortality data are lacking. The study purpose was to assess HCV-related mortality over time and across racial/ethnic categories from 1994 through 2003 among male prisoners in the Texas Department of Criminal Justice (TDCJ). METHODS: TDCJ decedent data were linked with Texas Vital Statistics multiple-cause-of-death data. Crude annual HCV death rates, age- and race-adjusted summary rates, and average annual percent changes were estimated. The proportion of deaths due to chronic liver disease/cirrhosis, liver cancer, hepatitis B, and HIV for which HCV was identified as an intervening or contributing cause of death was calculated. RESULTS: Among Texas male prisoners, HCV death rates were high and increased over the 10-year study period by an average 21% annually, with the largest increase occurring among Hispanic prisoners. HCV was identified as an intervening or contributing cause of death in 15% of chronic liver disease/cirrhosis deaths, 33% of liver cancer deaths, 81% of hepatitis B deaths, and 7% of HIV deaths. CONCLUSIONS: Because HCV-related deaths among Texas male prisoners are high and increasing, particularly among Hispanics, targeted prevention, screening, and treatment of HCV infections should be among the priorities of U.S. correctional healthcare systems. PMCID: PMC2857775 PMID: 19443239 [PubMed - indexed for MEDLINE] 61. Public Health Rep. 2009 Jan-Feb;124(1):120-6. Hepatocellular carcinoma prevalence and mortality in a male state prison population. Baillargeon J, Snyder N, Soloway RD, Paar D, Baillargeon G, Spaulding AC, Pollock BH, Arcari CM, Williams BA, Raimer BG. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA. jbaillar@utmb.edu

OBJECTIVES: The incidence of hepatocellular carcinoma (HCC) in the United States has increased dramatically over the last two decades, largely because of an increase in the number of people with advanced hepatitis C virus (HCV) infection. U.S. prisoners are at high risk for HCC, given their elevated rates of HCV infection, comorbid hepatitis B virus (HBV) infection, and alcoholic liver disease. The purpose of our study was to examine the prevalence and mortality of HCC in the nation's largest state prison system. METHODS: The study population consisted of 325,477 male Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between January 1, 2003, and July 31, 2006. Information on medical conditions and demographic characteristics was obtained from an institution-wide medical information system. RESULTS: During the 3.5-year study period, 176 male TDCJ inmates (54 per 100,000) were diagnosed with HCC and 108 (33 per 100,000) died as a result of HCC. Inmates who were Hispanic, older, and infected with HCV, HBV, or human immunodeficiency virus had elevated rates of both HCC prevalence and mortality. After adjusting for all study covariates, HCC prevalence, but not mortality, was modestly elevated among inmates with diabetes. CONCLUSIONS: Our study showed that the Texas male prison population had a sevenfold higher prevalence of HCC than the general U.S. male population and a fourfold higher death rate from HCC. These findings likely reflect the high concentration of HCC-related risk factors, particularly HCV, among prisoners. PMCID: PMC2602937 PMID: 19413034 [PubMed - indexed for MEDLINE] 62. J Infect. 2009 May;58(5):375-82. doi: 10.1016/j.jinf.2009.02.014. Epub 2009 Mar 27. Markers and risk factors for HCV, HBV and HIV in a network of injecting drug users in Melbourne, Australia. Miller ER, Hellard ME, Bowden S, Bharadwaj M, Aitken CK. Victorian Infectious Diseases Reference Laboratory, Locked Bag 815, Carlton South, Victoria 3053, Australia. emma.miller@deakin.edu.au BACKGROUND AND AIMS: Current injecting drug users (IDU) in major street drug markets within greater Melbourne were recruited to a longitudinal study on blood borne viruses. Here we investigated risk factors for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV infection in these IDU at the time of their recruitment. METHODS: Three hundred and eighty-two IDU completed detailed questionnaires on their drug use and risk behaviours, and provided blood samples for serology testing. These data were analysed using univariate and multivariate techniques. RESULTS: The overall prevalence of exposure to HCV, HBV and HIV was estimated at

70%, 34% and <1%, respectively. Independent predictors of HCV exposure were history of imprisonment (RR 1.34, 95% CI 1.19-1.52), use of someone else's needle or syringe (RR 1.23, 95% CI 1.07-1.42), >7.6years length of time injecting (RR 1.21, 95% CI 1.07-1.37), and originating from Vietnam (RR 1.12, 95% CI 1.07-1.18). Independent predictors of HBV exposure were HCV exposure (RR 2.15, 95% CI 1.35-3.43), >7.6years length of time injecting (RR 1.57, 95% CI 1.17-2.13) and originating from outside Australia (RR 1.60, 95% CI 1.22-2.10). Neither prison- nor community-applied tattoos predicted HCV or HBV exposure. Up to 31% of IDU who injected for 1year or less were HCV antibody positive, as were 53% of those who injected for 2years or less. CONCLUSIONS: Ongoing engagement with young IDU, through the provision of harm reduction education and resources, is critical if we are to address blood borne viral infections and other health and social harms associated with injecting drug use. PMID: 19328555 [PubMed - indexed for MEDLINE] 63. Prev Med. 2009 Jun;48(6):588-92. doi: 10.1016/j.ypmed.2009.03.011. Epub 2009 Mar 13. Liver cancer mortality among male prison inmates in Texas, 1992-2003. Harzke AJ, Baillargeon JG, Goodman KJ, Pruitt SL. Division of Epidemiology and Outcomes, Correctional Managed Care, University of Texas Medical Branch, Galveston, TX 77555, USA. ajharzke@utmb.edu OBJECTIVES: Prevalence estimates for several liver cancer risk factors-hepatitis C, hepatitis B, and history of alcohol abuse-are substantially higher in U.S. prison populations than in the general population. However, liver cancer mortality data from these populations are lacking. The primary aims of this study were to examine trends in liver cancer mortality rates from 1992 to 2003 among male prisoners in the Texas Department of Criminal Justice (TDCJ) and to compare these rates to general population rates. METHODS: TDCJ data on male decedents (N=4026) were linked with Texas Vital Statistics multiple-cause-of-death data. Crude average annual liver cancer death rates, average annual percent changes, and standardized mortality ratios were estimated. RESULTS: Crude liver cancer death rates increased by an average annual 6.1% among male prisoners, which was considerably higher than the average annual percent change among similarly aged males in Texas (2.0%) and the U.S. (2.9%). The number of liver cancer deaths among male prisoners was 4.7 (4.0-5.6) and 6.3 (5.3-7.5) times higher than the expected number of deaths estimated using age-specific rates from these reference populations.

CONCLUSIONS: From 1992 to 2003, liver cancer death rates and rate increases were elevated among Texas male prisoners. Findings support previous recommendations for targeted prevention, screening, and treatment of liver cancer risk factors in prison populations. PMCID: PMC2879635 PMID: 19289141 [PubMed - indexed for MEDLINE] 64. Am J Gastroenterol. 2009 Apr;104(4):1024-31. doi: 10.1038/ajg.2008.143. Epub 2009 Feb 24. Viral hepatitis in incarcerated adults: a medical and public health concern. Hunt DR, Saab S. Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA. Viral hepatitis is a common problem in the incarcerated population. It causes significant morbidity and mortality, and incarcerated inmates receive their health care almost exclusively from corrections-based health systems. The seroprevalence of hepatitis B and C infections is increased in this population, and a number of risk factors for viral hepatitis are particularly common and infer higher risk among inmates, including injection drug use (IDU), high-risk sexual activity, and tattoos. IDU, in particular, has been identified as an important and common risk factor for viral hepatitis in inmates, and variable rates of IDU among inmates have been found to be the most important cause of the marked variability of seroprevalence rates for exposure to hepatitis C virus. A number of risk reduction and management strategies have been identified that can decrease transmission to other inmates. Prison-based hepatitis A and hepatitis B vaccination programs, needle exchange programs, methadone maintenance programs, risk education programs, and hepatitis C virus antiviral programs, for example, have been shown to be safe and effective risk reduction and management strategies. Preliminary studies have shown that these strategies are underutilized in the United States. Reasons for this phenomenon are multifactorial, involving financial as well as ethical and political considerations. Additional funding, research, and formal consideration / discussion of the complex issues involving viral hepatitis in the US incarcerated population are clearly important for the sake of inmates and the community at large. In this article, the published medical literature regarding this important topic is reviewed. PMID: 19240708 [PubMed - indexed for MEDLINE]

65. Int J Law Psychiatry. 2009 Mar-Apr;32(2):101-7. doi: 10.1016/j.ijlp.2009.01.006. Epub 2009 Feb 23. Co-occurring psychiatric and substance use disorders among male detainees in Italy. Piselli M, Elisei S, Murgia N, Quartesan R, Abram KM. University of Perugia, Italy. This paper presents data on the prevalence of co-occurring substance use and psychiatric disorders among newly imprisoned males in Italy. Interviewers conducted semi-structured clinical interviews with n=302 male detainees seven days after their admission to the prison of Perugia from August 2005 through July 2006. Over half of male detainees (54.3%) had either a substance use disorder or another psychiatric disorder. One of every five detainees (20.9%) had comorbid substance use and psychiatric disorders. Compared to detainees with psychiatric disorder only, substance use disorder only, or no disorder, detainees with comorbid substance use and psychiatric disorders were significantly more likely to have severe impairment in the areas of employment, substance abuse, family and social functioning, and psychiatric symptoms. Findings underscore the need for careful diagnostic screening at intake, access to treatment during detention, and an effective transition to services at the time of release. PMID: 19237198 [PubMed - indexed for MEDLINE] 66. J Infect Public Health. 2009;2(1):47-51. doi: 10.1016/j.jiph.2009.01.001. Epub 2009 Mar 6. Seroprevalence study of HCV among hospitalized intravenous drug users in Ahvaz, Iran (2001-2006). Alavi SM, Alavi L. Infectious Diseases and Tropical Medicine Research Center, Jundishapoor University of Medical Sciences, Ahvaz, Iran. alavi1329dr@yahoo.com BACKGROUND AND AIMS: Prevalence of hepatitis C virus (HCV) in intravenous drug users (IDU) varies in different areas according to socioeconomic and geographical circumstances. The present study was performed to determine seroprevalence of HCV in IDU individuals in Ahvaz, Iran. MATERIALS AND METHODS: 142 IDU patients were included in this retrospective study in Ahvaz southwest Iran from 2001 to 2006. Patients were placed in two groups

determined by HCV Ab positive or negative status. Data were analyzed using SPSS for Windows (version 11.5; SPSS Inc., USA) software. RESULTS: Out of total 142 cases, 74 persons (52.11%) had a positive HCV-Ab test according to the ELISA method. There was no difference in age, sex, level of education, residency and co-infection with HIV and hepatitis B virus between HCV-Ab positive (HAP) and HCV-Ab negative (HAN) groups (p>0.05). HCV-Ab positivity was significantly related to imprisonment and duration spent in prison [OR: 3.22, 95% (CI) 2.61-3.76, p<0.0001]. CONCLUSION: Patients with IDU constitute a high-risk group for acquisition of HCV infection. Transmission of HCV via sharing syringe and needle as well as blood transfusion has been a significant source of hepatitis C infection for patients with intravenous drug addiction. PMID: 20701860 [PubMed - indexed for MEDLINE] 67. J Adolesc Health. 2008 Dec;43(6):609-11. doi: 10.1016/j.jadohealth.2008.04.008. Epub 2008 Jun 24. Immunization rates in a Canadian juvenile corrections facility. Bartlett L, Kanellos-Sutton M, van Wylick R. Department of Pediatrics, Queen's University, Kingston, Ontario, Canada. vanwylir@hdh.kari.net In Canada's judicial system there are more than 31,700 youths admitted to correctional services each year. Given the prevalence of documented medical problems and high-risk behavior in this population, it is important to assess the immunization status of adolescents admitted to juvenile detention facilities. We completed a chart review of all youth admitted to an adolescent custody facility in Kingston, Ontario, between January 2003 and October 2005. There were 234 admissions, representing a total of 148 youths between the ages of 12 and 17 years. Of the youths, 73% had incomplete immunizations according to National Advisory Committee on Immunizations. In all, 49% (73 of 148) were missing tetanus, diphtheria, and acellular pertussis immunizations; 33% (49 of 148), meningococcus; 2% (four of 148), measles, mumps, and rubella; and 37% (55 of 148), hepatitis B. Successful immunization delivery within the detention facility increased complete immunization rates from 27% to 65%. This study shows the prevalence of incomplete immunizations in this population of adolescents. Given this data, there should be a greater focus on obtaining immunization records and on consistently delivering immunizations. PMID: 19027650 [PubMed - indexed for MEDLINE]

68. Eur J Clin Microbiol Infect Dis. 2009 Apr;28(4):409-13. doi: 10.1007/s10096-008-0642-z. Epub 2008 Nov 8. Prevalence and risk factors of the whole spectrum of sexually transmitted diseases in male incoming prisoners in France. Verneuil L, Vidal JS, Ze Bekolo R, Vabret A, Petitjean J, Leclercq R, Leroy D. Department of Dermatology, CHU Clmenceau, Caen, France. verneuil-l@chu-caen.fr Sexually transmitted diseases (STD) are a public health issue in prison. As inmates are eventually released, it is also a community concern. There are very few data on the entire spectrum of STDs, particularly condyloma among prisoners. To determine the prevalence of all STDs: infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus (HSV), Chlamydia trachomatis, Neisseria gonorrhoea, syphilis, and condyloma among entering inmates. A cross-sectional study was conducted in France from November 2000 to June 2003. Male adults entering a prison remand center in Caen had a medical consultation and physical examination including external genital organs and perianal area for condyloma and herpes infection, a urethral swab for Chlamydia trachomatis and Neisseria gonorrhoea detection, and a blood sample for HBV, HCV, HIV, and syphilis serology. Five hundred and ninety-seven inmates agreed to participate in the study. Sixteen percent had at least one STD: 4.0% had condyloma, 4.0% chlamydia infection, and 4.9% were positive for HCV antibodies. Two had early syphilis and 1 had acute HBV, but no HIV infection, neither genital herpes nor gonorrhea. The analysis of the STD risk behaviors did not show any difference between the infected and uninfected participants, except that HCV-positive participants were more likely to be intravenous drug users. Results suggest that a systematic screening of all STDs should be at least proposed to every entering inmate since no demographic or sexual characteristics are consistently associated with STDs. PMID: 18998176 [PubMed - indexed for MEDLINE] 69. Int J Public Health. 2008;53(5):268-71. doi: 10.1007/s00038-008-6014-8. Detection and treatment of HIV and hepatitis virus infections in Swiss correctional facilities. Gerlich MG, Frick U, Pirktl L, Uchtenhagen A. Research Institute for Public Health and Addiction, Konradstrasse 32, P.O. Box 8031, Zurich, Switzerland. miriam.gerlich@isgf.uzh.ch OBJECTIVES: The aim of the study was to obtain an overview on diagnostic and

therapeutic activities concerning hepatitis A, B, C virus and HIV in Swiss prisons. METHODS: A standardized questionnaire was sent to 91 prisons in the German and Italian speaking parts in October 2004; 41 institutions (45%) answered the questionnaire. RESULTS: In almost all prisons serological examinations were not done routinely, but were provided when demanded by inmates or recommended by the medical service. Vaccination against hepatitis A or B infection and initiation of antiviral therapy was possible in most institutions. CONCLUSIONS: Most of the prisons investigated offered diagnostic and antiviral treatment for hepatitis virus and HIV infections. A reported problem was the discontinuation of ongoing treatments or vaccination cycles after discharge. In some cases deficient funding was an obstacle. PMID: 18820835 [PubMed - indexed for MEDLINE] 70. Int J STD AIDS. 2008 Sep;19(9):586-9. doi: 10.1258/ijsa.2008.008051. Measuring the gap: from Home Office to the National Health Service in the provision of a one-stop shop sexual health service in a female prison in the UK. Mahto M, Zia S. Genitourinary Medicine Department (Central and Eastern Cheshire PCT), Assura Health and Wellness Centre, Sunderland Street, Macclesfield, UK. mrinalini.mahto@echeshire-tr.nwest.nhs.uk The Genitourinary (GU) Medicine Service was transferred from the Home Office to the NHS from April 2006 at this female prison to give prisoners access to the same quality of health care as the general public. Medline search showed no published data on the prevalence of sexually transmitted infections (STIs) among female prisoners in the UK. The main aim was to develop a one stop sexual health shop and to determine the prevalence and risk factors for STIs, to determine the uptake rate for HIV testing, hepatitis B vaccination and cervical cytology along with requests for usage of contraceptive services. Challenges were met when introducing change to bring the services in line with the local GU medicine clinic. Review of the service at one year along with retrospective case note review from May 2006 to August 2007 was done. Of the 545 new patients seen, history of substance abuse, IVDU, sexual abuse, sex worker and past history of hepatitis C virus and chlamydia were 86%, 41%,12%, 6%, 17% and 24% respectively.The uptake rate for both STI screen and blood-borne viruses (BBVs) testing was high at 87% and 69.3% respectively. STI was diagnosed in 19.6%. Prevalence rates were: Trichomonas vaginalis (TV) 8.2%, chlamydia 5.3%, gonorrhoea 0.2%, genital warts 5.3%, HIV 0.8%, hepatitis C virus 12% and hepatitis B virus 11%. The uptake rate for 1(st) dose hepatitis B vaccination and

cervical cytology were 70% and 92% respectively, 36 accessed contraceptive services. Provision of one stop shop in a female prison is feasible and practical. STIs, particularly TV, and BBVs prevalence is high among the female inmates. Prevention methods targeting this population needs to be intensified. PMID: 18725547 [PubMed - indexed for MEDLINE] 71. J Urban Health. 2009 Jan;86(1):93-105. doi: 10.1007/s11524-008-9305-8. Epub 2008 Jul 12. Prevalence of infection with hepatitis B and C viruses and co-infection with HIV in three jails: a case for viral hepatitis prevention in jails in the United States. Hennessey KA, Kim AA, Griffin V, Collins NT, Weinbaum CM, Sabin K. Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention NCHHSTP, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. khennessey@cdc.gov Hepatitis B vaccination and targeted testing for hepatitis C virus (HCV) are recommended for jails with medical services available. This study estimates hepatitis B virus (HBV) and HCV infection prevalence among jail inmates, since most previous studies have been conducted among prison inmates. Prison and jail populations differ: jails hold a wide spectrum of persons for an average of 10-20 days, including persons awaiting arraignment, trial, conviction, or sentencing, while prisons typically hold convicted criminals for at least 1 year. A stratified random sample of sera obtained during routine syphilis testing of inmates entering jails in Chicago (March-April 2000), Detroit (March-August 1999), and San Francisco (June 1999-December 2000) was tested for serologic markers of HBV and HCV infection. All sera had been previously tested for antibody to HIV (anti-HIV). A total of 1,292 serum samples (12% of new inmates) was tested. Antibody to HCV (anti-HCV) prevalence was 13%. Antibody to hepatitis B core antigen (anti-HBc) prevalence was 19%, and hepatitis B surface antigen (HBsAg) prevalence was 0.9%; 12% had serologic evidence of hepatitis B vaccination. Hispanics had high rates of chronic HBV infection (3.6% HBsAg positive) along with Asians (4.7% HBsAg positive). Among HIV-infected persons, 38% were anti-HCV positive and 8.2% were HBsAg positive. Anti-HBc positivity was associated with anti-HCV positivity (aOR=4.58), anti-HIV positivity (aOR=2.94), syphilis infection (aOR=2.10), and previous incarceration (aOR=1.78). Anti-HCV-positivity was associated with anti-HBc positivity (aOR=4.44), anti-HIV-positivity (aOR=2.51), and previous incarceration (aOR=2.90). Jail entrants had high levels of HCV and HBV infection and HIV co-infection; HBV prevalence was comparable to previous prison studies, and HCV prevalence was lower than prison studies. Hispanics had an unexpectedly high rate of chronic

hepatitis B infection and had the lowest rate of hepatitis B vaccination. The finding that hepatitis B vaccination coverage among jail entrants is lower than the general population, despite this population's increased risk for infection, highlights the need to support vaccination in jail settings. PMCID: PMC2629523 PMID: 18622707 [PubMed - indexed for MEDLINE] 72. Praxis (Bern 1994). 2008 Apr 16;97(8):437-42. [Working under pressure]. [Article in German] Vetter Ch, Robert-Tissot L, Cottagnoud P, Stucki A. Klinik und Poliklinik fr Allgemeine Innere Medizin, Universittsspital Bern. chvetter_ol@spital.ktso.ch From medical view the main problems of investigation and convicts are in particular in the range of the drugs and alcohol illnesses to see transferable diseases (HIV, hepatitis B - C and tuberculosis) and psychological illnesses. These complex diseases require a close meshed and intensive support of each individual patient and represent actually the main problem during an arrest. The development of the health service could address the new requirements making possible cost-conscious acting in handling with resources in the health service. In the canton Berne 957197 inhabitants live on a total area of 5959 km2. The police and military management operates the regional and district prisons as well as the transportation service for prisoners in the canton Berne for prisoners. The canton Berne has altogether 327 places. Since May 1971 persons from the regional and district prison and the penal institutions needing hospitalisation can be accepted. In the University hospital Berne on a specially equipped guard station and be cared for their medical problems. The prisoners profit in such a way from the entire range of the university facilities. PMID: 18551914 [PubMed - indexed for MEDLINE] 73. AIDS Behav. 2008 Jul;12(4 Suppl):S17-24. doi: 10.1007/s10461-008-9409-x. Epub 2008 May 27. Prevalence and risk of blood-borne and sexually transmitted viral infections in incarcerated youth in Salvador, Brazil: opportunity and obligation for intervention.

Fialho M, Messias M, Page-Shafer K, Farre L, Schmalb M, Pedral-Sampaio D, Ramos M, Brites C. Centro de Referncia do Estado da Bahia para AIDS (CREAIDS), Salvador, Brazil. To determine the prevalence of sexually transmitted and blood-borne infections among incarcerated adolescents in Salvador, Brazil, we interviewed 300 incarcerated youth aged 11-18 years to participate in a physical examination and to provide a blood sample to test for HIV-1, hepatitis B and C viruses exposure, human T-cells lymphotrophic virus, and syphilis. Overall prevalence was anti-HIV, 0.34%; anti-HBc, 11.1%; HBsAg, 2.4%; anti-HCV, 6.4%; HTLV, 1.09%; and syphilis, 3.4%. The majority (86.3%) reported a history of sexual activity; 27% had never used condoms. Girls also reported previous pregnancy (35%), abortion (26%) and sexual abuse (74%). Many youth reported a family history of alcohol abuse (56%), illicit drug use (24.7%), or legal problems (38%). Serological results show that youth in Salvador are at high risk for blood-borne and sexually transmitted infections. Policies to reduce the risk and impact of these infections should be a requisite part of health care for incarcerated youth. PMID: 18500658 [PubMed - indexed for MEDLINE] 74. Int J Prison Health. 2008 Jun;4(2):77-82. doi: 10.1080/17449200802038207. Prevalence of Hepatitis B virus and/or Hepatitis C virus co-infections in prisoners infected with the Human Immunodeficiency Virus. Pontali E, Ferrari F. Prison of Genoa, Genoa, Italy. pontals@yahoo.com Correctional facilities host a disproportionately high prevalence of HBV, HCV and HIV infection. We evaluated the prevalence of HBV and/or HCV co-infection among HIV-infected inmates entering our correctional facility. Over a 30-month period, 173 consecutive HIV-infected inmates entered our institution and were evaluated. HCV co-infection was observed in more than 90% of the tested HIV-infected inmates, past HBV infection in 77.4% and active HBV co-infection in 6.7%; triple coinfection (HIV, HCV and HBs-Ag positivity) was seen in 6.1% of them. Given the observed high prevalence of co-infection, testing for HBV and HCV in all HIV-infected inmates at entry in any correctional system is recommended to identify those in need of specific care and/or preventing interventions. PMID: 18464061 [PubMed - indexed for MEDLINE]

75. Epidemiol Infect. 2008 Dec;136(12):1644-9. doi: 10.1017/S0950268808000502. Epub 2008 Mar 17. Modelling alternative strategies for delivering hepatitis B vaccine in prisons: the impact on the vaccination coverage of the injecting drug user population. Sutton AJ, Gay NJ, Edmunds WJ, Gill ON. Modelling and Economics Department, Health Protection Agency, Centre for Infections, Colindale, London, UK. Andrew.Sutton@warwick.ac.uk Since 2001 hepatitis B vaccination has been offered to prisoners on reception into prisons in England and Wales. However, short campaigns of vaccinating the entire population of individual prisons have achieved high vaccination coverage for limited periods, suggesting that short campaigns may be a preferable way of vaccinating prisoners. A model is used that describes the flow of prisoners through prisons stratified by injecting status to compare a range of vaccination scenarios that describe vaccination on prison reception or via regular short campaigns. Model results suggest that vaccinating on prison reception can capture a greater proportion of the injecting drug user (IDU) population than the comparable campaign scenarios (63% vs. 55.6% respectively). Vaccination on prison reception is also more efficient at capturing IDUs for vaccination than vaccination via a campaign, although vaccination via campaigns may have a role with some infections for overall control. PMCID: PMC2870786 PMID: 18346286 [PubMed - indexed for MEDLINE] 76. BMC Infect Dis. 2008 Mar 7;8:33. doi: 10.1186/1471-2334-8-33. Correlates of HIV, HBV, HCV and syphilis infections among prison inmates and officers in Ghana: A national multicenter study. Adjei AA, Armah HB, Gbagbo F, Ampofo WK, Boamah I, Adu-Gyamfi C, Asare I, Hesse IF, Mensah G. Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana. andrewadjei50@hotmail.com BACKGROUND: Prisons are known to be high-risk environments for the spread of bloodborne and sexually transmitted infections. Prison officers are considered to have an intermittent exposure potential to bloodborne infectious diseases on the job, however there has been no studies on the prevalence of these infections in

prison officers in Ghana. METHODS: A national multicenter cross-sectional study was undertaken on correlates of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis infections in sample of prison inmates and officers from eight of ten regional central prisons in Ghana. A total of 1366 inmates and 445 officers were enrolled between May 2004 and December 2005. Subjects completed personal risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for presence of antibodies to HIV, HCV and Treponema pallidum; and surface antigen of HBV (HBsAg). These data were analyzed using both univariate and multivariate techniques. RESULTS: Almost 18% (1336) of 7652 eligible inmates and 21% (445) of 2139 eligible officers in eight study prisons took part. Median ages of inmates and officers were 36.5 years (range 16-84) and 38.1 years (range 25-59), respectively. Among inmates, HIV seroprevalence was 5.9%, syphilis seroprevalence was 16.5%, and 25.5% had HBsAg. Among officers tested, HIV seroprevalence was 4.9%, HCV seroprevalence was 18.7%, syphilis seroprevalence was 7.9%, and 11.7% had HBsAg. Independent determinants for HIV, HBV and syphilis infections among inmates were age between 17-46, being unmarried, being illiterate, female gender, being incarcerated for longer than median time served of 36 months, history of homosexuality, history of intravenous drug use, history of sharing syringes and drug paraphernalia, history of participation in paid sexual activity, and history of sexually transmitted diseases. Independent determinants for HIV, HBV, HCV and syphilis infections among officers were age between 25-46, fale gender, being unmarried, being employed in prison service for longer than median duration of employment of 10 years, and history of sexually transmitted diseases. CONCLUSION: The comparably higher prevalence of HIV, HBV, HCV and syphilis in prison inmates and officers in Ghana suggests probable occupational related transmission. The implementation of infection control practices and risk reduction programs targeted at prison inmates and officers in Ghana is urgently required to address this substantial exposure risk. PMCID: PMC2311310 PMID: 18328097 [PubMed - indexed for MEDLINE] 77. Aust N Z J Public Health. 2008 Feb;32(1):73-80. doi: 10.1111/j.1753-6405.2008.00169.x. The physical health status of young Australian offenders. Butler T, Belcher JM, Champion U, Kenny D, Allerton M, Fasher M. National Drug Research Institute, Curtin University, Perth, Western Australia. tbutler2@optusnet.com.au AIMS: To describe the socio-economic background and physical health status of

young offenders in custody in New South Wales (Australia). DESIGN: Cross-sectional survey of all young offenders held at nine juvenile detention centres across New South Wales (NSW) (eight male and one female) between January and March 2003. METHODS: Demographic and health information was collected by nurse interviewers and psychologists using a face-to-face interview. Blood and urine samples were collected to screen for blood-borne viruses and sexually transmissible infections. RESULTS: The final sample comprised 242 young people (223 males and 19 females). Overall, 90% of those assessed rated their general health as 'excellent', 'very good' or 'good'. Sixty-nine (30%) young offenders reported that they had been previously diagnosed with asthma. Two young women reported a past diagnosis of diabetes with the results of the random blood glucose testing indicating that a further six young people required testing for possible diabetes. None of those tested were positive for HIV, 9% tested positive for hepatitis C antibody, and 11% tested positive for hepatitis B core-antibody. CONCLUSIONS: Our findings indicate that young offenders in New South Wales have backgrounds characterised by extreme disadvantage (poor educational attainment, unemployment, and care placements) and poor physical health. Parental incarceration was common to 43% of the sample. Our findings reinforce the concept that for marginalised groups, contact with the criminal justice system represents an important opportunity to detect illness, initiate treatment, and promote contact with health services. PMID: 18290917 [PubMed - indexed for MEDLINE] 78. AIDS Care. 2008 Jan;20(1):124-9. doi: 10.1080/09540120701426532. Psychiatric disorders, HIV infection and HIV/hepatitis co-infection in the correctional setting. Baillargeon JG, Paar DP, Wu H, Giordano TP, Murray O, Raimer BG, Avery EN, Diamond PM, Pulvino JS. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555-1006, USA. jbaillar@utmb.edu Psychiatric disorders such as bipolar disorder, schizophrenia and depression have long been associated with risk behaviors for HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV). The US prison population is reported to have elevated rates of HIV, hepatitis and most psychiatric disorders. This study examined the association of six major psychiatric disorders with HIV mono-infection, HIV/HCV co-infection and HIV/HBV co-infection in one of the nation's largest prison populations. The study population consisted of 370,511 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January

1, 2003 and July 1, 2006. Information on medical conditions and sociodemographic factors was obtained from an institution-wide electronic medical information system. Offenders diagnosed with HIV mono-infection, HIV/HCV, HIV/HBV and all HIV combined exhibited elevated rates of major depression, bipolar disorder, schizophrenia, schizoaffective disorder, non-schizophrenic psychotic disorder and any psychiatric disorder. In comparison to offenders with HIV mono-infection, those with HIV/HCV co-infection had an elevated prevalence of any psychiatric disorder. This cross-sectional study's finding of positive associations between psychiatric disease and both HIV infection and hepatitis co-infection among Texas prison inmates holds both clinical and public health relevance. It will be important for future investigations to examine the extent to which psychiatric disorders serve as a barrier to medical care, communication with clinicians and adherence to prescribed medical regimens among both HIV-mono-infected and HIV/hepatitis-co-infected inmates. PMID: 18278623 [PubMed - indexed for MEDLINE] 79. Rev Esp Sanid Penit. 2008 Feb;10(3):73-9. doi: 10.4321/S1575-06202008000300003. [HIV, hepatitis B and syphilis infection in inmates of Venezuela's prisons, 1998-2001]. [Article in Spanish] Posada A, Daz Tremarias M. Universidad Central de Venezuela, Venezuela. Objective: To determine the prevalence of HIV, Hepatitis B and syphilis amongst inmates during the time period 1998-2001. Materials and Methods: Descriptive, cross-sectional study carried out at 6 prisons using a volunteer sample of 1773 inmates. Blood samples were gathered and analysed using enzyme linked immunoassays (ELISA) and RPR screening tests to identify the presence of HIV antibodies, Hepatitis B anti-core antibodies and treponema pallidum. Results: 456 cases gave a positive response to tests, 70 (4,0%) of which gave positive results for HIV, 280 (16,2%) for Hepatitis B and 106 (6,1%) for syphilis. The greatest percentage of HIV cases were found amongst the youngest inmates (18 to 37 years). The number of Hepatitis B cases increased progressively in line with age until reaching a maximum percentage in the 48-57 age group. No significant statistical difference for age was observed in syphilis cases, but differences were found amongst HIV positive and Hepatitis B cases for age, length of sentence and number of prisons where inmate resided. PMID: 23128373 [PubMed]

80. Pediatrics. 2008 Jan;121 Suppl 1:S55-62. doi: 10.1542/peds.2007-1115G. Vaccinating adolescents in high-risk settings: lessons learned from experiences with hepatitis B vaccine. Sneller VP, Fishbein DB, Weinbaum CM, Lombard A, Murray P, McLaurin JA, Friedman L; Working Group on Vaccination of High-Risk Adolescents. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. Meeting the health needs of adolescents who live in high-risk settings such as homeless shelters, migrant camps, juvenile detention centers, prisons, and other types of residential facilities presents many challenges. Although there is no doubt that adolescents in many high-risk settings are at increased risk for hepatitis B and human papillomavirus, acute medical and psychological problems may consume all of the provider's time and resources. Potential health threats such as vaccine-preventable diseases must necessarily be given lower priority. Lack of vaccination expertise, supplies, and access to records further complicate delivery of vaccines. Since the 1990s, a number of approaches have been used to deliver hepatitis B vaccine to adolescents in many high-risk settings. Close collaboration among state and federal programs, local health departments, and community-based organizations has been necessary to introduce and sustain the delivery of vaccines to these young people. Medicaid, Statute 317 of the Public Health Service Act, the Vaccines for Children program, and State Children's Health Insurance Program have been used to finance vaccinations for adolescents 18 years or younger, and the expanded Medicaid option in the Foster Care Independence Act of 1999 has been used for adolescents older than 18 years of age. A number of states allow adolescents under age 18 to consent to their own hepatitis B vaccination under laws passed to allow treatment of sexually transmitted infections without parental consent. In this article, we present the experiences of several model programs that developed successful hepatitis B vaccination programs in venues that serve adolescents at risk, the important role of state laws and state agencies in funding immunization and other preventive health services for adolescents in high-risk situations, and discuss barriers and means to resolve them. PMID: 18174322 [PubMed - indexed for MEDLINE] 81. Clin Infect Dis. 2007 Oct 15;45(8):1047-55. Epub 2007 Sep 6. Infection control in jails and prisons.

Bick JA. California Medical Facility, California Department of Corrections and Rehabilitation, Vacaville, CA 95696, USA. joseph.bick@cdcr.ca.gov At the end of 2005, approximately 7 million people (or 1 of every 33 American adults) were either in jail, in prison, or on parole. Compared with the general public, newly incarcerated inmates have an increased prevalence of human immunodeficiency virus infection, hepatitis B virus infection, hepatitis C virus infection, syphilis, gonorrhea, chlamydia, and Mycobacterium tuberculosis infection. While incarcerated, inmates are at an increased risk for the acquisition of blood-borne pathogens, sexually transmitted diseases, methicillin-resistant Staphylococcus aureus infection, and infection with airborne organisms, such as M. tuberculosis, influenza virus, and varicella-zoster virus. While incarcerated, inmates interact with hundreds of thousands of correctional employees and millions of annual visitors. Most inmates are eventually released to interact with the general public. Tremendous opportunities exist for infectious diseases specialists and infection-control practitioners to have an impact on the health of correctional employees, the incarcerated, and the communities to which inmates return. This article presents a brief review of some of the most important infection-control challenges and opportunities within the correctional setting. PMID: 17879924 [PubMed - indexed for MEDLINE] 82. J Public Health (Oxf). 2007 Dec;29(4):429-33. Epub 2007 Sep 18. Predictors of hepatitis B vaccination in women prisoners in two prisons in England. Plugge EH, Yudkin PL, Douglas N. Department of Public Health, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, UK. emma.plugge@dphpc.ox.ac.uk BACKGROUND: Hepatitis B is an important public health issue, especially in the female prison population. The high prevalence in this population is largely accounted for by the high rates of injecting drug use and the fact that these women are more likely to exchange sex for drugs or money and practice unprotected sex. There is a national programme in English prisons to vaccinate everyone against Hepatitis B. This study aimed to investigate whether women who had been in prison before were more likely to have been vaccinated against hepatitis B and whether contact with community services was more likely to predict hepatitis B vaccination.

METHODS: A questionnaire survey of new entrants into two women's prisons in England. RESULTS: Four hundred and eighty seven out of 613 women approached completed the questionnaire and gave complete data on hepatitis B vaccination status, giving a response rate of 79.4%. One hundred and thirty three women (27.3%) had received at least three vaccinations against hepatitis B. Previous imprisonment and intravenous drug use were independent predictors of vaccination. Six months or more in prison greatly increased an individual's odds of being immunized [odds ratio 12.01 (95% confidence interval (CI) 5.53-26.10)]. Registration with a general practitioner (GP), contact with drug or alcohol services and exchanging money or goods for sex were not independently associated with vaccination status. CONCLUSION: Prisons play an important role in the delivery of hepatitis B vaccination. However, this should not prevent providers of health services making greater efforts to engage this marginalized group and to ensure that they receive an appropriate level of healthcare in the community. PMID: 17878212 [PubMed - indexed for MEDLINE] 83. J Med Virol. 2007 Nov;79(11):1674-8. High prevalence of occult hepatitis B virus infection in Taiwanese intravenous drug users. Lin CL, Liu CJ, Chen PJ, Lai MY, Chen DS, Kao JH. Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan. The epidemiology and impact of occult HBV infection in intravenous drug users remain largely unknown. The aim of the study was to investigate the prevalence of occult HBV infection among intravenous drug users in Taiwan. Molecular assays were used to determine the level of serum HBV DNA and the genotype in 304 intravenous drug users negative for both HBsAg and anti-HCV. Of 304 intravenous drug users, 125 (41.1%) were positive for serum HBV DNA. The genotype distribution of HBV was as follows: B, 55 (44%); C, 29 (23%); and mixed B and C infections, 41 (33%). The mean and median serum HBV DNA levels in 125 intravenous drug users with occult HBV infection were 4.0 +/- 0.6 and 4.0 log(10) copies/ml, respectively. The mean serum HBV DNA level in carriers with mixed genotype B and C infections was significantly higher than those infected with HBV genotype B or genotype C alone (mean, 4.2 +/- 0.6 log(10) vs. 3.9 +/- 0.5 log(10), and 3.9 +/0.7 log(10) copies/ml, P = 0.01 and 0.05, respectively). The amino acid sequence determination of HBV surface gene in 20 intravenous drug users with occult HBV infection selected at random showed no mutation of amino acid at codon 145. In conclusion, the prevalence of occult HBV infection and mixed HBV genotype infections are not uncommon in intravenous drug users residing in an HBV endemic

areas. In addition, intravenous drug users with occult mixed genotype B and C infections have significantly higher viral loads than those with occult infection of single HBV genotype. (c) 2007 Wiley-Liss, Inc. PMID: 17854041 [PubMed - indexed for MEDLINE] 84. J Viral Hepat. 2007 Sep;14(9):653-60. Hepatitis B vaccine uptake among injecting drug users in England 1998 to 2004: is the prison vaccination programme driving recent improvements? Hope VD, Ncube F, Hickman M, Judd A, Parry JV. Centre for Infections, Health Protection Agency, Colindale, London, UK. vivian.hope@hpa.org.uk In 1999, the Department of Health allocated additional funding to Health Authorities in England to expand hepatitis B immunization among injecting drug users (IDUs), with the aim of increasing coverage by 20%. In 2001, a vaccination programme for prison inmates in England was also instigated. Between 1998 and 2004 current IDUs participated in a series of annual unlinked anonymous surveys that recorded vaccine uptake (n = 11 383). The proportion self-reporting vaccine uptake rose significantly from 27% in 1998 to 59% in 2004 [adjusted odds ratio: 3.7 (95% CI 3.2-4.3); increase in uptake of 25% per annum (95% CI 22-27%)]. A second survey, which recruited 852 current IDUs from community settings in 2003/04, found that prisons were the most common source (38%) of vaccine doses, followed by drug services (28%) and general practitioners (17%), with only 14% receiving doses through needle exchanges. These data suggest that the 20% target of improving vaccination coverage has been met, with the prison vaccination programme likely to have made a substantive contribution in recent years. However, prevalence of antibodies to the hepatitis B core antigen was stable (21%) and is currently similar among the vaccinated and unvaccinated. Consideration needs to be given to improving community vaccination provision for IDUs, targeting recent initiates, and determining when surveillance data should indicate reductions in infection so that the effectiveness of the targeted strategy can be assessed. PMID: 17697018 [PubMed - indexed for MEDLINE] 85. Int J Drug Policy. 2007 Mar;18(2):129-35. Epub 2006 Dec 19. Implementation of harm reduction in Central and Eastern Europe and Central Asia.

Sarang A, Stuikyte R, Bykov R. Russian Harm Reduction Network, Moscow, Russia. anyasarang@mail.ru <anyasarang@mail.ru> Harm reduction (HR) interventions began in Central-Eastern Europe and Central Asia in the mid-1980s with the establishment of substitution treatment (ST) in Yugoslavia. In the mid-1990s, the first needle and syringe programmes (NSPs) opened in selected countries following the outbreaks of HIV among injecting drug users (IDUs). The number of NSPs continues to increase via a combination of international and state funding with large expansions made possible via the Global Fund to Fight AIDS, Tuberculosis and Malaria. While ST is still unaccepted in several countries, others have made some progress which is especially visible in South Eastern and Central Europe and the Baltic States. Development of regional networking including Central and Eastern European HR Network and a number of national networks helped to coordinate joint advocacy effort and in some cases sustain HR services. Activism of drug users and people living with HIV (PLWH) increased in the region in the last several years and helped to better link HR with the affected communities. Still a number of challenges remain important for the movement today such as repressive drug policies; stigma and discrimination of IDUs, PLWH, sex workers and inmates, including poor access to prevention and treatment; lack of important components of HR work such as naloxone distribution and hepatitis B vaccination, prevention in prisons; issues of quality control; sustaining services after finishing of major international projects; reaching of adequate coverage and others. PMID: 17689355 [PubMed - indexed for MEDLINE] 86. Int J Infect Dis. 2008 Jan;12(1):51-6. Epub 2007 Jul 23. Risk factors and algorithms to identify hepatitis C, hepatitis B, and HIV among Georgian tuberculosis patients. Kuniholm MH, Mark J, Aladashvili M, Shubladze N, Khechinashvili G, Tsertsvadze T, del Rio C, Nelson KE. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Suite E7133, 615 N. Wolfe St., Baltimore, MD 21205, USA. mkunihol@jhsph.edu OBJECTIVES: To determine prevalence, risk factors, and simple identification algorithms for HIV, hepatitis B, and hepatitis C co-infection; factors that may predispose for anti-tuberculosis therapy-induced hepatotoxicity. METHODS: We recruited 300 individuals at in-patient tuberculosis hospitals in three cities in Georgia, administered a behavioral questionnaire, and tested for

antibody to HIV, hepatitis C (HCV), hepatitis B core antigen (anti-HBc), and the hepatitis B surface antigen (HBsAg). RESULTS: Of the individuals tested, 0.7% were HIV positive, 4.3% were HBsAg positive, 8.7% were anti-HBc positive, and 12.0% were HCV positive. In multivariable analysis, a history of blood transfusion, injection drug use, and prison were significant independent risk factors for HCV, while a history of blood transfusion, injection drug use, younger age at sexual debut, and a high number of sex partners were significant risk factors for HBV. Three-questionnaire item algorithms predicted HCV serostatus 74.1% of the time and HBV serostatus 85.2% of the time. CONCLUSIONS: Treatment of tuberculosis patients in resource-limited countries with concurrent epidemics of HCV, HBV, and HIV may be associated with significant hepatotoxicity. Serologic screening of tuberculosis patients for HBV, HCV, and HIV or using behavioral algorithms to identify patients in need of intensive monitoring during anti-tuberculosis therapy may reduce this risk. PMCID: PMC2649965 PMID: 17644020 [PubMed - indexed for MEDLINE] 87. J Formos Med Assoc. 2007 Jun;106(6):467-74. Gender difference in the clinical and behavioral characteristics of human immunodeficiency virus-infected injection drug users in Taiwan. Cheng SH, Chiang SC, Hsieh YL, Chang YY, Liu YR, Chu FY. Yangmei Township Public Health Center, Public Health Bureau, Taoyuan County Government, Taoyuan, Taiwan. BACKGROUND/PURPOSE: Injection drug users (IDUs) have become the major contributors to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome epidemic in Taiwan, accounting for more than 60% of new cases in 2005. In Taiwan, gender difference in risk factors for HIV among IDUs has not been reported before. We studied the clinical and sociodemographic characteristics, sexual behaviors, drug use histories and criminal records of male and female HIV-infected IDUs. METHODS: A total of 100 male and 25 female HIV-infected inmates from two prisons were included. An individually structured interview was conducted with each inmate. Serostatus of hepatitis B virus (HBV) and hepatitis C virus (HCV) were tested. CD4+ T cell count and HIV viral load were also evaluated. RESULTS: The mean age of the HIV-infected inmates was 31.7 +/- 6.4 years. All inmates were co-infected with HCV and 20% were HBV carriers. The mean CD4+ T cell count was 498 cells/microL, and the mean viral load was 20,119 copies/mL. Heroin use history averaged 6.3 +/- 5.1 years, and 84.8% of patients had a previous criminal offense prior to current conviction. Female inmates were significantly

younger, had more sexual partners, had more drug-using family members or sexual partners, shared injection paraphernalia more frequently, and started using methamphetamine and heroin at younger ages (p < 0.05). Male inmates tended to be single, had less parental support, had been more frequently convicted of non drug-related crimes, started using non-illicit substances more frequently at younger ages and had sex with prostitutes more frequently (p < 0.05). CONCLUSION: The results of this study suggest that drug injection risks and sexual behavior related risks are equally important in determining the risk of HIV infection among IDUs. Gender-specific approaches to prevention which reflect differences in gender-related patterns of risk are also needed. PMID: 17588840 [PubMed - indexed for MEDLINE] 88. Aust N Z J Public Health. 2007 Apr;31(2):127-30. Evaluation of a prison-based hepatitis B immunisation pilot project. Devine A, Karvelas M, Sundararajan V. Victorian Public Health Training Scheme. devinea@unimelb.edu.au This paper describes the evaluation findings of a hepatitis B immunisation pilot project, which aimed to increase the uptake and compliance of hepatitis B vaccinations among female prisoners in Victoria. The evaluation used a mixed methods approach including in-depth interviews, focus group discussions and an analysis of quantitative data. Fifty-five per cent of potential participants (391/712) were offered hepatitis B immunisation. Of those offered immunisation, 204 were eligible for immunisation and 169 (83%) received the first dose. Ninety-three per cent of eligible women received two doses and 84% completed the three-dose series. Lessons learnt from the pilot led to the revision of key prison hepatitis B immunisation policies and practices to ensure uniformity across Victorian prisons. PMID: 17461002 [PubMed - indexed for MEDLINE] 89. Intern Med J. 2007 Jul;37(7):472-7. Epub 2007 Apr 16. Viral hepatitis among male amphetamine-inhaling abusers. Lai SW, Chang WL, Peng CY, Liao KF. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.

BACKGROUND: Few studies have focused on the clandestinely consumed amphetamine as a primary drug. The purpose of this study was to estimate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and the related factors in male amphetamine-inhaling abusers. METHODS: This was a cross-sectional study. From November 2004 to February 2005, 285 amphetamine-inhaling male subjects at one prison in Taiwan and 285 age-matched healthy men without history of using illicit drugs or tattooing were enrolled. A face-to-face interview focusing on amphetamine-addicted history and sociodemographic information was used. Hepatitis B surface antigen (HBsAg) and anti-HCV were tested. RESULTS: The mean age of the subjects was 34.1 +/- 8.6 years (range 17-75 years). Among 285 subjects, 13.3% were positive for HBsAg, 20.0% positive for anti-HCV and 2.5% positive for combined HBsAg and anti-HCV. Multivariate logistic regression analysis showed that tattoo (odds ratio (OR) 2.97, 95% confidence interval (CI) 1.37-6.43) and elevated alanine aminotransferase (ALT) (OR 3.15, 95% CI 1.49-6.66) were independently related to persons being anti-HCV positive. Elevated ALT was related to persons being HBsAg positive (OR 2.60, 95% CI 1.15-5.89). CONCLUSION: Screening of HBV and HCV infection among amphetamine-inhaling abusers remains necessary. Tattoo and elevated ALT are identified as the related factors for being anti-HCV positive. Elevated ALT is the related factor for being HBsAg positive. PMID: 17445007 [PubMed - indexed for MEDLINE] 90. HIV AIDS Policy Law Rev. 2006 Dec;11(2-3):23-4. Federal prison guards call for power to test prisoners for HIV. Betteridge G. The union representing federal prison guards is lobbying the government to amend the Corrections and Conditional Release Act (CCRA) to permit prison staff to apply for orders to test prisoners for HIV and the hepatitis B and C viruses. This article summarizes the union's proposal and the Legal Network's response. PMID: 17373062 [PubMed - indexed for MEDLINE] 91. Euro Surveill. 2007 Jan 20;12(1). [Epub ahead of print] Hepatitis and HIV in Northern Ireland prisons: a cross-sectional study.

Danis K, Doherty L, McCartney M, McCarrol J, Kennedy H. EPIET fellow, Communicable Disease Surveillance Centre-Northern Ireland. A study was undertaken in Northern Ireland (NI) prisons to (i) determine prevalence of bloodborne viruses among inmates, (ii) estimate the extent of self-reported risk behaviours. All three prisons in NI were included in the study. Outcome measures included (i) antibodies to hepatitis C (HCV), hepatitis B (HBV) core antigen, HIV, (ii) self-reported risk behaviour. Five prisoners (0.75 %) tested positive for HBV, seven (1.1%) for HCV and none for HIV. Eleven per cent reported ever having injected drugs. Of these, 20% had started injecting while in prison, and 12% shared injecting equipment in prison. Two per cent had completed HBV immunisation. Injecting drugs was associated with HCV (adjusted prevalence ratio=5.2; 95% CI 0.9-16) and HBV infection (adjusted prevalence ratio=4.1; 95% CI 0.7-23). The low prevalence of bloodborne viruses within NI prisons is not consistent with findings of studies in other countries, possibly reflecting the unique sociopolitical situation in NI. In spite of knowledge of the risks of transmission of bloodborne viruses in prison, high-risk practices are occurring. Preventing risk behaviours and transmission of infection in prisons now poses a challenge for health services in the United Kingdom. PMID: 17370979 [PubMed - as supplied by publisher] 92. Aust N Z J Public Health. 2007 Feb;31(1):44-50. The 2004 Australian prison entrants' blood-borne virus and risk behaviour survey. Butler T, Boonwaat L, Hailstone S, Falconer T, Lems P, Ginley T, Read V, Smith N, Levy M, Dore G, Kaldor J. Centre for Health Research in Criminal Justice and School of Public Health and Community Medicine, University of New South Wales, Eastgardens. tony.butler@justicehealth.nsw.gov.au OBJECTIVES: To assess the prevalence of blood-borne viruses and associated risk factors among prison entrants at seven Australian prisons across four States. DESIGN: Consecutive cross-sectional design. Voluntary confidential testing of all prison entrants for serological markers of human immunodeficiency virus (HIV), hepatitis C (HCV) and hepatitis B (HBV) over 14 consecutive days in May 2004. Demographic data and data related to risks for blood-borne virus transmission, such as sexual activity, body piercing, tattooing, and injecting drug use, were collected. RESULTS: National prevalence for HIV was 1%, hepatitis B core antibody 20%, and hepatitis C antibody 34%. Fifty-nine per cent of participants had a history of injecting drug use. Among injecting drug users, the prevalence of HIV was 1%,

hepatitis C antibody 56%, and hepatitis B core antibody 27%. Forty-one per cent of those screened reported a previous incarceration. In the multivariate model, Queensland and Western Australian (WA) prison entrants were significantly less likely to test positive to HCV than those in New South Wales (NSW). Amphetamine was the most commonly injected drug in Queensland, Tasmania and WA. In NSW, heroin was the most common drug injected. In the multivariate analysis a history of injecting drug use, being aged 30 years or more, and a prior incarceration were positively associated with hepatitis C infection. For hepatitis B core antibody, age over 30 years and a history of injecting drug use were associated with an increased risk. CONCLUSIONS: The findings support the view that prisoner populations are vulnerable to blood-borne virus infection, particularly hepatitis B and C. Prisoner populations should be included in routine surveillance programs so as to provide a more representative picture of blood-borne virus epidemiology in Australia. PMID: 17333608 [PubMed - indexed for MEDLINE] 93. Public Health Rep. 2007 Jan-Feb;122(1):44-8. Vaccination in juvenile correctional facilities: state practices, hepatitis B, and the impact on anticipated sexually transmitted infection vaccines. Tedeschi SK, Bonney LE, Manalo R, Mayer KH, Shepardson S, Rich JD, Lally MA. The Miriam Hospital, Providence, RI 02906, USA. OBJECTIVES: Juvenile correctional facilities are an ideal setting to provide preventive vaccines to adolescents who are at risk. In many instances of incarceration, facilities overcome the need for parental consent by making young people wards of the state and the state providing consent. The authors investigated current state practices for administering hepatitis B vaccine to incarcerated adolescents. These may impact the delivery of anticipated sexually transmitted infection (STI) vaccines to incarcerated adolescents. METHODS: From June to August 2004, interviews were conducted with state Immunization Program Managers by telephone about hepatitis B vaccination and consent policies in juvenile correctional facilities. RESULTS: Forty-five states were able to provide information about hepatitis B immunization in publicly funded juvenile correctional facilities. Forty-one of the 45 states offered hepatitis B vaccine to adolescents who were sentenced and thereby considered to be wards of the state. Of those 41 states, 20 also made hepatitis B vaccine easily accessible to detained adolescents (no parental consent required). Those 20 states considered detained adolescents as wards of the state (n=13), or allowed them to self-consent for the vaccine (n=7). CONCLUSIONS: Most states offer hepatitis B vaccination to sentenced adolescents

in correctional facilities. Just over half of these states also vaccinate detained adolescents. Juvenile correctional facilities have experience administering vaccines, and this might allow for expansion of vaccination services when new STI vaccines become available. Still, there are major barriers to universal vaccination of incarcerated adolescents, including the issue of consent. PMCID: PMC1802118 PMID: 17236607 [PubMed - indexed for MEDLINE] 94. Infect Control Hosp Epidemiol. 2007 Jan;28(1):24-30. Epub 2006 Dec 29. Prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers. Gershon RR, Sherman M, Mitchell C, Vlahov D, Erwin MJ, Lears MK, Felknor S, Lubelczyk RA, Alter MJ. Mailman School of Public Health, Columbia University, New York, NY 10032, USA. rg405@columbia.edu OBJECTIVE: To determine the prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers (CHCWs).Design. Cross-sectional risk assessment study with a confidential questionnaire and serological testing performed during 1999-2000. SETTING: Correctional systems in 3 states. RESULTS: Among 310 participating CHCWs, the rate of percutaneous injury (PI) was 32 PIs per 100 person-years overall and 42 PIs per 100 person-years for CHCWs with clinical job duties. Underreporting was common, with only 25 (49%) of 51 PIs formally reported to the administration. Independent risk factors for experiencing PI included being age 45 or older (adjusted odds ratio [aOR], 2.41 [95% confidence interval (CI), 1.31-4.46]) and having job duties that involved needle contact (aOR, 3.70 [95% CI, 1.28-10.63]) or blood contact (aOR, 5.05 [95% CI, 1.45-17.54]). Overall, 222 CHCWs (72%) reported having received a primary hepatitis B vaccination series; of these, 150 (68%) tested positive for anti-hepatitis B surface antigen, with negative results significantly associated with receipt of last dose more than 5 years previously. Serologic markers of hepatitis B virus infection were identified in 31 individuals (10%), and the prevalence of hepatitis C virus infection was 2% (n=7). The high hepatitis B vaccination rate limited the ability to identify risk factors for infection, but hepatitis C virus infection correlated with community risk factors only. CONCLUSION: Although the wide coverage with hepatitis B vaccination and the decreasing rate of hepatitis C virus infection in the general population are encouraging, the high rate of exposure in CHCWs and the lack of exposure documentation are concerns. Continued efforts to develop interventions to reduce

exposures and encourage reporting should be implemented and evaluated in correctional healthcare settings. These interventions should address infection control barriers unique to the correctional setting. PMID: 17230384 [PubMed - indexed for MEDLINE] 95. J Med Virol. 2007 Feb;79(2):167-73. Human herpesvirus 8 and human herpesvirus 2 infections in prison population. Sarmati L, Babudieri S, Longo B, Starnini G, Carbonara S, Monarca R, Buonomini AR, Dori L, Rezza G, Andreoni M; Gruppo di Lavoro Infettivologi Penitenziari (GLIP). Clinic of Infectious Diseases, University of Tor Vergata, Rome, Italy. Incarcerated persons have high rates of infectious diseases. Few data on the prevalence of sexually transmitted diseases in prisoners are available. This multi-center cross-sectional study enrolled 973 inmates from eight Italian prisons. Demographic and behavioral data were collected using an anonymous standardized questionnaire and antibodies to HIV, HCV, HBV, HSV-2, and HHV-8 were detected in a blood sample obtained from each person at the time of the enrollment in the study. Two hundred and two out of the 973 subjects (20.7%) had antibodies against HHV-8. HHV-8-seropositive subjects were more likely to be older than 30 years with a higher educational level. HHV-8 infection was associated significantly with HBV (P < 0.001) and HSV-2 (P = 0.004) seropositivity and with previous imprisonments. Multivariate analysis showed that HHV-8 infection in Italian inmates was associated with HBV (P < 0.001) and HSV-2 (P = 0.002) seropositivity otherwise among foreigners inmates HHV-8 was significantly associated with HBV infection (P = 0.05). One hundred and eighty-six (21.2%) prisoners had anti-HSV-2 antibodies. At multivariate analysis HSV-2-positivity was significantly associated with HIV (P < 0.001) and HHV-8 infections (P = 0.003), whereas it was inversely associated with HCV infection (0.004). A relatively high seroprevalence of HHV-8 and HSV-2 among Italian prison inmates was found. The association of HHV-8 and HSV-2 infections suggest sexual transmission of these viruses among Italian prison inmates. PMID: 17177300 [PubMed - indexed for MEDLINE] 96. Am J Infect Control. 2006 Aug;34(6):399. Hepatitis B vaccination in correctional health care workers. Lara GM, Barcillos NT, Fuchs SC, Tudesco DS.

Comment on Am J Infect Control. 2005 Nov;33(9):510-8. PMID: 16877112 [PubMed - indexed for MEDLINE] 97. Epidemiol Infect. 2007 Feb;135(2):274-80. Epub 2006 Jul 7. Prevalence of hepatitis C in a German prison for young men in relation to country of birth. Meyer MF, Wedemeyer H, Monazahian M, Dreesman J, Manns MP, Lehmann M. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany. A high prevalence of hepatitis C (HCV) virus infection of up to 80% has been reported for injecting drug users (IDUs) in prison communities. However, there are only very limited data available on the prevalence and course of HCV in young offenders. We performed a study on hepatitis C markers in the largest German Young Offenders' Institution (YOI), a prison for men (aged 16-24 years). In 2002, all 1176 incoming offenders were asked to participate in the study of whom >95% agreed. Ninety-seven inmates (8.6%) tested positive for anti-HCV or HCV RNA, 79% of whom were viraemic. None of the patients had evidence of cirrhosis at presentation. Interestingly, six individuals (6%) tested positive for HCV RNA in the absence of anti-HCV antibodies, four of whom cleared HCV spontaneously during follow-up without either clinical signs of acute hepatitis or developing HCV antibodies. Hepatitis C markers were significantly more prevalent among immigrants from the former Soviet Union (NIS) than among German inmates (31% vs. 6% respectively, P<0.0001). HIV co-infection was found in five individuals, all of whom were German. In contrast, hepatitis B surface antigen (HBsAg) was detected in five NIS immigrants, one Lebanese and one German inmate. HCV genotypes 2 and 3 were more prevalent in immigrants than in German inmates, while biochemical parameters did not differ significantly between the two groups. In conclusion, the prevalence of hepatitis C was relatively low among inmates of German YOIs although there were significant differences in relation to the country of birth. Our data highlight the need for educational programmes for young offenders in order to prevent the further spread of HCV. PMCID: PMC2870573 PMID: 16824250 [PubMed - indexed for MEDLINE] 98. Scand J Gastroenterol. 2006 Aug;41(8):969-73.

Screening for viral hepatitis among male non-drug-abuse prisoners. Liao KF, Lai SW, Chang WL, Hsu NY. Department of Internal Medicine, Taichung Prison, and Department of Surgery, China Medical University Hospital, Taiwan. OBJECTIVE: To describe the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and the associated risk factors in a prison population. MATERIAL AND METHODS: In this cross-sectional study, from November 2004 to February 2005, all 297 newly sentenced prisoners (mean age 37.5+/-11.7 years, age range 16-69 years), who had never used illicit drugs received routine blood check-ups and completed a face-to-face interview. Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies were tested using the t-test, chi-square test, and logistic regression. RESULTS: Among the 297 subjects, 13.1% were positive for HBsAg, 8.4% were positive for anti-HCV, and 1.7% were positive for combined HBsAg and anti-HCV. Logistic regression analysis demonstrated that tattooing (odds ratio=2.24, 95% CI=1.03-4.88) and an elevated alanine aminotransferase (ALAT) level (odds ratio=4.10, 95% CI=1.61-10.40) were independently related to HCV infection. CONCLUSIONS: Screening of HBV and HCV infection in prison populations remains necessary. Tattooing and elevated ALAT level are identified as the related factors of HCV infection. PMID: 16803696 [PubMed - indexed for MEDLINE] 99. J Addict Dis. 2006;25(2):25-32. Hepatitis and human immunodeficiency virus co-infection among injection drug users in Los Angeles County, California. Fisher DG, Reynolds GL, Jaffe A, Perez MJ. Center for Behavioral Research and Services, California State University, Long Beach, CA 90813, USA. fisher@csulb.edu This study examined the prevalence of hepatitis A (HAV), B (HBV), C (HCV), and Human Immunodeficiency Virus (HIV) co-infection among Injection Drug Users (IDUs) in Los Angeles County, California, and predictors of multiple infections in this population. Six hundred seventy-nine IDUs were recruited from October 2002 through June 2004. Participants completed questionnaires to elicit demographic, drug and sex risk information, and were tested for hepatitis A, B, C and HIV.A linear regression model predicting the total number of infections (0 to 4 possible) was constructed. Significant associations were found between HAV and HBV infection, HAV and HCV infection, and HBV and HCV infection. Predictors of

total co-infections included age of first injection, lifetime years in jail, and Hispanic ethnicity. Latinos had the highest proportion of HAV and HBV co-infection with HCV. The total number of co-infections, especially those co-infected with all three of the hepatitis infections, was unexpectedly high. PMID: 16785216 [PubMed - indexed for MEDLINE] 100. Eur J Epidemiol. 2006;21(5):383-7. Epub 2006 Jun 9. Surveillance of HIV and viral hepatitis by analysis of samples from drug related deaths. Christensen PB, Kringsholm B, Banner J, Thomsen JL, Cowan S, Stein GF, Jrgensen GW, Grasaasen K, Georgsen J, Pedersen C. Department of Infectious Diseases, Odense University Hospital, Odense C, DK5000, Denmark. peer.christensen@dadlnet.dk OBJECTIVES: To determine the prevalence of antibodies against HIV, hepatitis B (HBV) and hepatitis C (HCV) in postmortem samples from drug related deaths (DRDs) in Denmark. DESIGN: Prospective cohort study. Postmortem samples tested for anti-HIV, anti-HCV anti-HBc and anti-HBs. Comparison to pre-mortem testing when possible. DRDs were searched for in the national register of drug treatment, national prison registers, and the national infectious disease register. SETTING: National level. PARTICIPANTS: Drug related deaths admitted to Danish Institutes of Forensic Medicine during 2004. MAIN OUTCOME MEASURES: Prevalence of antibodies, injection drug use, drug treatment experience and prevalence of cirrhosis. RESULTS: Samples for analysis were obtained from 78% (233/299) of DRDs. The prevalences of anti-HIV, anti-HCV and anti-HBc were 4% (9/214), 51% (110/215), and 35% (74/209), indicating a persisting low prevalence of HIV and a declining prevalence of HCV and HBV. Injecting ever was detected among 45% of DRDs and this was associated with a significantly higher prevalence of hepatitis B and C. Among the DRDs 56% received drug treatment and 12% had cirrhosis at autopsy. Evidence of vaccination against HBV was found among 16% (21/128). CONCLUSIONS: Monitoring of viral hepatitis and HIV among DRDs is feasible, and our survey indicates a falling prevalence among Danish drug users. Surveillance based on drug users in treatment may overestimate the true prevalence. PMID: 16763882 [PubMed - indexed for MEDLINE] 101. Clin Infect Dis. 2006 Jun 15;42(12):1663-70. Epub 2006 May 11.

Acute hepatitis C virus infection in incarcerated injection drug users. McGovern BH, Wurcel A, Kim AY, Schulze zur Wiesch J, Bica I, Zaman MT, Timm J, Walker BD, Lauer GM. Lemuel Shattuck Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. bmcgovern@tufts-nemc.org Comment in Clin Infect Dis. 2006 Jun 15;42(12):1671-3. BACKGROUND: The Centers for Disease Control and Prevention has emphasized the need for interventional programs regarding hepatitis C virus (HCV) infection for injection drug users, the group of persons who are at highest risk of acquiring acute infection. METHODS: We designed a pilot study to assess the feasibility of identifying injection drug users with acute HCV infection in correctional and detoxification facilities. On-site medical providers were educated regarding risk factors and signs and symptoms of infection and were instructed to refer all patients with hepatitis to our specialty clinic. RESULTS: Over a 30-month period, 21 patients received a diagnosis of acute hepatitis C, 3 received a diagnosis of hepatitis B, and 1 received a diagnosis of hepatitis A. Of the 21 patients with acute hepatitis C, 19 were identified in the prison setting shortly after incarceration. Of the 17 patients who were observed serially (mean duration of observation, 6.3 months), 8 had spontaneous virologic clearance. Early therapy with pegylated interferon was initiated for 5 patients with persistent viremia and led to a sustained virologic response in 2 individuals. All patients agreed to undergo human immunodeficiency virus counseling and testing, as well as to receive immunization for hepatitis A and B. CONCLUSIONS: Incarceration presents a unique opportunity to identify injection drug users with acute HCV infection, to initiate counseling regarding other bloodborne pathogens, and to facilitate immunizations and HCV treatment. PMID: 16705568 [PubMed - indexed for MEDLINE] 102. N S W Public Health Bull. 2005 Sep-Oct;16(9-10):166-7. Bug Breakfast in the Bulletin: Blood-borne viruses in correctional facilities. Wallace C, Hailstone S, Lloyd A. NSW Public Health Officer Training Program, NSW Department of Health. PMID: 16596152 [PubMed - indexed for MEDLINE]

103. J Med Microbiol. 2006 May;55(Pt 5):593-7. Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis among prison inmates and officers at Nsawam and Accra, Ghana. Adjei AA, Armah HB, Gbagbo F, Ampofo WK, Quaye IK, Hesse IF, Mensah G. Department of Pathology, University of Ghana Medical School, College of Health Sciences, Korle-Bu, Accra, Ghana. andrewadjei50@hotmail.com Comment in J Med Microbiol. 2006 May;55(Pt 5):481-2. Although the high prevalence of blood-borne viral infections and syphilis in correctional facilities has been well documented globally, such data are sparse from Africa, and there has been no such data from Ghana. This study sought to estimate the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis among prison inmates and officers at prisons in Nsawan and Accra, Ghana. Prisoners and officers in 3 of the 46 prisons in Ghana were surveyed from May 2004 to May 2005. Subjects voluntarily completed a risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for the presence of antibodies to HIV, HCV and Treponema pallidum, the causative agent of syphilis, and the surface antigen of hepatitis B virus (HBsAg). Almost 16% (3770) of the total of 23,980 prison inmates in Ghana were eligible, and 281 (7.5%) of those eligible took part, whilst almost 23% (1120) of the total of 4910 prison officers were eligible, and 82 (7.3%) of those eligible took part. For the 281 inmates tested, HIV seroprevalence was 19.2%, 17.4% had HBsAg, HCV seroprevalence was 19.2% and reactive syphilis serology was noted in 11%. For the 82 officers tested, HIV seroprevalence was 8.5%, 3.7% had HBsAg, HCV seroprevalence was 23.2% and reactive syphilis serology was noted in 4.9%. The data indicate a higher prevalence of HIV and HCV in correctional facilities (both prison inmates and officers) than in the general population in Ghana, suggesting their probable transmission in prisons in Ghana through intravenous drug use, unsafe sexual behaviour and tattooing as pertains to prisons worldwide. PMID: 16585647 [PubMed - indexed for MEDLINE] 104. J Med Microbiol. 2006 May;55(Pt 5):481-2. Human immunodeficiency virus and hepatitis virus infection in correctional institutions in Africa: is this the neglected source of an epidemic? Senok AC, Botta GA.

Comment on J Med Microbiol. 2006 May;55(Pt 5):593-7. PMID: 16585631 [PubMed - indexed for MEDLINE] 105. Epidemiol Infect. 2006 Apr;134(2):231-42. Modelling the hepatitis B vaccination programme in prisons. Sutton AJ, Gay NJ, Edmunds WJ, Andrews NJ, Hope VD, Gilbert RL, Piper M, Gill ON. Health Protection Agency, Modelling and Economics Unit, Colindale, London, UK. Andrew.Sutton@hpa.org.uk A vaccination programme offering hepatitis B (HBV) vaccine at reception into prison has been introduced into selected prisons in England and Wales. Over the coming years it is anticipated this vaccination programme will be extended. A model has been developed to assess the potential impact of the programme on the vaccination coverage of prisoners, ex-prisoners, and injecting drug users (IDUs). Under a range of coverage scenarios, the model predicts the change over time in the vaccination status of new entrants to prison, current prisoners and IDUs in the community. The model predicts that at baseline in 2012 57% of the IDU population will be vaccinated with up to 72% being vaccinated depending on the vaccination scenario implemented. These results are sensitive to the size of the IDU population in England and Wales and the average time served by an IDU during each prison visit. IDUs that do not receive HBV vaccine in the community are at increased risk from HBV infection. The HBV vaccination programme in prisons is an effective way of vaccinating this hard-to-reach population although vaccination coverage on prison reception must be increased to achieve this. PMCID: PMC2870404 PMID: 16490125 [PubMed - indexed for MEDLINE] 106. Vaccine. 2006 Mar 20;24(13):2377-86. Epub 2005 Dec 9. Modelling the impact of prison vaccination on hepatitis B transmission within the injecting drug user population of England and Wales. Sutton AJ, Gay NJ, Edmunds WJ. Modelling and Economics Unit, Health Protection Agency, Centre for Infections, 61 Colindale Ave, Colindale, London NW9 5EQ, UK. andrew.sutton@hpa.org.uk

A vaccination programme offering hepatitis B (HBV) vaccine at reception into prison has been introduced into selected prisons in England and Wales. The work here considers the impact of prison vaccination on the incidence and prevalence of hepatitis B virus (HBV) in the injecting drug user (IDU) population of England and Wales. A dynamic model of the transmission of HBV in IDUs is developed with key model assumptions and parameters being subject to sensitivity analyses. The base case model (that assumes that the vaccination coverage on prison reception is 5% in 2002, 10% in 2003 and then increases linearly up to 50% of prison receptions being vaccinated by 2006) predicts that the incidence of HBV in IDUs might be reduced by almost 80% in 12 years, and the HBV prevalence (IDUs ever infected by HBV) may be reduced from approximately 18% in 2002 to 7% in 2015. The model presented here demonstrates that HBV vaccination on prison reception can have a significant impact on the prevalence and incidence of HBV in the IDU population over time. PMID: 16384627 [PubMed - indexed for MEDLINE] 107. Epidemiol Infect. 2006 Aug;134(4):814-9. Epub 2005 Dec 22. A syringe exchange programme in prison as prevention strategy against HIV infection and hepatitis B and C in Berlin, Germany. Stark K, Herrmann U, Ehrhardt S, Bienzle U. Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany. starkk@rki.de In two prisons in Berlin, Germany, provision of sterile injection equipment for injecting drug users (IDUs) started in 1998. To assess the programme's impact, the frequency of injecting drug use and syringe sharing, and the incidence of HIV, HBV, and HCV infection were determined in a follow-up study. Of all IDUs (n=174), 75% continued to inject. After the project start the level of syringe sharing declined from 71% during a 4-month period of previous imprisonment to 11% during the first 4 months of follow-up, and to virtually zero thereafter. Baseline seroprevalences for HIV, HBV, and HCV were 18, 53, and 82%. HIV and HCV seroprevalence at baseline was significantly associated with drug injection in prison prior to the project start. No HIV and HBV seroconversions, but four HCV seroconversions occurred. The provision of syringes for IDUs in appropriate prison settings may contribute to a substantial reduction of syringe sharing. However, the prevention of HCV infection requires additional strategies. PMCID: PMC2870452 PMID: 16371183 [PubMed - indexed for MEDLINE]

108. HIV AIDS Policy Law Rev. 2005 Aug;10(2):51. UK: legal action on needle exchange programs in prisons dismissed. Valette D. In April 2005, a judicial review application against the UK Home Secretary for his failure to introduce needle exchange programs in prisons in England and Wales was dismissed by a judge at the Royal Courts of Justice (Administrative Court Division). PMID: 16365988 [PubMed - indexed for MEDLINE] 109. Drug Alcohol Depend. 2006 Jul 27;83(3):210-7. Epub 2005 Dec 15. Prevalence of injecting drug use and associated risk behavior among regular ecstasy users in Australia. White B, Day C, Degenhardt L, Kinner S, Fry C, Bruno R, Johnston J. National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Australia. Bethany@burnet.edu.au BACKGROUND: The aim of the study was to investigate the prevalence of injecting drug use and associated risk behaviour among a sentinel sample of ecstasy users. METHODS: Cross-sectional surveys were conducted with regular ecstasy users as part of an annual monitoring study of ecstasy and related drug markets in all Australian capital cities. RESULTS: Twenty-three percent of the sample reported having ever injected a drug and 15% reported injecting in the 6 months preceding interview. Independent predictors of lifetime injection were older age, unemployment and having ever been in prison. Completion of secondary school and identifying as heterosexual was associated with a lower likelihood of having ever injected. Participants who had recently injected typically did so infrequently; only 9% reported daily injecting. Methamphetamine was the most commonly injected drug. Prevalence of needle sharing was low (6%), although half (47%) reported sharing other injecting equipment in the preceding 6 months. CONCLUSIONS: Ecstasy users who report having injected a drug at some time appear to be demographically different to ecstasy users who have not injected although neither are they typical of other drug injectors. The current investigation suggests that ongoing monitoring of injecting among regular ecstasy users is warranted. PMID: 16343810 [PubMed - indexed for MEDLINE]

110. Epidemiol Infect. 2005 Dec;133(6):1146-8. Tattoos, incarceration and hepatitis B and C among street-recruited injection drug users in New Mexico, USA: update. Samuel MC, Bulterys M, Jenison S, Doherty P. To the Editor:In a previous report [1], we described significant risks for hepatitis B (HBV) and hepatitis C (HCV) positivity associated with receipt of tattoos, particularly while incarcerated, among a street-recruited population of injection drug users (IDUs) in New Mexico, United States from 1995 to 1997. Another recent report in this Journal, based on a study conducted on prisoners in Australia, found tattooing in prison to be an independent risk for HCV [2]. Another report also described a strong association between tattoos and HCV, but found the strongest association to be with commercial tattooing venues [3]. That study found the risk associated with receipt of tattoos in prison elevated, but not statistically significant. That same report reviewed other articles and found a significant risk for HCV infection associated with tattoos in six out of eight studies that had data available. Further, a recent U.S. Centers for Disease Control and Prevention (CDC) document summarized the literature on risks for hepatitis infections in correctional settings and developed extensive control guidelines [4]. PMCID: PMC2870351 PMID: 16274514 [PubMed - indexed for MEDLINE] 111. Am J Med. 2005 Oct;118 Suppl 10A:84S-89S. A call to immunize the correctional population for hepatitis A and B. Gondles EF. Institute for Criminal Justice Healthcare, Arlington, Virginia 22207, USA. desifl@aol.com An increasing number of the 12 million people who pass through jails and prisons in the United States each year are infected with hepatitis B or C. Many have routinely engaged in sexual and drug-use behaviors that put them and their contacts at risk for infection, and many are likely to return to these behaviors on their release, further spreading the infection. Thus, the prevalence of hepatitis infections among the incarcerated population is an enormous health problem not only for the correctional system but also for the community at large. There is no federal mandate for screening members of the incarcerated population who may be at risk or those who are already infected. Public health and

correctional authorities must join forces to offer educational programs, prevention services, and intervention strategies to offenders, many of whom have their first contact with the healthcare system when they enter a correctional facility. Safe and effective vaccines for hepatitis A and B have been available for >11 years and, despite the challenges of conducting an immunization program for this population, the correctional environment provides a unique opportunity to reach these individuals and reduce the spread of viral hepatitis. PMID: 16271547 [PubMed - indexed for MEDLINE] 112. Am J Infect Control. 2005 Nov;33(9):510-8. Hepatitis B vaccination in correctional health care workers. Gershon RR, Mitchell C, Sherman MF, Vlahov D, Lears MK, Felknor S, Lubelczyk RA. Mailman School of Public Health, Columbia University, New York, NY 10032, USA. rg405@columbia.edu Comment in Am J Infect Control. 2006 Aug;34(6):399. BACKGROUND: Data on bloodborne pathogen risk among health care workers (HCWs) employed in the correctional setting are sparse, even though the prevalence of bloodborne infections, including hepatitis B virus (HBV), among inmates is high. To address this, we determined prevalence and correlates of hepatitis B virus vaccination status in correctional health care workers (CHCWs) employed in 3 state correctional health care facilities. METHODS: A confidential, self-administered cross-sectional survey was performed. RESULTS: Four hundred eleven (69.8%) of 588 eligible participants completed the survey. Of these, 264 (64.2%) reported receiving a primary hepatitis B (HB) vaccine series. Vaccination rates varied by state and by job category. Parenteral exposures were not uncommon; 8.6% (n = 24) of clinical CHCWs and 2.0% (n = 7) of nonclinical CHCWs reported one or more needlesticks in the 6-month period prior to the study. Among clinical staff, vaccination correlated with licensure (RN or MD) and race (white) and in nonclinical staff with history of close contact with HBV infected inmates and with needlestick injury. CONCLUSION: Although the HB vaccination rate among CHCWs was generally high, given their potential risk of exposure to HBV, universal vaccination should be encouraged and should include those nonclinicians with job duties that may involve potential exposure to blood/body fluids. PMID: 16260326 [PubMed - indexed for MEDLINE]

113. AIDS. 2005 Oct;19 Suppl 3:S41-6. Hepatitis B, hepatitis C, and HIV in correctional populations: a review of epidemiology and prevention. Weinbaum CM, Sabin KM, Santibanez SS. Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cweinbaum@cdc.gov The 2 million persons incarcerated in US prisons and jails are disproportionately affected by hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV, with prevalences of infection two to ten times higher than in the general population. Infections are largely due to sex- and drug-related risk behaviors practised outside the correctional setting, although transmission of these infections has also been documented inside jails and prisons. Public health strategies to prevent morbidity and mortality from these infections should include hepatitis B vaccination, HCV and HIV testing and counseling, medical management of infected persons, and substance abuse treatment in incarcerated populations. PMID: 16251827 [PubMed - indexed for MEDLINE] 114. Acta Med Port. 2004 Sep-Oct;17(5):381-4. Epub 2004 Dec 20. [Prevalence infections and risk factors due to HIV, Hepatitis B and C in a prison establishment in Leiria]. [Article in Portuguese] Passadouro R. Centro de Sade Dr. Arnaldo Sampaio, Leiria. The present study emerged due to HIV, Hepatitis B and C test samples that have been taking place in a prison establishment in Leiria. The samples were taken from 788 (77%) of the 1019 prisoners that entered the prison during the periods between February of 1999 to September 2003. A questionnaire was carried to the transmission of HIV, Hepatitis B and C infections and blood samples were also taken to determine the immunologic situation in relationship to the same viruses. Of the 788 prisoners that participated, 699 (89%) were male and 89(11%) were female. The average age was 32.3, the oldest person was 70 and the youngest was 16 years old. 294 (40%) prisoners admitted using injectable drugs and 606 (84%) confirmed they had more than one sexual partner. HIV infection were found in 47 (6%) of the prisoners, HCV infection in 326 (42%), HBsAg in 21 (3%), HBsAc in 309 (40%) and HBcAc in 312 (40%) of the prisoners. Statistics confirm a significant

relationship between injectable drugs and the presence of HIV infection and HBcAc and between sexual relationships with an infected partner and the presence of HBcAc, anti-HCV and HIV infection. The prevalence of infected prisoners with HIV was 6%, with HBV 40% and with HCV 42%. Hepatitis B and C infected 70% of the prisoner who used injectable drugs. The prevalence of hepatitis B and C and HIV infection that were found compel for the continuation of prevention. PMID: 16197845 [PubMed - indexed for MEDLINE] 115. J Clin Virol. 2006 Mar;35(3):244-9. Epub 2005 Sep 6. HTLV infection among young injection and non-injection heroin users in Spain: prevalence and correlates. de la Fuente L, Toro C, Soriano V, Brugal MT, Vallejo F, Barrio G, Jimnez V, Silva T; Project Itnere Working Group. Centro Nacional de Epidemiologa, Instituto de Salud Carlos III, C/Sinesio Delgado 6, 28029 Madrid, Spain. lfuente@isciii.es BACKGROUND: Although some studies have described the epidemiology of infection with HIV or hepatitis B and C in young users in Spain - one of the European countries with the highest prevalences - there are no studies of the prevalence of HTLV infection and the most important associated factors. OBJECTIVES: To evaluate the prevalence and main determinants of HTLV-1 and HTLV-2 infection in young heroin users (including both injection (IDUs) and non-injection drug users (NIDUs)) recruited outside health care services in three of Spain's principal cities. STUDY DESIGN: Cross-sectional cohort study. All participants (981) were street-recruited by chain referral procedures between April 2001 and December 2003. Face-to-face interviews were conducted using a structured questionnaire and dried blood spot samples were collected for serological testing. RESULTS: No sample was positive for HTLV-1 and 27 samples were positive for HTLV-2; all of these were found only in Spanish IDUs in the cities of Madrid (17, 6.2%) and Barcelona (10, 3.5%). The only two factors significantly associated with HTLV infection in the logistic regression analysis were HIV infection (OR 5.7; 95% CI 2.2-14.8) and having injected in the last 30 days (OR 6.5; 95% CI 1.4-29.8). Having been in prison (OR 2.4; 95% CI 0.9-6.4) and HCV infection (OR 3.8; 95% CI 0.5-30.7), which were strongly and significantly associated in the bivariate analysis, were no longer significant in the logistic analysis. Almost the same variables were selected in the tree analysis, in which subjects could be classified into three groups: high prevalence (28.5%, HIV+ and HBV+ who had injected in the last 30 days), medium prevalence (17.8%) and low (<3%) or zero prevalence (HIV-, HCV- and HBV-).

CONCLUSIONS: HTLV-1 was not detected among young Spanish heroin users. HTLV2 was not found in NIDUs (perhaps due to the low rate of sexual transmission); it was found only in IDUs from Madrid and Barcelona, but not in those from Seville. Its prevalence is very low and the main correlates of infection were HIV infection and injection as the usual route of heroin administration. PMID: 16143565 [PubMed - indexed for MEDLINE] 116. Clin Infect Dis. 2005 Oct 1;41(7):998-1002. Epub 2005 Aug 30. Community incidence of hepatitis B and C among reincarcerated women. Macalino GE, Vlahov D, Dickinson BP, Schwartzapfel B, Rich JD. Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA. BACKGROUND: The incarceration rate has increased 239% in the United States over the past 2 decades. This increase in incarceration has been fueled by the movement towards a criminal, rather than medical, response to the problem of drug dependence. For women in particular, incarceration and drug use are interdependent epidemics. Given that incarceration is common among drug-dependent persons, infectious diseases--including hepatitis B virus (HBV) and hepatitis C virus (HCV) infection--are prevalent among incarcerated persons. We sought to determine the incidence of HBV and HCV infection among recidivist women prisoners. METHODS: From 1996 through 1997, excess from serum samples collected during HIV testing of female admittees to a state Department of Corrections facility were tested for HBV and HCV. Multiple samples obtained from women incarcerated multiple times during the study period were compared for incidence. RESULTS: Baseline prevalences of markers of HBV and HCV were 36% and 34%, respectively. Incidence rates for HBV and HCV infection among reincarcerated women were 12.2 and 18.2 per 100 person-years, respectively. The majority of the time spent between serial intakes was not spent in the correctional facility; thus, incident infections likely occurred in the community. CONCLUSIONS: Incidences of HBV and HCV infection among reincarcerated women were high. Prisons and jails can be efficient locations for the diagnosis, treatment, and prevention of hepatitis B and C through programs such as testing, counseling, education, vaccination, and linkage to medical and drug treatment services. PMID: 16142665 [PubMed - indexed for MEDLINE] 117. J Urban Health. 2005 Sep;82(3 Suppl 4):iv101-12.

Marginalized and socially integrated groups of IDUs in Hungary: potential bridges of HIV infection. Gyarmathy VA, Neaigus A. Institute for International Research on Youth at Risk, National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY, USA. gyarmathy@ndri.org The discrepancy in HIV rates among Eastern and central European injecting drug users (IDUs) suggests that, in addition to risk behaviors, social contact patterns also play an important role. We identify two groups of IDUs in Budapest, Hungary, marginalized IDUs (M-IDUs) and socially integrated IDUs (SI-IDUs) and compare their HIV/hepatitis B virus (HBV)/hepatitis C virus (HCV) social and risk network characteristics, risk behaviors, and travel patterns. Between May 2003 and January 2004, 29 nontreatment-recruited young IDUs in Budapest participated in ethnographic interviews and focus groups. The mean age was 23.6 years (SD=3.6); eight were female and two Roma/Gypsy. Most injected heroin (n=23) and/or amphetamines (n=10) in the past 30 days. M-IDUs had no legal employment, injected heroin and sniffed glue, and stopped using drugs in treatment/prison. SI-IDUs had regular jobs or were students, injected heroin and sniffed cocaine, and stopped using drugs before exams/tests. Both M-IDUs and SI-IDUs shared injecting equipment on occasion and used condoms rarely. M-IDUs had a large social network of "buddies" and a small risk network of "friends". SI-IDUs had two separate large social networks of "buddies": a M-IDU and a non-IDU network; and a small risk network of "friends". Both groups reported monogamous sexual relationships. M-IDUs traveled within Hungary, whereas SI-IDUs traveled to Western Europe. If an HIV epidemic among IDUs in Hungary is not prevented, SI-IDUs may form a potential "bridge" of HIV infection between high-risk IDU populations and the low-risk general population, whereas M-IDUs may become cores of infection. Different approaches may be appropriate for M-IDUs and SI-IDUs to prevent HIV. PMCID: PMC2656943 PMID: 16107433 [PubMed - indexed for MEDLINE] 118. Eur Respir J. 2005 Aug;26(2):298-304. Tuberculosis, HIV seroprevalence and intravenous drug abuse in prisoners. Drobniewski FA, Balabanova YM, Ruddy MC, Graham C, Kuznetzov SI, Gusarova GI, Zakharova SM, Melentyev AS, Fedorin IM. HPA National Mycobacterium Reference Unit, Dept of Microbiology and Infection,

King's College Hospital (Dulwich), East Dulwich Grove, London SE22 8QF, UK. francis.drobniewski@kcl.ac.uk High rates of tuberculosis (TB) and HIV are believed to exist in Russian prisons. Prisoners with TB were studied in order to identify the following: 1) prevalence of HIV, and risk factors for HIV and other blood-borne virus infections; and 2) clinical and social factors that might compromise TB treatment effectiveness and/or patient adherence and, hence, encourage treatment failure. A 1-yr cross-sectional prevalence study of 1,345 prisoners with TB was conducted at an in-patient TB facility in Samara, Russian Federation. HIV and hepatitis B and/or C co-infection occurred in 12.2% and 24.1% of prisoners, respectively, and rates were significantly higher than in civilians. Overall, 48.6% of prisoners used drugs, of which 88.3% were intravenous users. Prisoners were more likely to be intravenous drug users and HIV positive compared with civilians with TB, and 40.2% of prisoners shared needles. Two-thirds of prisoners (68.6%) had received previous TB drug therapy (frequently multiple, interrupted courses) and were significantly more likely than civilians to have had previous therapy consistent with the high drug-resistance rates seen. Prisons are major drivers of the tuberculosis and HIV epidemics. Novel strategies are needed to reduce the spread of blood borne diseases, particularly in intravenous drug users. PMID: 16055879 [PubMed - indexed for MEDLINE] 119. Epidemiol Infect. 2005 Aug;133(4):679-85. Hepatitis virus and HIV infections in inmates of a state correctional facility in Mexico. Alvarado-Esquivel C, Sablon E, Martnez-Garca S, Estrada-Martnez S. Facultad de Medicina, Universidad Jurez del Estado de Durango, Mxico. alvaradocosme@yahoo.com We sought to determine the prevalence and associated characteristics of hepatitis A, B, C and D viruses and HIV infections in a prison in Durango, Mexico. Sera from 181 inmates were analysed for HAV antibody, hepatitis B core antibody (HBcAb), hepatitis B surface antigen (HBsAg), HCV antibody, HDV antibody, HIV antibody and HCV genotypes. Prevalence of HAV antibody, HBcAb, HBsAg, HCV antibody, HDV antibody and HIV antibody were 99.4, 4.4, 0.0, 10.0, 0.0 and 0.6% respectively. HCV genotype 1a predominated in HCV-infected inmates (62.5%), followed by HCV genotype 1b (25%) and HCV genotype 3 (12.5%). An association between HBV infection and age > 30 years was found. HCV infection was associated with being born in Durango City, history of hepatitis, ear piercing, tattooing, drug abuse history, intravenous drug use and lack of condom use. We concluded that the prevalence of HAV, HBV, HDV and HIV infections in inmates in Durango,

Mexico were comparable to those of the Mexican general population and blood donors, but lower than those reported in other prisons around the world. However, HCV infection in inmates was higher than that reported in Mexican blood donors but lower than those reported in other prisons of the world. These results have implications for the optimal planning of preventive and therapeutic measures. PMCID: PMC2870296 PMID: 16050514 [PubMed - indexed for MEDLINE] 120. Drug Alcohol Depend. 2005 Dec 12;80(3):297-302. Epub 2005 Jun 14. Heroin overdose among young injection drug users in San Francisco. Ochoa KC, Davidson PJ, Evans JL, Hahn JA, Page-Shafer K, Moss AR. University of California, San Francisco General Hospital, 995 Potrero Avenue, Building 90, Ward 95, Room 513, San Francisco, CA 94110, USA. OBJECTIVES: We sought to identify prevalence and predictors of heroin-related overdose among young injection drug users (IDU). METHODS: A total of 795 IDU under age of 30 years were interviewed in four neighbourhoods in San Francisco, California, USA. Participants were recruited as part of a broader study of HIV, hepatitis B and C among injecting drug users in San Francisco using street outreach and snowball techniques. Independent predictors of recent heroin overdose requiring intervention were determined using regression analysis. RESULTS: Of 795 injecting drug users under age of 30 years, 22% (174/795) of participants reported a heroin overdose in the last year. In stepwise multiple logistic regression, independent predictors of recent heroin overdose were lifetime incarceration exceeding 20 months (odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.52-5.88); heroin injection in the last 3 months (OR = 4.89, 95% CI = 2.03-11.74); cocaine injection in the last 3 months (OR = 1.67, 95% CI = 1.14-2.45); injection of heroin mixed with methamphetamine in the last 3 months (OR = 1.74, 95% CI = 1.15-2.65); ever tested for hepatitis B or C (OR = 1.66 per year, CI = 1.09-2.54) and ever having witnessed another person overdose (OR = 2.89, 95% CI = 1.76-4.73). CONCLUSIONS: Individuals with high levels of incarceration are at great risk of overdose, and prison or jail should be considered a primary intervention site. Further research on the role of cocaine and amphetamine in heroin-related overdose is indicated. PMID: 15961257 [PubMed - indexed for MEDLINE] 121. J Clin Forensic Med. 2005 Aug;12(4):196-8.

Patterns of illicit drug use of prisoners in police custody in London, UK. Payne-James JJ, Wall IJ, Bailey C. Forensic Healthcare Services Ltd., 19 Speldhurst Road, London E9 7EH, UK. jasonpaynejames@aol.com AIMS AND METHODS: The aims of the study were to explore the current characteristics of drug misusers seen in police custody and identify trends or changes that have taken place in the last decade. A prospective, anonymised, structured questionnaire survey was undertaken of consenting consecutive, self-admitted illicit drug users seen by forensic physicians in police custody within the Metropolitan Police Service in London, UK in 2003. RESULTS: 30% of detainees were dependent on heroin or crack cocaine. Drug users (n=113) were studied in 2003. 95.4% completed the questionnaire. 82% were male, 18% female. Mean age was 28.5 y (range 18-49). 80% were unemployed; significant mental health issues (e.g., schizophrenia) were present in 18%; 15% had alcohol dependence; heroin was the most frequently used drug (93%); crack cocaine -- 87%; mean daily cost of drugs -- heroin GBP 76 (range 20-240), crack GBP 81 (range 20-300). >50% users inject crack and heroin simultaneously. 56% used the intravenous route; 25% had shared needles; 100% had accessible sources of clean needles; 6.4% were hepatitis B positive; 42% were aware of hepatitis prophylaxis; hepatitis C positive -- 20.2%; 3.6% were HIV positive. Mean length of time of drug use was 7.5 y (range 1 month -- 20 years); 82% had served a previous prison sentence; 54% had used drugs in prison; 11% had used needles in prison; 3% of users stated they had started using in prison. 38% had been on rehabilitation programs; 11% had been on Drug Treatment and Testing; Orders (DTTO); 32% had used the services of Drug Arrest Referral Teams in police stations; 10% were in contact with Drug Teams at the time of assessment. CONCLUSIONS: In the last decade, there appears to be a substantial increase in the prevalence of drug use in this population -- particularly of crack cocaine. Treatment interventions are either not readily available, or not followed through. In very general terms, the illicit drug use problem appears to have significantly worsened in the population seen in police custody in London, UK, in the last decade although there is evidence that health education and harm reduction messages appear to have had some positive effects. PMID: 15950514 [PubMed - indexed for MEDLINE] 122. JAMA. 2005 Jun 8;293(22):2726-31. Drug-resistant tuberculosis, clinical virulence, and the dominance of the Beijing strain family in Russia.

Drobniewski F, Balabanova Y, Nikolayevsky V, Ruddy M, Kuznetzov S, Zakharova S, Melentyev A, Fedorin I. HPA Mycobacterium Reference Unit, Department of Microbiology and Infection, Guy's King's and St Thomas' Medical School, London, England. francis.drobniewski@kcl.ac.uk Comment in JAMA. 2005 Jun 8;293(22):2788-90. JAMA. 2005 Jun 8;293(22):2790-3. CONTEXT: Tuberculosis and multidrug-resistant tuberculosis is a serious public health problem in Russia. OBJECTIVE: To address the extent of "Beijing strain" transmission in the prison/civil sectors and the association of drug resistance, clinical, and social factors with the Beijing genotype. DESIGN AND SETTING: Cross-sectional population-based molecular epidemiological study of all civilian and penitentiary tuberculosis facilities in the Samara region, Russia. PATIENTS: Consecutively recruited patients with bacteriologically proven tuberculosis (n = 880). MAIN OUTCOME MEASURE: Proportion of Beijing strains and association with drug resistance, human immunodeficiency virus infection, imprisonment, radiological, clinical, and other social factors. RESULTS: Beijing-family strains (identified by spoligotyping and composed of 2 main types by mycobacterial interspersed repetitive unit analysis) were predominant: 586/880 (66.6%; 95% confidence interval [CI], 63.4%-69.7%) with a significantly higher prevalence in the prison population (rate ratio [RR], 1.3; 95% CI, 1.2-1.5) and those aged younger than 35 years (RR, 1.2; 95% CI, 1.0-1.3). Comparable proportions were co-infected with the human immunodeficiency virus ( approximately 10%), concurrent hepatitis B and C (21.6%), drank alcohol ( approximately 90%), smoked ( approximately 90%), and had a similar sexual history. Drug resistance was nearly 2-fold higher in patients infected with Beijing strains compared with non-Beijing strains: multidrug resistance (RR, 2.4; 95% CI, 1.9-3.0), for isoniazid (RR, 1.8; 95% CI, 1.5-2.1), for rifampicin (RR, 2.2; 95% CI, 1.7-2.7), for streptomycin (RR, 1.9; 95% CI, 1.5-2.3), and for ethambutol (RR, 2.2; 95% CI, 1.6-3.2). Univariate analysis demonstrated that male sex (odds ratio [OR], 1.5; 95% CI, 1.1-1.9), advanced radiological abnormalities (OR, 3.3; 95% CI, 1.3-8.4), homelessness (OR, 5.6; 95% CI, 1.1-6.3), and previous imprisonment (OR, 2.0; 95% CI, 1.5-2.7) were strongly associated with Beijing-strain family disease. Multivariate analysis supported previous imprisonment to be a risk factor (OR, 2.0; 95% CI, 1.4-3.3) and night sweats to be less associated (OR 0.7; 95% CI, 0.5-1.0) with Beijing-strain disease. CONCLUSIONS: Drug resistance and previous imprisonment but not human immunodeficiency virus co-infection were significantly associated with Beijing-strain infection. There was evidence that Beijing isolates caused

radiologically more advanced disease. PMID: 15941801 [PubMed - indexed for MEDLINE] 123. Eur Respir J. 2005 Jun;25(6):1070-6. Correlates of Mycobacterium tuberculosis infection in a prison population. Carbonara S, Babudieri S, Longo B, Starnini G, Monarca R, Brunetti B, Andreoni M, Pastore G, De Marco V, Rezza G; GLIP (Gruppo di Lavoro Infettivologi Penitenziari). Clinica Malattie Infettive, Universit di Bari, Piazza G. Cesare 11, 70124 Bari, Italy. s_carbonara@yahoo.it Prisons represent a crucial setting for tuberculosis control. Currently, there is scarce information concerning Mycobacterium tuberculosis (MT) infection in European prisons, and no data are available for Italy. This study aims to describe the prevalence and correlates of MT infection in an Italian prison population. In this multicentre cross-sectional study, 1,247 inmates from nine prisons were recruited and asked to undergo questioning regarding socio-economic and demographic variables, tuberculin skin testing (TST), chest radiographs and testing for HIV, hepatitis B and hepatitis C virus infection. TST was positive in 17.9% of the 448 evaluable subjects. With multivariate logistic regression (performed among male inmates), MT infection was correlated with age (adjusted odds ratio (OR) 4.12 for inmates aged 31-40 yrs; 3.78 for those aged >40 yrs), being foreign-born (OR = 4.9), education < or =5 yrs (OR = 1.88) and length of detention (increased risk per yr: 11%). As with elsewhere in the world, the prison system in Italy features a population with an increased rate of Mycobacterium tuberculosis infection and at-risk rate for Mycobacterium tuberculosis transmission. Improved tuberculosis surveillance and control measures are deemed necessary in correctional facilities nationwide, especially for subjects with the above risk factors and those who are HIV infected, in whom the tuberculin skin testing can be misleading. The screening of entrants is particularly important to avoid undiagnosed smear-positive tuberculosis cases. PMID: 15929964 [PubMed - indexed for MEDLINE] 124. J Med Virol. 2005 Jul;76(3):311-7. Correlates of HIV, HBV, and HCV infections in a prison inmate population: results from a multicentre study in Italy. Babudieri S, Longo B, Sarmati L, Starnini G, Dori L, Suligoi B, Carbonara S,

Monarca R, Quercia G, Florenzano G, Novati S, Sardu A, Iovinella V, Casti A, Romano A, Uccella I, Maida I, Brunetti B, Mura MS, Andreoni M, Rezza G. Istituto Malattie Infettive, Universit di Sassari, Sassari, Italy. babuder@uniss.it A cross-sectional study was undertaken on the correlates of infection for the human immunodeficiency virus (HIV) and hepatitis viruses B and C (HBV and HCV) in a sample of inmates from eight Italian prisons. A total of 973 inmates were enrolled [87.0% males, median age of 36 years, 30.4% intravenous drug users (IDUs), 0.6% men who have sex with men (MSWM)]. In this sample, high seroprevalence rates were found (HIV: 7.5%; HCV: 38.0%; anti-HBc: 52.7%; HBsAg: 6.7%). HIV and HCV seropositivity were associated strongly with intravenous drug use (OR: 5.9 for HIV; 10.5 for HCV); after excluding IDUs and male homosexuals, the HIV prevalence remained nonetheless relatively high (2.6%). HIV prevalence was higher for persons from Northern Italy and Sardinia. The age effect was U-shaped for HIV and HCV infections; HBV prevalence increased with age. Tattoos were associated with HCV positivity (OR: 2.9). The number of imprisonments was associated with HIV infection, whereas the duration of imprisonment was only associated with anti-HBc. The probability of being HIV-seropositive was higher for HCV-seropositive individuals, especially if IDUs. In conclusion, a high prevalence of HIV, HCV, and HBV infections among inmates was observed: these high rates are in part attributable to the high proportion of IDUs. Frequency of imprisonment and tattoos were associated, respectively, with HIV and HCV positivity. Although it is possible that the study population is not representative of Italy's prison inmate population, the results stress the need to improve infection control measures users was prisons. Copyright (c) 2005 Wiley-Liss, Inc. PMID: 15902712 [PubMed - indexed for MEDLINE] 125. Int J STD AIDS. 2005 Feb;16(2):117-22. Screening for sexually transmitted diseases and hepatitis in 18-29-year-old men recently released from prison: feasibility and acceptability. Sosman JM, MacGowan RJ, Margolis AD, Eldridge E, Flanigan T, Vardaman J, Fitzgerald C, Kacanek D, Binson D, Seal DW, Gaydos CA; Project START Study Group. Department of Medicine, University of Wisconsin Medical School, Madison, WI 53705, USA. jms@medicine.wisc.edu Men entering prisons have high rates of sexually transmitted disease (STD), hepatitis, and HIV. This study sought to determine the acceptability and

feasibility of screening for STD and hepatitis in young men released from prison. Participants were interviewed six months after release and offered free screening. Of 42 (56%) eligible men who participated in the qualitative interview, 33 (79%) provided at least a blood or urine specimen. Eight of 33 (24%) men tested had chlamydia, trichomoniasis, hepatitis B or C virus (HBV or HCV). Three of 32 (9%) had chlamydia, three of 32 (9%) had trichomoniasis, two of 28 (7%) had prior syphilis, and two of 28 (7%) had HCV. Of 28 tested for HBV, six (21%) were immune, two (7%) had chronic infection, and 20 (71%) were susceptible. Barriers to screening included lack of forewarning, inconvenience, and insufficient incentive. In conclusion, screening for STD and hepatitis among former inmates can be acceptable and feasible. Forewarning, reducing the time burden, and providing monetary incentives may increase screening rates. PMID: 15825246 [PubMed - indexed for MEDLINE] 126. Commun Dis Public Health. 2004 Dec;7(4):306-11. Increasing hepatitis B vaccine coverage in prisons in England and Wales. Gilbert RL, Costella A, Piper M, Gill ON. Prison Surveillance Unit, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ. ruth.gilbert@hpa.org.uk The most frequently reported risk factor for hepatitis B infection in England and Wales is injecting drug use (38%). Since approximately 61% of injecting drug users (IDUs) had been imprisoned and less than 40% had received hepatitis B vaccine, a prison based hepatitis B vaccination programme was set up in 2001. At the 42 establishments participating in this study, all prisoners were offered vaccine at reception. Prisoners over 18 years were vaccinated using the 0, 7 and 21 days schedule and those under 18 years, using the 0, 1 and 2 months schedule. As far as possible a fourth dose was given to all after 12 months. In 2003, 14,163 prisoners received at least one dose of vaccine and altogether 26,265 doses were administered. A further 1111 prisoners reported they had already been vaccinated against hepatitis B. The median vaccine coverage rate was 17% (range 0-94%). Despite low coverage levels, the vaccination programme in prisons can be said to have vaccinated a sizable number of young, male prisoners, a group that have previously been shown to be at high risk of infection. The prisons which achieved vaccine coverage levels over 50% had designated nursing staff who ran the vaccination clinics. PMID: 15779795 [PubMed - indexed for MEDLINE] 127. AIDS Read. 2005 Feb;15(2):54-5.

The role of prisons in dissemination of HIV and hepatitis. Laurence J. PMID: 15712392 [PubMed - indexed for MEDLINE] 128. Aust N Z J Public Health. 2004 Dec;28(6):537-41. Hearing health of New South Wales prison inmates. Murray N, LePage E, Butler T. National Acoustic Laboratories, New South Wales. narellem@optusnet.com.au OBJECTIVE: To assess the hearing health of New South Wales prison inmates. METHODS: The method of testing hearing chosen was the rapid click-evoked otoacoustic emissions technique, from which two key variables were evaluated for early status of ear damage. Hearing variables, including hearing history and self-reported symptoms, were incorporated in a multivariate analysis of other health and demographic variables in the prison sample. RESULTS: The analysis shows that the hearing acuity of prisoners is poor compared with the general Australian population. Variables significantly related to the hearing scores were history of hearing problems or having arthritis or diabetes. In this sample hearing did not interact with alcohol or drugs. Those testing positive for Hepatitis B Core-Antibody were also found to have poorer hearing than those without. CONCLUSIONS AND IMPLICATIONS: Prisoners in general have poorer hearing than a normative Australian population. Some conditions have a significant impact on hearing, which may be due to associated medications. A previous history of ear problems was found to be significantly related to hearing acuity as was a history of exposure to noise. Health screening programs within the correctional system may need to include hearing loss prevention programs and medical follow-ups in relation to hearing health. PMID: 15707202 [PubMed - indexed for MEDLINE] 129. Curr Opin Infect Dis. 2005 Feb;18(1):67-72. Sexual transmission of hepatitis B. Atkins M, Nolan M.

Department of Microbiology, Chelsea and Westminster Hospital, Fulham Road, London, UK. m.atkins@imperial.ac.uk PURPOSE OF REVIEW: Hepatitis B virus infection is prevalent worldwide and is a significant cause of morbidity and mortality particularly in Asia. Adults chronically infected with hepatitis B virus remain a significant potential source of sexually transmitted hepatitis B. The purpose of this article is to review the recent literature relating to hepatitis B virus transmission with particular emphasis on sexual transmission and efforts to prevent spread. RECENT FINDINGS: The introduction of hepatitis B virus vaccine and the implementation of universal childhood vaccination for hepatitis B in some countries have led to a dramatic reduction in the number of children with chronic hepatitis B. However, recent reports suggest that we are not as successful in preventing infection by sexual transmission. It is clear that sexual transmission of hepatitis B virus is still widespread and is a major problem in certain high-risk groups such as men who have sex with men, intravenous drug users, prisoners and sex workers. Significant problems remain with respect to education and vaccination within these groups. SUMMARY: Hepatitis B virus remains a major health burden but it is preventable by education and vaccination. Greater resources are required to expand vaccination to the at-risk, sexually active adult populations if the World Health Organization ideal of hepatitis B virus eradication is to be realized and the burden of hepatitis B virus-related morbidity and mortality contained. PMID: 15647702 [PubMed - indexed for MEDLINE] 130. Health Educ Behav. 2004 Dec;31(6):775-89. A qualitative study of substance use and sexual behavior among 18- to 29-year-old men while incarcerated in the United States. Seal DW, Belcher L, Morrow K, Eldridge G, Binson D, Kacanek D, Margolis AD, McAuliffe T, Simms R; Project START Study Group. Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee 53202, USA. dseal@mcw.edu The article describes men's perceptions of and experience with substance use and sexual behavior during incarceration. Grounded theory content analyses were performed on qualitative interviews conducted with 80 men, aged 18 to 29, in four U.S. states. Participants believed that drugs were easily available in prison. Half reported using substances, primarily marijuana or alcohol, while incarcerated. Key themes included the role of correctional personnel in the flow of substances in prison and the economic significance of substance trafficking. With regard to sexual behavior, most men acknowledged that it occurred but were

hesitant to talk in-depth about it. There was a strong belief in "don't look, don't tell," and sex in prison was often associated with homosexual behavior or identity. Sex during incarceration was reported by 12 men, mostly with female partners. Participants were pessimistic about HIV/STD/hepatitis prevention efforts inside correctional facilities. These findings highlight the need for risk reduction programs for incarcerated men. PMID: 15539547 [PubMed - indexed for MEDLINE] 131. Epidemiol Prev. 2004 May-Jun;28(3):163-8. [HIVAb, HCVAb and HBsAg seroprevalence among inmates of the prison of Bologna and the effect of counselling on the compliance of proposed tests]. [Article in Italian] Sabbatani S, Giuliani R, Fulgaro C, Paolillo P, Baldi E, Chiodo F. UO malattie infettive, Policlinico S. Orsola di Bologna. sabbatani@med.unibo.it OBJECTIVES: The aims of the study were to evaluate the HIVAb, HCVAb and HBsAg seroprevalence among Italian and foreign inmates of the prison of Bologna, to evaluate if the extensive counselling of "new" inmates has significantly enhanced adherence to laboratory tests. DESIGN: The serological status was determined by a blood withdraw following the informed consent. Before asking their consent, patients were informed by cultural mediators who had been instructed about the aims of the study/exam during introductory meetings. The initial step managed by mediators was followed by further individual counselling interventions, carried out by hospital infective disease unit, prison and prison drug abuse service physicians. The laboratory tests were performed in an external structure. SETTING: Prison of Bologna. PARTICIPANTS: The study was conducted on 433 subjects among a whole population of 900 inmates in the local prison: 390 subjects were males (90.1%) and 43 were females (9.9%). The median age of the whole population was 34.86 years (+/- 9.9). The studied population counted 147 (33.9%) intravenous drug users (IDU) and 286 not addicts (66.1%). As regards nationality, 212 subjects were Italian (48.9%) and 221 (51.1%) foreigners. Among the total 433 inmates considered, 78 (18%) were known as previous IDU with conviction history or condemned to long term sentences, while 59 (13.6%) were inmates recently convicted active IDU assisted by the internal drug abusers service. The third group was composed by 296 inmates imprisoned during the summer (103 Italians and 193 foreigners) self declared not IDU.

RESULTS: A. 12.5% of inmates were HIV positive, 8.1% HBV positive and 31.1% HCV positive. 25 subjects were found positive both to HIV and HCV; 1 both to HIV and HBV and 5 to HIV, HBV and HCV. HIV positivity is more common among Italian vs. foreigners inmates, among IDU vs. not IDU. HCV positivity is more common among Italian vs. foreigners inmates, and among IDU vs. not IDU. The distribution of HBV seropositivity among the different groups shows no statistically significant differences. All subjects receiving multi-focal counselling reached better compliance levels: 10% vs. 1% for HIV, 16% vs. 1% for HBV and 35% vs. 0.3% for HCV, with statistically significant coefficients of contingency. CONCLUSIONS: In the prison of Bologna drug addiction is prevalent in italian seropositive personers and it is often associated with HIV and HCV positivity. Foreign inmates, mostly in the not-IDU group, show a lower prevalence of these two infections. Multi-focal counselling before test increased significantly the adherence of inmates to the study. PMID: 15532873 [PubMed - indexed for MEDLINE] 132. Vaccine. 2004 Nov 25;23(2):210-4. Sudden rise in uptake of hepatitis B vaccination among injecting drug users associated with a universal vaccine programme in prisons. Hutchinson SJ, Wadd S, Taylor A, Bird SM, Mitchell A, Morrison DS, Ahmed S, Goldberg DJ. Scottish Centre for Infection and Environmental Health, Clifton House, Clifton Place, Glasgow G3 7LN, UK. sharon.hutchinson@scieh.csa.scot.nhs.uk Hitherto, services have failed to deliver the UK Government's 1988 recommendation to vaccinate injecting drug users (IDUs) against hepatitis B virus (HBV). In April 1999, the Scottish Prison Service implemented an initiative to offer HBV vaccination to all inmates; we sought to determine the impact of this initiative on the IDU population. Among community-recruited IDUs (who had injected for < or =5 years) in Glasgow, vaccine uptake was significantly higher among those surveyed in 2001-2002 (52% of 387) than in 1993 (16% of 166), 1994 (19% of 138) or January-March 1999 (15% of 128); of the 2001-2002 vaccinees, 56% had been vaccinated in prison. Our results indicate that the universal offer of vaccination to all prisoners, within two years of the initiative's implementation, has had a dramatic impact on uptake among IDUs. PMID: 15531039 [PubMed - indexed for MEDLINE] 133. Clin Infect Dis. 2004 Oct 1;39(7):945-52. Epub 2004 Sep 10.

Widespread dissemination in England of a stable and persistent hepatitis B virus variant. Hallett RL, Ngui SL, Meigh RE, Mutton KJ, Boxall EH, Teo CG. Sexually Transmitted and Blood Borne Virus Laboratory, Health Protection Agency Colindale, London, United Kingdom. Rachel.Hallett@lshtm.ac.uk Comment in Clin Infect Dis. 2004 Oct 1;39(7):953-4. BACKGROUND: Outbreaks of acute hepatitis B among inmates of 6 prisons in 3 regions of northern England occurring from 1992 through 1994 were found to be associated with a single hepatitis B virus (HBV) variant, which was carried by 20 of the 24 case patients. We instigated a study of cases of acute hepatitis B to trace the spread and prevalence of this variant. METHODS: A denaturing gradient gel electrophoresis assay was optimized to detect the HBV variant, and cases of acute HBV infection in 3 regions in England occurring from 1990 through 1996 were screened for its presence. Samples from HBV-transmission incidents that were received for molecular investigation were also tested. RESULTS: The variant was identified in 117 (41%) of the 266 cases of acute hepatitis examined in representative regions in England. In North Humberside, but not in southeast England or the West Midlands, a trend toward an increase in the prevalence of the variant was observed. Furthermore, the same variant was identified in the case patients or the individuals implicated in transmission in 11 (22%) of 51 transmission incidents occurring in England from 1997 through 2002. The spread of the variant was primarily associated with injection drug use. CONCLUSIONS: The finding of a single, genetically identical variant (over the 600 bp sequenced) occupying a large niche among the circulating viruses was unexpected. This finding has major implications for the use of DNA sequencing analysis in the investigation of chains of transmission. The study also highlights the need for better protection of at-risk groups through vaccination against HBV, a strategy that currently achieves poor coverage. PMID: 15472844 [PubMed - indexed for MEDLINE] 134. J Gastroenterol Hepatol. 2004 Oct;19(10):1114-20. Risk behaviors and antibody hepatitis B and C prevalence among injecting drug users in south-western Sydney, Australia. Maher L, Chant K, Jalaludin B, Sargent P. School of Public Health and Community Medicine, University of New South Wales,

Sydney, NSW, Australia. L.Maher@unsw.edu.au BACKGROUND AND AIM: Hepatitis C virus (HCV) infection is now the leading notifiable disease in Australia. The current study aimed to determine the prevalence of HCV and hepatitis B virus (HBV) infection and associated risk behaviors among injecting drug users (IDUs) screened in south-western Sydney as part of a multisite prospective cohort study. METHODS: Using a combination of snowball sampling and word-of-mouth recruitment strategies, 377 IDUs were interviewed using a structured questionnaire and tested for exposure to HCV and HBV. Entry criteria were injecting drug use in the previous 6 months and antibody HCV serostatus not known to be positive. RESULTS: More than one-third (36.6%) tested HCV antibody positive and one-quarter (28%) had been exposed to HBV. Independent predictors of HCV seropositivity were HBV core antibody positive serostatus, incarceration in the past year, injecting in public, Asian ethnicity and duration of injecting. Individual risk behaviors, including sharing needles and syringes, sharing other injecting equipment and being injected by others, were not significant in either bivariate or multivariate models. CONCLUSIONS: Results indicate an urgent need for structural interventions designed to reduce the exposure of IDUs, particularly indigenous Australian and Asian injectors, to risk environments. Structural interventions, including population-based hepatitis B immunization, expanded access to needle and syringe programs and drug treatment, prison diversion programs and medically supervised injecting facilities, should be incorporated into existing blood-borne virus prevention efforts. PMID: 15377287 [PubMed - indexed for MEDLINE] 135. Vaccine. 2004 Sep 28;22(29-30):3897-901. Hepatitis B vaccination in prison with a 3-week schedule is more efficient than the standard 6-month schedule. Christensen PB, Fisker N, Krarup HB, Liebert E, Jaroslavtsev N, Christensen K, Georgsen J. Department of Medicine C, Section of Infectious Diseases, Odense University Hospital, DK 5000 Odense C, Denmark. peer.christensen@dadlnet.dk A randomized study of injecting drug users in a Danish prison comparing vaccination at 0, 1 and 3 weeks with the 0, 1 and 6 months schedule (20microg Engerix B i.m.) was conducted. Due to a low participation rate, a second nonrandomized study was conducted in Estonia where all prisoners were vaccinated with the short schedule. In the randomized study, the compliance with three doses was 63% (12/19) in the 3-week schedule compared to 20% (3/15) in the 6-month

schedule (P = 0.017). In the nonrandomized study, the compliance was 81% (457/566) and the seroprotection rate at month 7 was 67% (97/145), resulting in protection of 54% of the population at risk. This was significantly higher than the estimated 34-42% protection that would have been achieved with the 6-month schedule. PMID: 15364437 [PubMed - indexed for MEDLINE] 136. Rev Soc Bras Med Trop. 2004 Sep-Oct;37(5):391-5. Epub 2004 Sep 3. [HIV and hepatitis B virus co-infection: prevalence and risk factors]. [Article in Portuguese] Souza MG, Passos AD, Machado AA, Figueiredo JF, Esmeraldino LE. Departamento de Medicina Social, Faculdade de Medicina de Ribeiro Preto, Universidade de So Paulo, Ribeiro Preto, SP. The objective of this study was to assess the prevalence of hepatitis B virus and possible risk factors for this disease in 401 patients infected with the human immunodeficiency virus, followed at the University Hospital of the Ribeiro Preto Medical School, So Paulo State University. Each participant was submitted to a specific questionnaire and had a blood sample tested for the serologic markers HBsAg, total anti-HBcAg, anti-HBsAg and anti-HCV, using ELISA technique. The overall prevalence of hepatitis B markers was 40.9%, with 8.5% for HBsAg, 39.7% for total anti-HBcAg and 5.5% for anti-HBsAg. The variables that showed association with HBV were: age, higher education level, history of jaundice, time spent in prison, having a homosexual partner and positive markers for anti-HCV. Co-infection HBV/HCV was present in 20.4% of the participants. PMID: 15361955 [PubMed - indexed for MEDLINE] 137. MMWR Morb Mortal Wkly Rep. 2004 Aug 6;53(30):681-3. Hepatitis B vaccination of inmates in correctional facilities--Texas, 2000-2002. Centers for Disease Control and Prevention (CDC). In December 2002, approximately 2.2 million persons were incarcerated in the United States; an estimated 8 million were released to the community that year. In 2001, approximately 22,000 acute hepatitis B cases and 78,000 new hepatitis B virus (HBV) infections occurred in the United States (3); an estimated 29% of these cases were in persons who had been incarcerated previously. The majority of

HBV infections among incarcerated persons are acquired in the community; however, infection also is transmitted within correctional settings. Hepatitis B vaccination of incarcerated persons is recommended to prevent transmission in correctional facilities and in previously incarcerated persons on their return to the community. In May 2000, the Texas Department of Criminal Justice (TDCJ), which oversees custody of state jail and prison inmates, implemented a hepatitis B vaccination program. To determine hepatitis B vaccination rates of inmates during 2000-2002, TDCJ reviewed charts of inmates released during a 3-day period for documentation of vaccination. This report summarizes the results of that study, which indicated that rates of vaccine acceptance and vaccine series completion among inmates were high. Establishing hepatitis B vaccination programs in prisons and jails can prevent a substantial proportion of HBV infections among adults in the outside community. PMID: 15295312 [PubMed - indexed for MEDLINE] 138. MMWR Morb Mortal Wkly Rep. 2004 Aug 6;53(30):678-81. Transmission of hepatitis B virus in correctional facilities--Georgia, January 1999-June 2002. Centers for Disease Control and Prevention (CDC). Incarcerated persons have a disproportionate burden of infectious diseases, including hepatitis B virus (HBV) infection. Among U.S. adult prison inmates, the overall prevalence of current or previous HBV infection ranges from 13% to 47%. The prevalence of chronic HBV infection among inmates is approximately 1.0%-3.7%, two to six times the prevalence among adults in the general U.S. population. Incarcerated persons can acquire HBV infection in the community or in correctional settings. This report summarizes the results of 1) an analysis of hepatitis B cases among Georgia inmates reported to the Georgia Department of Human Resources, Division of Public Health (DPH) during January 1999-June 2002, including a retrospective investigation of cases reported during January 2001-June 2002; and 2) a prevalence survey conducted in prison intake centers during February-March 2003. These efforts identified cases of acute hepatitis B in multiple Georgia prisons and documented evidence of ongoing transmission of HBV in the state correctional system. The findings underscore the need for hepatitis B vaccination programs in correctional facilities. PMID: 15295311 [PubMed - indexed for MEDLINE] 139. Am J Public Health. 2004 Jul;94(7):1218-23. Prevalence and incidence of HIV, hepatitis B virus, and hepatitis C virus

infections among males in Rhode Island prisons. Macalino GE, Vlahov D, Sanford-Colby S, Patel S, Sabin K, Salas C, Rich JD. Brown University Medical School, Providence, RI 02912, USA. grace_macalino@brown.edu Erratum in Am J Public Health. 2004 Nov;94(11):1847. OBJECTIVES: We evaluated prevalence and intraprison incidence of HIV, hepatitis B virus, and hepatitis C virus infections among male prison inmates. METHODS: We observed intake prevalence for 4269 sentenced inmates at the Rhode Island Adult Correctional Institute between 1998 and 2000 and incidence among 446 continuously incarcerated inmates (incarcerated for 12 months or more). RESULTS: HIV, hepatitis B virus, and hepatitis C virus prevalences were 1.8%, 20.2%, and 23.1%, respectively. Infections were significantly associated with injection drug use (odds ratio = 10.1, 7.9, and 32.4). Incidence per 100 person-years was 0 for HIV, 2.7 for HBV, and 0.4 for HCV. CONCLUSIONS: High infection prevalence among inmates represents a significant community health issue. General disease prevention efforts must include prevention within correctional facilities. The high observed intraprison incidence of HBV underscores the need to vaccinate prison populations. PMCID: PMC1448424 PMID: 15226146 [PubMed - indexed for MEDLINE] 140. J Urban Health. 2004 Mar;81(1):25-37. Prevalence of HIV, syphilis, hepatitis B, and hepatitis C among entrants to Maryland correctional facilities. Solomon L, Flynn C, Muck K, Vertefeuille J. Maryland Department of Health and Mental Hygiene, AIDS Administration, 500 North Calvert Street, Baltimore, MD 21202, USA. solomonl@dhmh.state.md.us Although high prevalence of hepatitis C virus (HCV) in correctional institutions has been established, data are sparse regarding the comorbidities of hepatitis B virus (HBV), HCV, and human immunodeficiency virus (HIV), all of which may complicate the management of HCV. This study sought to estimate the prevalence and correlates associated with HCV prevalence among entrants into the Maryland Division of Correction and the Baltimore City Detention Center. Participants included all newly incarcerated entrants between January 28 and March 28, 2002. Excess sera with identifiers removed from samples drawn for routine syphilis

testing were assayed for antibodies to HIV and HCV and for HBV surface antigen and surface and total core antibodies. Separately, all HIV-positive specimens were tested using the serological testing algorithm for recent HIV seroconversion. Of the 1,081 inmates and 2,833 detainees, reactive syphilis serology was noted in 0.6% of the combined population; HIV seroprevalence was 6.6%; HCV prevalence was 29.7%; and 25.2% of detainees and prisoners had antigen or core or surface antibodies to HBV. A multivariate analysis of predictors of HCV positivity indicated that detainees, women, whites, older age groups, those who were HIV seropositive, and individuals with past or present infection with HBV were significantly more likely to be positive for HCV. These data indicate that hepatitis C remains an important public health concern among entrants to jail and prison and is complicated with coinfections that need to be addressed for effective treatment. PMCID: PMC3456140 PMID: 15047781 [PubMed - indexed for MEDLINE] 141. Eur Addict Res. 2004;10(2):56-60. Self-reported substance misuse in Greek male prisoners. Fotiadou M, Livaditis M, Manou I, Kaniotou E, Samakouri M, Tzavaras N, Xenitidis K. South London & Maudsley NHS Trust, London, UK. MariaFotiadou@slam.nhs.uk The aim of this survey was to determine levels and severity of self-reported alcohol and drug misuse and associated physical and mental health problems in Greek male prisoners. The sample consisted of 80 randomly selected convicted and remanded male prisoners in a prison in northern Greece. The Mini International Neuropsychiatric Interview (MINI) was used to assess psychiatric disorders including substance abuse and dependence. All prisoners who participated completed the Alcohol Use Disorders Identification Test (AUDIT). Those who reported daily use of opiates and stimulants completed the Severity of Dependence Scale (SDS). Information was obtained from medical notes about the prisoners' hepatitis B and HIV status. The MINI identified 27.5% of the prisoners as dependent on opiates, 26.3% on alcohol and 73.8% as cannabis users, while 13.8% were misusing both alcohol and illicit drugs. Severity of dependence was rated, using SDS, as serious for all opiate and stimulant users. In terms of physical health examination of medical records indicated that no prisoner was HIV-positive but 26.5% were hepatitis-B-positive. Of those who had a previous history of substance misuse, 31.2% fulfilled the criteria for depression and 37.5% for antisocial personality disorder. Similarly, 15% of those misusing substances had a previous history of deliberate self-harm and 16% were assessed to have moderate to high suicide risk.

Copyright 2004 S. Karger AG, Basel PMID: 15004448 [PubMed - indexed for MEDLINE] 142. Vaccine. 2004 Mar 12;22(9-10):1241-8. Cost effectiveness of hepatitis A/B versus hepatitis B vaccination for US prison inmates. Jacobs RJ, Rosenthal P, Meyerhoff AS. Capitol Outcomes Research Inc., 6188 Old Franconia Road, Alexandria, VA 22310, USA; University of California at San Francisco, San Francisco, CA, USA. jake.jacobs@capitoloutcomesresearch.com Hepatitis B immunization is provided in many US prison systems. We examined the cost effectiveness of substituting bivalent hepatitis A/B vaccine in this setting, considering regional variation in hepatitis A risks and the potential for disease transmission by former prisoners. Where hepatitis A rates are >200, 100-200, and <100% the national average, declines in hepatitis A treatment costs would offset 137, 88, and 40% of the bivalent vaccine's added cost. In the three regions considered, cost effectiveness would be US$ <0, 2131, and 22,819 per life-year saved, respectively. Prison-based hepatitis A/B immunization would meet accepted standards of cost effectiveness throughout the US. PMID: 15003653 [PubMed - indexed for MEDLINE] 143. GMHC Treat Issues. 2003 Oct;17(10):6-7. Vaccinate to prevent hepatitis B. Huff B. PMID: 14689928 [PubMed - indexed for MEDLINE] 144. Drugs. 2003;63(23):2625-49. Combined hepatitis A and B vaccines: a review of their immunogenicity and tolerability. Murdoch DL, Goa K, Figgitt DP.

Adis International Limited, Auckland, New Zealand. Three combined hepatitis A and B vaccine preparations are commercially available in various countries: a two-dose paediatric formulation (Ambirix) [administered at months 0 and 6-12]; and a three-dose adult (Twinrix Adult) or paediatric (Twinrix Paediatric) formulation (administered at months 0, 1 and 6). The adult vaccine provides consistent, marked immunogenicity which is at least similar to that of its constituent vaccines used together and with a tolerability profile that is possibly improved. An accelerated, day-0, -7 and -21 regimen has also shown immunogenicity similar to that of the monovalent vaccines given concurrently, and now has an emerging role in adults likely to travel to hepatitis A virus (HAV) and/or hepatitis B virus (HBV) endemic regions within 1 month. The adult vaccine appears effective and generally well tolerated when given concurrently with monovalent typhoid vaccine (Typherix). Immunogenicity of the two-dose paediatric vaccine is high and appears to be similar whether administered as a month-0, -6 or month-0, -12 schedule and when compared to that of the three-dose paediatric vaccine (months 0, 1, 6), both of which provide a similar degree of protection to the adult vaccine. Although both preparations also provide high end-of-schedule seroprotection against hepatitis B surface antigen, protection between the first and second doses of the two-dose regimen appears lower than with the three-dose schedule. Therefore, the three-dose paediatric vaccine is a practical option in individuals at risk of immediate exposure to HBV, while the two-dose regimen may have an important function in immunisation programmes in regions where such risk is low. Combined hepatitis A and B vaccines are generally well tolerated. The most frequently reported adverse events in clinical trials were injection-site pain and redness, and general fatigue and headache; most events were mild and transient. Pharmacoeconomic models suggest the combined vaccine is cost effective compared with no vaccine (in children/adolescents) or monovalent hepatitis B vaccine (in children/adolescents and prison inmates).CONCLUSION: The three commercially available combined hepatitis A and B adult and paediatric vaccines are highly immunogenic and generally well tolerated; the adult vaccine demonstrates immunogenicity at least as marked as that of monovalent hepatitis A and B vaccines. While further research is required to confirm potential advantages such as improved cost effectiveness, the combined vaccines have established a key role in the prevention of hepatitis A and B in defined risk groups, and have an expanding role in population-based vaccination programmes with younger age groups. PMID: 14636084 [PubMed - indexed for MEDLINE] 145. Public Health Rep. 2003 Nov-Dec;118(6):550-8. An economic assessment of pre-vaccination screening for hepatitis A and B.

Jacobs RJ, Saab S, Meyerhoff AS, Koff RS. Capitol Outcomes Research, Inc., Alexandria, VA 22310, USA. jake.jacobs@capitoloutcomesresearch.com OBJECTIVE: The availability of a single vaccine active against hepatitis A and B may facilitate prevention of both infections, but complicates the question of whether to conduct pre-vaccination screening. The authors examined the cost-effectiveness of pre-vaccination screening for several populations: first-year college students, military recruits, travelers to hepatitis A-endemic areas, patients at sexually transmitted disease clinics, and prison inmates. METHODS: Three prevention protocols were examined: (1) screen and defer vaccination until serology results are known; (2) screen and begin vaccination immediately to avoid a missed vaccination opportunity; and (3) vaccinate without screening. Data describing pre-vaccination immunity, vaccine effectiveness, and prevention costs borne by the health system (i.e., serology, vaccine acquisition, and administration) were derived from published literature and U.S. government websites. Using spreadsheet models, the authors calculated the ratio of prevention costs to the number of vaccine protections conferred. RESULTS: The vaccinate without screening protocol was most cost-effective in nine of 10 analyses conducted under baseline assumptions, and in 69 of 80 sensitivity analyses. In each population considered, vaccinate without screening was less costly than and at least equally as effective as screen and begin vaccination. The screen and defer vaccination protocol would reduce costs in seven populations, but effectiveness would also be lower. CONCLUSIONS: Unless directed at vaccination candidates with the highest probability of immunity, pre-vaccination screening for hepatitis A and B immunity is not cost-effective. Balancing cost reduction with reduced effectiveness, screen and defer may be preferred for older travelers and prison inmates. PMCID: PMC1497596 PMID: 14563912 [PubMed - indexed for MEDLINE] 146. Commun Dis Public Health. 2003 Jun;6(2):97-100. Changing epidemiology of hepatitis A: should we be doing more to vaccinate injecting drug users? Perrett K, Granerd J, Crowcroft N, Carlisle R. South Yorkshire Health Protection Service, Department of Public Health, Rotherham Primary Care Trust, Bevan House, Oakwood Hall Drive, Rotherham, South Yorkshire S60 3AQ. kevin.perrett@rotherhampct.nhs.uk Since 2001 there have been significant outbreaks of hepatitis A virus (HAV)

across South Yorkshire, largely in intravenous drug users, and HAV infection has been reported to be an increasing problem in England and Scotland during this time. This paper reports a brief investigation to clarify current HAV epidemiology in England and Wales. The epidemiology of HAV in England, but not yet Wales, has recently changed. Laboratory reports now show that most cases are occurring in young adults, mainly young men, and that the commonest reported risk group is injecting drug users. That cases may now be concentrated in injecting drug users is supported by reports from consultants in communicable disease control (CsCDC). These detail fourteen outbreaks in England in 2002 alone, all involving injecting drug users. Links to prisons and to the homeless, usually those in hostels, were also common. A combined Hepatitis A/B vaccine is readily available and we recommend that this now be used to extend the national immunisation programme against Hepatitis B in injecting drug users to include HAV. PMID: 12889286 [PubMed - indexed for MEDLINE] 147. Med J Aust. 2003 Jun 2;178(11):546-9. Hepatitis C transmission and HIV post-exposure prophylaxis after needle- and syringe-sharing in Australian prisons. O'Sullivan BG, Levy MH, Dolan KA, Post JJ, Barton SG, Dwyer DE, Kaldor JM, Grulich AE. New South Wales Department of Health, Sydney, NSW, Australia. OBJECTIVES: To determine whether infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) occurred after two potential episodes of exposure through needle- and syringe-sharing in Australian prisons, and to examine use of post-exposure prophylaxis (PEP) against HIV infection in the prison setting. DESIGN: Cohort study of potential contacts of two prisoners infected with HIV, HBV and HCV followed up for up to 14 months. SETTING: Two Australian prisons between November 2000 (time of exposure) and December 2001. PARTICIPANTS: Two index patients (both infected with HIV and HCV; one also infectious for HBV) from two different prisons, and 104 inmates who shared needles and syringes. MAIN OUTCOME MEASURES: Seroconversions to HIV, HBV and HCV related to the high-risk exposure and uptake and completion of HIV PEP determined from medical records of inmates. RESULTS: There were four seroconversions to HCV within 14 months of the potential exposure (14% of those susceptible in the cohort), but no recorded HIV or HBV seroconversions. Forty-six inmates (82% of those eligible) were offered PEP, and

34 of these (74%) elected to receive it. Only eight (24% of the 34) completed the full PEP course. CONCLUSIONS: HCV transmission in the prison setting is related to high-risk needle- and syringe-sharing. Administering HIV PEP in the prison setting is complicated by challenging risk assessment and follow-up. PMID: 12765501 [PubMed - indexed for MEDLINE] 148. Am J Med. 2003 Mar;114(4):316-8. A review of the case for hepatitis B vaccination of high-risk adults. Rich JD, Ching CG, Lally MA, Gaitanis MM, Schwartzapfel B, Charuvastra A, Beckwith CG, Flanigan TP. The Miriam Hospital/Brown University School of Medicine, 164 Summit Avenue, Providence, RI 02906, USA. jrich@Lifespan.org The sequelae of hepatitis B virus infection include fulminant liver failure, chronic liver disease, hepatocellular carcinoma, and death. The hepatitis B vaccine is efficacious, safe, and cost-effective, but has been consistently underutilized in high-risk adults despite long-standing recommendations. Instituting routine hepatitis B vaccination for high-risk adults in settings such as prisons and jails, sexually transmitted disease clinics, drug treatment centers, and needle exchange programs could prevent up to 800 cases of hepatitis, and 10 deaths from hepatitis, per 10,000 vaccinations, with an overall cost savings. Low rates of completion of the three-dose series and lack of funding for adult immunizations have always been challenges to offering hepatitis B vaccines to high-risk adults. However, there is benefit to an incomplete vaccination series, and high-risk populations are accessible for follow-up vaccination outside of traditional medical settings. A clear national objective and federal funding for vaccinating high-risk adults are needed. PMID: 12681460 [PubMed - indexed for MEDLINE] 149. Health Bull (Edinb). 2001 Mar;59(2):114-9. Prison admission health screening as a measure of health needs. Morrison DS, Gilchrist G. MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow. OBJECTIVE: To assess the validity of routine prison screening admission data for

measuring health needs and planning health services. DESIGN: Retrospective descriptive study of routinely collected admission data. SETTING: The largest Scottish men's prison with an annual throughput of around 20,000 men. SUBJECTS: All adult male (> or = 21 years) prisoners admitted during January 1998. RESULTS: Nine hundred and six men were screened in January 1998. Thirty-eight per cent of men entering prison said they currently or had previously used illegal drugs and 22% of all admissions gave a history of intravenous drug use. Six men (0.7%) reported hepatitis C infection and two (0.2%) reported hepatitis B infection. A history of major mental illness was reported by 10% of all prisoners, 7% of drug users and 15% of problem drinkers. Deliberate self-harm was reported by 10% of all prisoners, 9% of drug users and 17% of problem drinkers. CONCLUSION: There is a high prevalence of reported substance misuse and its sequelae and mental illness in prisoners. However, mental illness, substance use and some infectious diseases (such as HIV, hepatitis B and hepatitis C) may be under-reported, possibly because of social stigma or low expectations of treatment in prison. Health screening on admission to prison presents a unique opportunity to identify health needs at an early stage. However, there is a need to improve detection of some stigmatized conditions if individual care and health service planning are to be improved. PMID: 12664725 [PubMed - indexed for MEDLINE] 150. MMWR Recomm Rep. 2003 Jan 24;52(RR-1):1-36; quiz CE1-4. Prevention and control of infections with hepatitis viruses in correctional settings. Centers for Disease Control and Prevention. Weinbaum C, Lyerla R, Margolis HS; Centers for Disease Control and Prevention. Division of Viral Hepatitis, National Center for Infectious Diseases, USA. Erratum in MMWR Recomm Rep. 2003 Mar 14;52(10):205-14. This report consolidates previous recommendations and adds new ones for preventing and controlling infections with hepatitis viruses in correctional settings. These recommendations provide guidelines for juvenile and adult correctional systems regarding 1) identification and investigation of acute viral hepatitis; 2) preexposure and postexposure immunization for hepatitis A and hepatitis B; 3) prevention of hepatitis C virus infection and its consequences; 4) health education; and 5) release planning. Implementation of these recommendations can reduce transmission of infections with hepatitis viruses among adults at risk in both correctional facilities and the outside community.

These recommendations were developed after consultation with other federal agencies and specialists in the fields of corrections, correctional health care, and public health at a meeting in Atlanta, March 5-7, 2001. This report can serve as a resource for those involved in planning and implementing health-care programs for incarcerated persons. PMID: 12562146 [PubMed - indexed for MEDLINE] 151. Addiction. 2003 Feb;98(2):153-8. Prison-based syringe exchange programmes: a review of international research and development. Dolan K, Rutter S, Wodak AD. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. k.dolan@unsw.edu.au Journal publications and conference presentations on prison-based syringe exchange (PSE) programmes were identified by a comprehensive search of electronic databases. Experts involved with development and evaluation of current PSE programmes or policy were contacted for reports, documents and unpublished material. Spanish information on PSE was translated for this review. We identified 14 papers specifically on PSE programmes in Switzerland (six papers), Germany (four) and Spain (four). The first PSE programme started in 1992 in Switzerland. As of December 2000, seven PSEs were operating in Switzerland, seven in Germany and five in Spain. There have been six evaluations of prison syringe exchange programmes and all have been favourable. Reports of drug use decreased or remained stable over time. Reports of syringe sharing declined dramatically. No new cases of HIV, hepatitis B or hepatitis C transmission were reported. The evaluations found no reports of serious unintended negative events, such as initiation of injection or of the use of needles as weapons. Staff attitudes were generally positive but response rates to these surveys varied. Overall, this review indicated that prison syringe exchange programmes are feasible and do provide benefit in the reduction of risk behaviour and the transmission of blood-borne infection without any unintended negative consequences. PMID: 12534419 [PubMed - indexed for MEDLINE] 152. Emerg Med J. 2003 Jan;20(1):48-51. Impact of a newly opened prison on an accident and emergency department. Boyce SH, Stevenson J, Jamieson IS, Campbell S.

Accident and Emergency Department, Crosshouse Hospital, Kilmarnock, Scotland. steveboyce_scotland@yahoo.com OBJECTIVE: To determine the impact of a newly opened prison on an accident and emergency (A&E) department. METHOD: A new category B prison opened in April 1999, the first privately run prison in Scotland and the third largest in population. All prisoners referred to the A&E department for treatment were identified prospectively during the first year after the opening of the prison. RESULTS: 99 prisoners and four members of staff attended during the one year period. Ages ranged from 18-64 years with a mean age of 29.8 years. Presentations were as a result of deliberate self harm (22%), injury after violence (18%), sports injury (15%), surgical condition (15%), medical illness (13%), accidental injury (9%), ENT problem (2%), and miscellaneous (6%). Thirty seven prisoners (35.6%) were admitted to the hospital. Further review at outpatient clinics was arranged for 15 prisoners. One prisoner died, the result of suicide by hanging. The remaining prisoners were returned to the prison for further management by the prison medical and nursing team. Twelve prisoners re-attended a total of 37 times, ranging from twice to a maximum of eight visits. Some 42.3% of attendances were during "working hours" (09.00-17.00) and 57.7% attended "out of hours" (17.00-09.00). Twenty four referrals (23.1%) were deemed inappropriate by the prison medical team on retrospective review. Sixteen of these occurred "out of hours". Forty one prisoners (39.4%) were known to have a history of injecting drug misuse. Including re-attenders, 59 presentations (56.7%) to the A&E department had a history of injecting drug misuse. Of these 41 prisoners, 11 (26.8%) were hepatitis C positive, with eight of these having a positive polymerase chain reaction test. No prisoners had HIV and only one prisoner was hepatitis B positive. CONCLUSION: The opening of the prison resulted in only a slight increase in the workload of the A&E department. A significant proportion of prisoners were admitted to the hospital highlighting the practical and logistical problems of managing people restrained and in custody. Most cases can be safely referred back to the prison. Increased input is required from the prison medical team when dealing with deliberate self harm, frequent attenders, and "out of hours" referrals. All A&E staff must be aware of the increased risk of hepatitis C infection when dealing with a confined prison population. PMCID: PMC1726011 PMID: 12533368 [PubMed - indexed for MEDLINE] 153. Vaccine. 2002 Dec 13;21(3-4):312-21. Cost-effectiveness of hepatitis B vaccination of prison inmates.

Pisu M, Meltzer MI, Lyerla R. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS D59, Atlanta, GA 30333, USA. mpisu@dopm.uab.edu The purpose of this paper is to determine the cost-effectiveness of vaccinating inmates against hepatitis B. From the prison perspective, vaccinating inmates at intake is not cost-saving. It could be economically beneficial when the cost of a vaccine dose is <US dollars 30 per dose, or there is no prevalence of infection upon intake, or the costs of treating acute or chronic disease are about 70% higher than baseline costs, or the incidence of infection during and after custody were >1.6 and 50%, respectively. The health care system realizes net savings even when there is no incidence in prison, or there is no cost of chronic liver disease, or when only one dose of vaccine is administered. Thus, while prisons might not have economic incentives to implement hepatitis B vaccination programs, the health care system would benefit from allocating resources to them. PMID: 12450707 [PubMed - indexed for MEDLINE] 154. J Palliat Med. 2002 Aug;5(4):549-52. Hospice care for the incarcerated in the United States: an introduction. Linder JF, Enders SR, Craig E, Richardson J, Meyers FJ. University of California, Davis, Health System, Sacramento, California 95817, USA. john.linder@ucdmc.ucdavis.edu Prison populations throughout the Unites States are growing; the 1990s saw an average 6.5% per year increase. Average inmate age is increasing, as are both the number and rate of inmate deaths. Aging inmates experience health concerns typical of the general, free, aging population. Inmates have higher incidence of health complications associated with various circumstances, risk behaviors, and associated medical conditions. These circumstances include prison violence, incarceration-related constraints on exercise, and diet. Inmates are more likely to have a history of alcohol abuse, substance abuse or addiction and sex industry work. Risk-behavior conditions include human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), hepatitis B and C, liver disease, tuberculosis, endocarditis, and cardiomyopathy. Hospice is increasingly the preferred response to the health and care needs of terminally ill inmates. Implementing hospice behind bars has some unique challenges in addition to those inherent in hospice work. This series will provide an in-depth look at four hospice programs for inmates in the United States. PMID: 12243679 [PubMed - indexed for MEDLINE]

155. Bull World Health Organ. 2002;80(7):569-74. Epub 2002 Jul 30. Hepatitis B vaccination in prisons. Awofeso N. New South Wales Corrections Health Service, Population Health Unit, PO Box 150, Matraville, New South Wales 2036, Australia. awofeson@chs.health.nsw.gov.au The opportunities and problems for hepatitis B vaccination programmes in prison settings are discussed. In particular, the advantages of modelling are stressed and an active case-finding approach is advocated. Measures for maintaining good case-holding are also discussed, and a 0, 1, 2 months vaccination regimen with 20 microg doses of vaccine is advocated for prison settings. A higher reference level for inferring adequate immunization is also recommended, with booster injections for inmates who do not meet the higher reference after a primary course of vaccination. PMCID: PMC2567552 PMID: 12163921 [PubMed - indexed for MEDLINE] 156. MMW Fortschr Med. 2002 May 16;144(20):52-4. [Medicine behind bars. Illness is usual not grounds for modifying imprisonment]. [Article in German] Schwarzkopf A, Zenker M. Facharzt fr Mikrobiologie und Infektionsepidemiologie, Krankenhaushygiene-Berater, Bad Bocklet. The article describes the possibilities of medical care in prison as exemplified by the Kassel 1 prison with its attached central hospital facility. The main areas of medical care covered there are the treatment of wounds, conservative treatment of fractures, ophthalmology, ENT, urology, dentistry and, via external consultant physicians, also internal medicine, pneumology, dermatology and gynecology. Such infections as hepatitis B and C, syphilis, and tuberculosis have a greater prevalence among prisoners--in contrast to other infections afflicting people housed under similar living conditions, such as in communal living facilities, which show no such increased prevalence. Furthermore, there is a relatively high percentage of injuries, including those that are self-inflicted. The problem of certifying a prisoner medically unfit to tolerate imprisonment is

discussed. PMID: 12119886 [PubMed - indexed for MEDLINE] 157. Public Health Rep. 2001 May-Jun;116(3):203-9. Hepatitis B vaccination practices in state and federal prisons. Charuvastra A, Stein J, Schwartzapfel B, Spaulding A, Horowitz E, Macalino G, Rich JD. The Miriam Hospital/Brown Medical School, Providence, RI. Rhode Island Department of Corrections/Rhode Island Hospital, Providence, RI 02906, USA. OBJECTIVE: Incarcerated populations are a group at high risk for hepatitis B. About 30% of people experiencing acute hepatitis B virus infection (HBV) have a history of incarceration. Offering routine HBV vaccinations to incarcerated individuals could have a significant effect on public health. The objective of this study is to identify current vaccine practices and the perceived feasibility of routine vaccinations for hepatitis B within correctional settings. METHOD: The authors surveyed the medical directors of state correctional facilities in all 50 states and the federal prison system regarding current HBV vaccine practices. Surveys were faxed or mailed between July 1 and September 1, 2000. RESULTS: Thirty-five states and the federal system responded (response rate = 70.6%). These systems account for 77% of all inmates in federal or state prisons and jails. Two states give hepatitis B vaccine routinely, nine states offer no hepatitis B vaccine, and 26 states and the Federal Bureau of Prisons offer hepatitis vaccine to some inmates. Most states do not spend enough money to vaccinate even those prisoners at highest risk. Under the Vaccine for Children program, 19,520 youths could receive vaccine immediately. According to the respondents, if vaccine were available at no-cost, 25 states and the Federal Bureau of Prisons would routinely offer vaccination to all inmates. CONCLUSIONS: Most correctional systems do not routinely offer vaccine to their incarcerated populations, but would if funds were available. There exists now a unique public health opportunity to prevent a significant proportion of new hepatitis B infections. PMCID: PMC1497321 PMID: 12034909 [PubMed - indexed for MEDLINE] 158. Ann Med Interne (Paris). 2001 Nov;152 Suppl 7:6-8. [Prevalence of HBV and HCV infections and incidence of HCV infection after 3, 6

and 12 months detention in La Sant prison, Paris]. [Article in French] Arrada A, Zak Dit Zbar O, Vasseur V. Unit de Consultations et de Soins Ambulatoires, Hpital Cochin, Maison d'Arrt de Paris, La Sant, France. arrada-75@hot_mail.com The concentration of a marginal population (35% drug addicts) in prisons necessitates systematic and rigorous screening for hepatitis B and hepatitis C in subjects at risk. In June 1998, a screening program was initiated to determine the prevalence of HBV and HBC infections in prisoners and to determine the incidence after 3, 6 and 12 months detention. The screening program was proposed to 900 prisoners in a Paris prison (Maison d'arrt de Paris-La Sant) from June 3 to November 10, 1998. The program included hepatitis B and hepatitis C serology at incarceration. For prisoners who were seronegative for HCV at incarceration, a new HCV serology was proposed after 3, 6 and 12 months detention. It was postulated that HCV contamination could occur during incarceration (syringe sharing, tattooing). After one year of incarceration, no seroconversions for HCV were observed among the prisoners participating in this study. These findings should be interpreted with caution due to the particular detention conditions at the prison involved, raising important methodology interrogations concerning this type of survey. PMID: 11965092 [PubMed - indexed for MEDLINE] 159. Biomedica. 2002 Mar;22(1):77-88. [The status of sexually transmitted diseases, Colombia, 1976-2000]. [Article in Spanish] Acosta J, Prieto F, Rodrguez D, Rueda C. Programa ETS/SIDA, Instituto Nacional de Salud, Bogot, D.C., Colombia. PMID: 11957369 [PubMed - indexed for MEDLINE] 160. J Infect Dis. 2002 Mar 15;185(6):713-9. Epub 2002 Feb 28. Incidence and risk factors for acute hepatitis B in the United States, 1982-1998: implications for vaccination programs.

Goldstein ST, Alter MJ, Williams IT, Moyer LA, Judson FN, Mottram K, Fleenor M, Ryder PL, Margolis HS. Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. From 1982-1998, enhanced sentinel surveillance for acute hepatitis B was conducted in 4 counties in the United States to determine trends in disease incidence and risk factors for infection. During this period, the reported incidence of acute hepatitis B declined by 76.1% from 13.8 cases per 100,000 in 1987 to 3.3 cases per 100,000 in 1998. Cases associated with injection drug use (IDU) decreased by 90.6%, men who have sex with men (MSM) by 63.5%, and heterosexual activity by 50.7%. During 1994-1998, the most commonly reported risk factor for infection was high-risk heterosexual activity (39.8%) followed by MSM activity (14.6%) and IDU (13.8%). Over half of all patients (55.5%) reported treatment for a sexually transmitted disease (STD) or incarceration in a prison or jail prior to their illness, suggesting that more than half of the acute hepatitis B cases might have been prevented through routine hepatitis B immunization in STD clinics and correctional health care programs. PMID: 11920288 [PubMed - indexed for MEDLINE] 161. Epidemiol Infect. 2001 Dec;127(3):475-84. Association between heroin use, needle sharing and tattoos received in prison with hepatitis B and C positivity among street-recruited injecting drug users in New Mexico, USA. Samuel MC, Doherty PM, Bulterys M, Jenison SA. Public Health Division, New Mexico Department of Health, Sanita Fe, USA. This study aimed to assess the seroprevalence and risk factors for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV-1 infections among injecting drug users (IDU) in New Mexico. Serological and behavioural surveys were conducted in conjunction with street-based outreach, education and HIV counselling and testing. High rates of antibody positivity for HCV (82.2%) and HBV (61.1%), and a low rate for HIV (0.5%) were found. In multivariate analyses, both HBV and HCV infection were positively associated with increasing age, increasing years of injection and heroin use. Receipt of a tattoo in prison/jail was associated with HBV (odds ratio = 2.3, 95% confidence interval 1.4, 3.8) and HCV (OR = 3.4, 95% CI = 1.6, 7.5) infections. Prevention of bloodborne pathogens among IDUs should focus on young users, early in their drug use experience. Studies examining the relationship between tattooing and HBV and HCV infection are needed as are efforts to promote sterile tattooing, in prisons and elsewhere.

PMCID: PMC2869773 PMID: 11811881 [PubMed - indexed for MEDLINE] 162. Addiction. 2001 Dec;96(12):1787-97. Predictors of hepatitis B and C infection in injecting drug users both in and out of drug treatment. Cook PA, McVeigh J, Syed Q, Mutton K, Bellis MA. Public Health Sector, School of Health and Human Sciences, Liverpool John Moores University, Liverpool, UK. p.a.cook@livjm.ac.uk AIMS: To assess prevalence of, and behavioural risk factors for, hepatitis B and C in drug users both in and out of contact with drugs services. DESIGN: Cross-sectional survey of hepatitis B and C prevalence using blood samples and self-completed risk factor questionnaires. PARTICIPANTS: Three hundred and sixty injecting drug users (IDUs) in treatment for their drug use, attending syringe exchange schemes (SES), and not in contact with any services in Wirral and Manchester between 1997 and 1999, for whom test results were available for 334 (hepatitis B) and 341 (hepatitis C). FINDINGS: Hepatitis B prevalence differed between groups, from 19% of those not in contact to 41% of those presenting to request a test (p = 0.040). Prevalence of hepatitis C ranged from 48% (SES) to 62% among those presenting for a test (p = 0.233). After multivariate adjustment, hepatitis B was predicted by prison stays (p = 0.030) and injecting for longer (p = 0.003). For hepatitis C, length of injecting career (p = 0.036), having been to prison (p = 0.034), having injected more than one drug type (p < 0.001) and being female (p = 0.037) predicted infection. Overall, 38% had shared some form of injecting equipment in the previous 4 weeks. People recently starting injecting were more likely to share, and sharing was more likely to occur when injecting with only one other user rather than in larger groups. Those who had previously presented for a hepatitis C test, regardless of the result, were less likely to have recently shared injecting equipment. CONCLUSIONS: Behaviours associated with transmission of hepatitis B and C are common among IDUs. In particular, sharing of injecting equipment was more likely in small groups and in those recently beginning injecting. More broadly, chaotic drug use and time in prison were also risk factors for hepatitis infections. When assessing prevalence of hepatitis B and C, our results suggest that figures cannot be extrapolated from those in service contact to those in the wider drug-using population. PMID: 11784471 [PubMed - indexed for MEDLINE]

163. Infect Control Hosp Epidemiol. 2001 Sep;22(9):555-9. Infection control practices among correctional healthcare workers: effect of management attitudes and availabiity of protective equipment and engineering controls. Green-McKenzie J, Gershon RR, Karkashian C. The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA. OBJECTIVES: To determine the relation of the availability of personal protective equipment (PPE) and engineering controls to infection control (IC) practices in a prison healthcare setting, and to explore the effect on IC practices of a perceived organizational commitment to safety. DESIGN: Cross-sectional survey. SETTING: The study population was drawn from the 28 regional Correctional Health Care Workers Facilities in Maryland. PARTICIPANTS: All full-time Maryland correctional healthcare workers (HCWs) were surveyed, and 225 (64%) of the 350 responded. METHOD: A confidential, self-administered questionnaire was mailed to all correctional HCWs employed in the 28 Maryland Correctional Health Care Facilities. The questionnaire was analyzed psychometrically and validated through extensive pilot testing. It included items on three major constructs: IC practices, safety climate (defined as the perception of organizational commitment to safety), and availability of IC equipment and supplies. RESULTS: A strong correlation was found between the availability of PPE and IC practices. Similarly, a strong correlation was found between IC practices and the presence of engineering controls. In addition, an equally strong association was seen between the adoption of IC practices and employee perception of management commitment to safety. Those employees who perceived a high level of management support for safety were more than twice as likely to adhere to recommended IC practices. IC practices were significantly more likely to be followed if PPE was always readily available. Similarly, IC practices were more likely to be followed if engineering controls were provided. CONCLUSION: These findings suggest that ready availability of PPE and the presence of engineering controls are crucial to help ensure their use in this high-risk environment. This is especially important because correctional HCWs are potentially at risk of exposure to bloodborne pathogens such as human immunodeficiency virus and hepatitis B and C viruses. Commitment to safety was found to be highly associated with the adoption of safe work practices. There is an inherent conflict of "custody versus care" in this setting; hence, it is especially important that we understand and appreciate the relation between safety climate and IC practices. Interventions designed to improve safety climate, as well as availability of necessary IC supplies and equipment, will

most likely prove effective in improving employee compliance with IC practices in this healthcare setting. PMID: 11732784 [PubMed - indexed for MEDLINE] 164. BMJ. 2001 Nov 24;323(7323):1209-13. Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in entrants to Irish prisons: a national cross sectional survey. Long J, Allwright S, Barry J, Reynolds SR, Thornton L, Bradley F, Parry JV. Department of Community Health, Trinity College Center, Adelaide and Meath Hospital, Dublin 24, Republic of Ireland. Comment in BMJ. 2002 Apr 6;324(7341):850. BMJ. 2002 Apr 6;324(7341):850. OBJECTIVES: To determine the prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in entrants to Irish prisons and to examine risk factors for infection. DESIGN: Cross sectional, anonymous survey, with self completed risk factor questionnaire and oral fluid specimen for antibody testing. SETTING: Five of seven committal prisons in the Republic of Ireland. Participants: 607 of the 718 consecutive prison entrants from 6 April to 1 May 1999. MAIN OUTCOME MEASURES: Prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in prison entrants, and self reported risk factor status. RESULTS: Prevalence of antibodies to hepatitis B core antigen was 37/596 (6%; 95% confidence interval 4% to 9%), to hepatitis C virus was 130/596 (22%; 19% to 25%), and to HIV was 12/596 (2%; 1% to 4%). A third of the respondents had never previously been in prison; these had the lowest prevalence of antibodies to hepatitis B core antigen (4/197, 2%), to hepatitis C (6/197, 3%), and to HIV (0/197). In total 29% of respondents (173/593) reported ever injecting drugs, but only 7% (14/197) of those entering prison for the first time reported doing so compared with 40% (157/394) of those previously in prison. Use of injected drugs was the most important predictor of antibodies to hepatitis B core antigen and hepatitis C virus. CONCLUSIONS: Use of injected drugs and infection with hepatitis C virus are endemic in Irish prisons. A third of prison entrants were committed to prison for the first time. Only a small number of first time entrants were infected with one or more of the viruses. These findings confirm the need for increased infection control and harm reduction measures in Irish prisons.

PMCID: PMC59992 PMID: 11719410 [PubMed - indexed for MEDLINE] 165. Eur J Public Health. 2001 Sep;11(3):243-50. Surveillance of HIV infection and related risk behaviour in European prisons. A multicentre pilot study. Rotily M, Weilandt C, Bird SM, Kll K, Van Haastrecht HJ, Iandolo E, Rousseau S. INSERM U 379, 23 Rue Stanislas Torrents, 13006 Marseille, France. rotily@marseille.inserm.fr BACKGROUND: In order to demonstrate the feasibility of human immunodeficiency virus (HIV) infection and related risk behaviour surveillance in European prisons, a multicentre pilot study was undertaken. METHODS: A cross-sectional survey was carried out in six European prisons (France, Germany, Italy, The Netherlands, Scotland and Sweden). Inmates were invited to complete a self-administered and anonymous questionnaire and to give a saliva sample in order to test for HIV antibodies. RESULTS: Eight hundred and forty-seven out of 1,124 inmates participated in the survey (response rate 75%). Saliva from 817 inmates (73%) was collected and processed for HIV antibodies. Twenty-seven per cent reported that they had ever injected drugs and 49% of these reported they had injected whilst in prison. Eighteen per cent of inmates reported that they had been tattooed whilst in prison, which was found to be higher among injecting drug users (IDUs). One and sixteen per cent reported that they had ever had homosexual and heterosexual intercourse in prison respectively. The HIV prevalence among IDUs was 4% (versus 1% among non-IDUs) (p = 0.02). The proportions of inmates previously tested for hepatitis C and vaccinated against hepatitis B were 24 and 16% respectively. CONCLUSION: This survey demonstrates the feasibility of cross-sectional surveys in European prison inmates and highlights the importance of surveillance of HIV prevalence and related risk behaviour among inmates. The continuing high HIV prevalence and potential for HIV spread in prisons should encourage decision makers in implementing or enhancing harm reduction and education programmes and substance abuse treatment services in prison. PMID: 11582600 [PubMed - indexed for MEDLINE] 166. JAMA. 2001 Aug 8;286(6):665-7. From the Centers for Disease Control and Prevention. Hepatitis B outbreak in a state correctional facility, 2000.

[No authors listed] PMID: 11508311 [PubMed - indexed for MEDLINE] 167. Braz J Infect Dis. 2001 Jun;5(3):111-8. High prevalence of hepatitis C infection in a Brazilian prison: identification of risk factors for infection. Guimares T, Granato CF, Varella D, Ferraz ML, Castelo A, Kalls EG. Federal University of So Paulo, Medical College, So Paulo, SP, Brazil. tguimaraes@wac.com.br Hepatitis C virus (HCV) causes infectious hepatitis worldwide. It is transmitted mainly by blood products and sharing of intravenous paraphernalia during illicit drug use. High prevalence rates have been described among specific groups considered to be at higher risk for HCV infection, including prison inmates. The objectives of this study were: to determine the HCV seroprevalence among inmates of Casa de Deteno de So Paulo; to identify risk factors for HCV infection; and to compare the seroprevalence of HCV to other blood borne or sexually transmitted diseases. From December, 1993, to January, 1994, a total of 779 inmates were interviewed to collect information on sociodemographic status, sexual behavior, and past experience with illicit drugs. Blood samples were obtained from 756 inmates for serological tests. 310 (41%) blood samples were positive for anti-HCV, 425 (56.2%) were negative, and 21 (2.8%) showed indeterminate results. In this population, we found a seroprevalence of 13.7% for HIV, 3.3% for syphilis (VDRL), and 68.1% for hepatitis B virus previous infection. Four variables were each identified as associated with a positive anti-HCV serologic test: a positive VDRL (OR = 2.63 IC 95% 1.08 to 6.36); a time of current imprisonment longer than 130 months (OR = 2.44 IC 95% 1.04 to 5.71); previous incarceration at Casa de Deteno de So Paulo (OR = 1.73 IC 95% 1.19 to 2.52) and; illicit drug use before admission to the Casa de Deteno de So Paulo (OR = 1.64 IC 95% 1.15 to 2.33). The seroprevalence of HCV antibodies among the study population was high (41%), indeed, one of the highest clusters of HCV infection recorded until now. Four variables were each shown to be associated with HCV infection. The simultaneous presence of these 4 variables is associated with an 82% probability of being anti-HCV positive. Although risk factor analysis indicates most HCV infections occur prior to inprisonment, initiation of control measures to prevent continued transmission after incarceration should be done. PMID: 11506773 [PubMed - indexed for MEDLINE]

168. Rev Clin Esp. 2001 May;201(5):249-55. [Study of cases of HIV infection in Castile-Leon prisons]. [Article in Spanish] Grupo castellano-leons para el estudio de infeccin VIH en prisiones. OBJECTIVE: To study the HIV infection cases among inmates in Castile-Len prisons and the therapy status and clinical follow-up. MATERIALS Y METHODS: The socio-demographic, clinical and virological parameters were studied of all seropositive inmates of seven out of eight prisons in Castile-Len. A personal survey and a review of the medical records were conducted. RESULTS: A total of 413 HIV infected inmates were detected (12.05% out of 3,426 inmates); 98.6% were males, mostly of them caucasians. Parenteral drug abuse accounted for most infections (94.9%). Co-infection with hepatitis C virus was present in 81.4%, whereas the presence of surface antigen of the hepatitis B virus was detected in 12.6%. The median of CD4 lymphocyte count was 426.5 (interquartile range: 264.25 to 598.50) and of viral load 3.69 logs of particles/ml (interquartile range: 2.18 to 4.45). A total of 171 individuals are on anti-retroviral therapy, most of them with triple therapy; 40.4% of them had a viral load below 400 copies/ml. Over one third of seropositive individuals (37.3%) required therapy and are not on therapy, either because they have not initiated therapy or because of non-compliance. CONCLUSIONS: A highly representative study of the area which reveals a low number of identified seropositive individuals, mainly in association with drug abuse. The therapeutic guidelines are the standards but there is a high percentage of individuals requiring therapy. Co-infection with hepatitis C virus is extremely high, which will undoubtedly pose new therapeutic approaches. PMID: 11458793 [PubMed - indexed for MEDLINE] 169. MMWR Morb Mortal Wkly Rep. 2001 Jun 29;50(25):529-32. Hepatitis B outbreak in a state correctional facility, 2000. Centers for Disease Control and Prevention (CDC). On March 31, 2000, acute hepatitis B was confirmed serologically in a 34-year-old man (index patient) who had been incarcerated for 2.5 years at a high-security state correctional facility and who presented to the facility medical unit with jaundice and abnormal liver enzymes. He reported having unprotected sex with his cellmate as his only risk factor for infection during the 6 months preceding his illness. Serologic testing of the 21-year-old cellmate confirmed that he had chronic hepatitis B virus (HBV) infection. He reported no history of symptoms

compatible with hepatitis and was previously unaware of his chronic infection, but he did report having unprotected sex with the index patient and two additional inmates in the dormitory (dorm Y). On May 15, 2000, the state's department of health and department of corrections and CDC initiated an investigation to identify additional cases and determine risk factors for HBV infection. This report summarizes the results of the investigation, which identified additional cases of HBV infection in this correctional facility and underscores the need to implement hepatitis B vaccination in correctional facilities. PMID: 11446570 [PubMed - indexed for MEDLINE] 170. J Epidemiol Biostat. 2001;6(3):243-65; discussion 279-85. Projecting severe sequelae of injection-related hepatitis C virus epidemic in the UK. Part 1: Critical hepatitis C and injector data. Bird SM, Goldberg DJ, Hutchinson SJ. MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK. BACKGROUND: Hepatitis C is transmitted by transfusion of unscreened blood, through injecting drugs, from mother-to-child and, on occasion, sexually. Transmission generally requires that the infector is hepatitis C virus (HCV) RNA positive, a 'carrier'. About three-quarters of injectors who are hepatitis C antibody positive are HCV-RNA positive and so infectious to others. Incubation periods from HCV infection to cirrhosis and hepatocellular carcinoma are even longer than from HIV infection to AIDS, being counted in decades; they depend on age, gender, alcohol consumption and co-infection with other viruses. We identify 25 data sources that are available, or required, for projecting the severe sequelae of the injection-related hepatitis C epidemic. DATA SOURCES: Three data sources relate to hepatitis C diagnosis: register of confirmed HCV infections (with initial of first name + soundex of surname + date of birth + gender = master index, exposure category, year of starting to inject, and region); surveys of HCV test-uptake by injectors and others; documentation of pregnancy and its outcome in HCV-infected women (injectors and others). Four data sources relate to HCV prevalence and incidence among injectors and others: anonymous testing for HCV antibodies in blood or saliva (for sentinel groups ranging from new blood donors, pregnant women, patients awaiting kidney transplantation, non-injector prisoners, health-care workers, non-injector heterosexuals attending genitourinary medicine clinics; to injectors in the community, at drug treatment centres or in prison); historical data on HCV prevalence in injectors; HCV incidence studies in injectors; and uptake of harm reduction measures--frequency of sharing and methadone substitution--by injectors. Key reporting problems in HCV incidence studies, which inhibit checks

on the convenient exponential assumption for time from start of injecting to hepatitis C infection, are discussed. Nine critical data sources are identified for monitoring the late sequelae of hepatitis C carriage, its investigation and treatment: linkage surveillance, for example by master index, to identify deaths, hospitalisations or cancer registrations among confirmed HCV infections; surveys of HCV status among patients who undergo liver biopsy, are newly diagnosed with cirrhosis or are newly diagnosed with liver cancer; surveys of liver-biopsy rate in HCV-infected injectors and others; uptake and outcome of interferon + ribavirin in the treatment of hepatitis C carriers; cohort studies of HCV progression; sample surveys of genotype in HCV-infected injectors, and others; acute hepatitis B infections and uptake of hepatitis B immunisation by injectors; liver transplantation in HCV-infected patients; and hepatitis C-status and other risk factors in deaths from cirrhosis or liver cancer, to determine whether they are HCV and injector-related. Finally, nine critical data sources are identified for quantitative understanding of the underlying injector epidemic: drug misuse databases plus capture-recapture methods to assess number of injectors, drug-related deaths by region to assess injector numbers; number of HIV-infected injectors; HIV progression in injectors; overdose and other causes of death in injectors; expert opinion on injector incidence historically, plus survey information on age-distribution at initiation and duration of injector careers; injector incidence historically inferred from hepatitis C infected blood donors; age-distribution of current injectors and at initiation, as a check on the assumptions made in stochastic simulation about injector incidence and 'outcidence' from injecting historically; mortality of former injectors; and general population or other survey ratios of surviving ever-injectors to injectors in the last 5 years, last year and currently, as a check on simulations. RECOMMENDATIONS: We recommend a common HCV diagnosis report form to improve ascertainment of risk-factor information, especially year of starting to inject--which is a key date epidemiologically. We also recommend updated surveys of current and former injectors' HCV-test uptake, or a denominator study that registers master index and risk factor information for all HCV testees. We recommend that injector surveys ask about typical frequency of needle sharing per 4 weeks in three distinct periods this year, last year and in the first year of injecting. We also recommend the location of stored historical samples from injectors to be tested retrospectively and anonymously for HCV antibodies. We recommend immediate attention to the uptake of, and response to, combination treatment by hepatitis C carriers who are former or recovering injectors. We rec PMID: 11437088 [PubMed - indexed for MEDLINE] 171. Eur J Epidemiol. 2000;16(11):1043-9. Prevalence and incidence of bloodborne viral infections among Danish prisoners.

Christensen PB, Krarup HB, Niesters HG, Norder H, Georgsen J. Department of Clinical Immunology, Odense University Hospital, Aalborg Hospital, Denmark. peer.christensen@dadlnet.dk In order to determine the prevalence and incidence of bloodborne viral infections among prisoners, we conducted a prospective study in a Danish medium security prison for males. The prisoners were offered an interview and blood test for hepatitis and human immunodeficiency virus HIV at inclusion as well as at release from prison or end of study. Of 403 prisoners available 325 (79%) participated in the initial survey and for 142 (44%) a follow-up test was available. 43% (140/325) of the participants were injecting drug users (IDUs) of whom 64% were positive for hepatitis B (HBV) and 87% for hepatitis C (HCV) markers. No cases of HIV or human T lymphotropic virus (HTLV) were found. 32% of all prisoners could transmit HBV and/or HCV by blood contact. 70% of IDUs had shared injecting equipment, and 60% had injected inside prison. Only 2% of IDUs were vaccinated against HBV. Duration of injecting drug use, numbers of imprisonments, and injecting in prison were independently and positively associated with the presence of HBV antibodies among IDUs by logistic regression analysis. The HBV incidence was 16/100 PY (95% CI: 2-56/100 PY) and the HCV incidence 25/100 PY (1-140) among injecting drug users (IDUs). We conclude that IDUs in prison have an incidence of hepatitis B and C 100 times higher than reported in the general Danish population. They should be vaccinated against hepatitis B and new initiatives to stop sharing of injecting equipment in and outside prison is urgently needed. PMID: 11421474 [PubMed - indexed for MEDLINE] 172. J Urban Health. 2001 Jun;78(2):264-78. Using a jail-based survey to monitor HIV and risk behaviors among Seattle area injection drug users. Thiede H, Romero M, Bordelon K, Hagan H, Murrill CS. Public Health, Seattle and King County, Washington 98104, USA. hanne.thiede@metrokc.gov Routine monitoring of human immunodeficiency virus (HIV) and risk behaviors among injection drug users (IDUs) is difficult outside drug treatment settings. We developed and implemented a survey of recently arrested IDUs to describe the prevalence of HIV, drug use, and sexual behaviors among them. A probability sampling survey was instituted in the King County Correctional Facility in Seattle, Washington, to sample recently arrested IDUs at the time of booking and

in the jail health clinic between 1998 and 1999. Following HIV risk assessment and blood draw, additional information on drug use practices was gathered using a standardized questionnaire. Potential participants who were released from jail early could complete the study at a nearby research storefront office. Of the 4,344 persons intercepted at booking, 503 (12%) reported injection drug use, and 201 of the IDUs (40%) participated in the study. An additional 161 IDUs were enrolled in the study from the jail health clinic. Among the 348 unduplicated subjects, HIV prevalence was 2%; in the past 6 months, 69% reported two or more shooting partners, 72% used a cooker after someone else, 60% shared a syringe to divide up drugs, and 62% injected with used needles. Only 37% reported being hepatitis C seropositive, and 8% reported hepatitis B vaccination. It was feasible to conduct a jail-based survey of recently arrested IDUs that yielded useful information. The high prevalence of reported risky drug use practices warrants ongoing monitoring and illustrates the need for improving prevention programs for HIV and hepatitis B and C in this population, including expansion of hepatitis C screening and provision of hepatitis B vaccination at the jail health clinic. PMCID: PMC3456353 PMID: 11419580 [PubMed - indexed for MEDLINE] 173. AIDS Policy Law. 1999 Jun 25;14(12):14-5. Inaction on study creates inference that prison was indifferent. [No authors listed] AIDS: An Illinois appeals court has revived a lawsuit by an inmate who claims he contracted hepatitis B while incarcerated. A lower court granted a defense motion for dismissal, but the Appellate Court gave the Statesville Correctional Center inmate an opportunity to go through the discovery process. The appeals panel ruled that the plaintiff must show during this process that the prison disregarded a known and intolerable risk of harm. The inmate argued that prison officials conducted a seroprevalence study with the Centers for Disease Control and Prevention (CDC), and therefore knew about the existence of hepatitis B within the prison population. However, prison officials did not isolate the infected inmates, as required by law. PMID: 11367290 [PubMed - indexed for MEDLINE] 174. AIDS Policy Law. 1998 May 15;13(9):12. Oklahoma adopts testing laws for inmates, rape suspects. [No authors listed]

AIDS: Oklahoma Senate Bill 886 requires inmates to undergo HIV and hepatitis B testing if they expose other people to body fluids. The definition of exposure to body fluids is broad and the Department of Corrections sought a narrower definition that reflects actual transmission risk. The bill requires the Department of Corrections to provide the results to the person who was potentially exposed. If the prison already knows that the inmate is HIV-positive, the testing requirement is waived. Existing law requires officers to be notified before contact if the inmate has HIV or AIDS. Prompted by a case involving a Tulsa County rape victim, a second bill, House Bill 2570, was passed to expedite HIV testing of defendants charged with sex offenses. PMID: 11365329 [PubMed - indexed for MEDLINE] 175. AIDS Policy Law. 1997 Oct 31;12(20):12. California approves compassionate release, viatical bill. [No authors listed] AIDS: Governor Pete Wilson of California vetoed six of ten HIV-related bills approved by the Democrat-led legislature. A plan to encourage people living with AIDS to return to work and a bill to demonstrate the cost-effectiveness of public health care provision for HIV-positive patients whose disease has not progressed to AIDS were among those rejected by Governor Wilson. The governor did approve Assembly Bill 29, granting early prison release to terminally ill inmates who apply through the courts. Assembly Bill 489, allowing people with terminal illness the opportunity to viaticate their group life insurance policies, was also approved. Under the terms of the bill, a person with AIDS could make an absolute assignment for the value of the insurance policy. Senate Bill 1262 allows insurers to use any testing method approved by the Food and Drug Administration (FDA) to screen applicants for HIV. Assembly Bill 441 regulates the screening of sperm donors for infectious diseases, including hepatitis B, hepatitis C, and syphilis. HIV remains on the prohibited list of diseases. PMID: 11364781 [PubMed - indexed for MEDLINE] 176. Commun Dis Public Health. 2000 Dec;3(4):309. Preventing transmission of bloodborne viruses in prisons. Munslow G. Comment on Commun Dis Public Health. 2000 Jun;3(2):84-5.

PMID: 11280271 [PubMed - indexed for MEDLINE] 177. Commun Dis Public Health. 2000 Dec;3(4):253-5. Comparison between self-reported hepatitis B, hepatitis C, and HIV antibody status and oral fluid assay results in Irish prisoners. Thornton L, Barry J, Long J, Allwright S, Bradley F, Parry JV. Department of Public Health, Eastern Regional Health Authority, Dr Steevens' Hospital, Dublin 8. thornton@ehbph.iol.ie Self-reported hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection status was compared with the results of oral fluid assays of antibodies to these viruses in prisoners from nine of the 15 prisons in the Republic of Ireland. A total of 1205 out of 1366 prisoners completed a confidential questionnaire and 1193 provided analysable oral fluid specimens for testing for antibodies to HBV core antigen (anti-HBc), HCV (anti-HCV), and HIV (anti-HIV). The self-reported prevalence of hepatitis infection (hepatitis B: 5%; hepatitis C: 19%) was lower than that derived from oral fluid assays (anti-HBc: 9%; anti-HCV: 37%). The self-reported prevalence of HIV infection was similar to that found by oral fluid assay (2%). Many discrepancies were found between self-reported results and the results of oral fluid assays. Of those who reported being positive for HBV, HCV, or HIV, 48%, 5%, and 58%, respectively, tested negative on the oral fluid assay. Of those who reported a previous negative test result for HBV, HCV, or HIV, 10%, 37%, and 2%, respectively, had positive oral fluid assays. Self-reports of hepatitis and HIV infection status are unreliable and should not be used as a basis for planning preventive and treatment services for prisoners. All prisoners should have the opportunity to be tested for HBV, HCV, and HIV infection. PMID: 11280253 [PubMed - indexed for MEDLINE] 178. BMJ. 2001 Feb 17;322(7283):398-9. Issues in the management of prisoners infected with HIV-1: the King's College Hospital HIV prison service retrospective cohort study. Edwards S, Tenant-Flowers M, Buggy J, Horne P, Hulme N, Easterbrook P, Taylor C. Department of Genitourinary/HIV Medicine, Caldecot Centre, King's College Hospital, London SE5 9RS. Comment in BMJ. 2001 Jul 28;323(7306):230-1.

BMJ. 2001 Jul 28;323(7306):231. PMCID: PMC26569 PMID: 11179158 [PubMed - indexed for MEDLINE] 179. Dig Dis Sci. 2000 Oct;45(10):1949-52. Serum alanine aminotransferase levels in relation to hepatitis B and C virus infections among drug abusers in an area hyperendemic for hepatitis B. Chang CJ, Ko YC, Liu HW. Department of Family Medicine, and School of Public Health, Kaohsiung Medical College, Taiwan. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major agents responsible for hepatitis in Taiwan. The purpose of this study was to assess the serum alanine aminotransferase (ALT) activity in relation to HBV and HCV infection among drug abusers. This survey included 769 male drug abusers aged 14-59 years, from the Kaohsiung Narcotic Abstention Institute and Kaohsiung Prision. The prevalence of HBsAg seropositivity was 21.5%, and anti-HCV seropositivity was 27.2%, respectively. Drug abusers with HBsAg or anti-HCV had higher serum AST and ALT levels than those without HBsAg and anti-HCV. The prevalence of raised ALT and AST (> or =45 IU/liter) in the HCV-positive group was more significant than in the negative group, while that of the HBsAg-positive group did not reach statistical significance. Among the HCV-positive group, ALT levels are more closely associated with HCV infection than AST levels. Our results indicated that HCV infection plays an important role in the etiology of raised ALT activity among drug abusers, while HBV infection plays a minor role. ALT screening still remains a simple and valuable method in the early recognition of HCV infection. PMID: 11117565 [PubMed - indexed for MEDLINE] 180. Sex Transm Dis. 2000 Oct;27(9):491-5. Sexually transmitted diseases among female prisoners in Brazil: prevalence and risk factors. Miranda AE, Vargas PM, St Louis ME, Viana MC. Infectious Diseases Unit, Federal University of Esprito Santo State, Brazil. espinosa@tropical.com.br

BACKGROUND: Sexually transmitted diseases (STDs) have become an important medical problem in prisons. GOAL: To determine the prevalence of and risk factors for STDs among female inmates in a Brazilian prison. STUDY DESIGN: All female prisoners at the Esprito Santo State Prison were offered enrollment in this cross-sectional study. An interview exploring demographics, criminal charges, and risk behavior was conducted. Blood and genital specimens were collected for STD testing. RESULTS: Of 122 eligible women, 121 (99%) agreed to participate. Prevalence rates were: HIV 9.9%, human T-cell lymphotrophic virus type I 4.1%, hepatitis B virus 7.4%, hepatitis C virus 19%, syphilis 16%, gonorrhea 7.6%, chlamydial infection 11%, human papillomavirus-related cytologic changes 9.3%, trichomoniasis 30%, and bacterial vaginosis 15%. Previous or current drug abuse (54%), injection drug use (11%), and blood transfusion (16%) were associated with at least one STD. Condom use was infrequent. CONCLUSION: The prevalence of STDs and of behaviors leading to ongoing transmission are high among female inmates in Vitria, Brazil, and demonstrate the potential importance of prevention activities targeting this population. PMID: 11034522 [PubMed - indexed for MEDLINE] 181. Rev Med Interne. 2000 Jun;21(6):505-9. [Drug-addicted prisoners: seroprevalence of human immunodeficiency virus and hepatitis B and C virus soon after the marketing of buprenorphine]. [Article in French] Claudon-Charpentier A, Hoibian M, Glasser P, Lalanne H, Pasquali JL. Service pharmacie, hpital de Hautepierre, Hpitaux universitaires de Strasbourg, France. PURPOSE: Considering the importance to public health and the frequency with which drug addicts are imprisoned, we studied the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), as well as drug addiction of patients admitted to the Elsau prison in Strasbourg (France). METHODS: The prospective study included all entering inmates from 1 September to 31 October 1997 (270 persons) to whom HIV, HBV and HCV blood tests were offered as well as a questionnaire on their drug addiction. RESULTS: Thirty-six percent of the entering inmates were drug addicts, of whom 1% were HIV positive, 11.2% HBV positive and 30% HCV positive, compared to, respectively, 0.6, 9.9 and 6.4% for non-drug addicts. Ninety-five of the 98 patients used several drugs, including buprenorphine for 53 patients. At the

beginning of this study, buprenorphine had been available in France for 9 months. CONCLUSION: The results are to be taken seriously regarding the misuse of this product in this selected population (intravenous use, multiple drug use, dealing). PMID: 10909149 [PubMed - indexed for MEDLINE] 182. Commun Dis Public Health. 2000 Jun;3(2):121-6. Prevalence of HIV, hepatitis B, and hepatitis C antibodies in prisoners in England and Wales: a national survey. Weild AR, Gill ON, Bennett D, Livingstone SJ, Parry JV, Curran L. PHLS Communicable Disease Surveillance Centre, London. awield@phls.nhs.uk Comment in Commun Dis Public Health. 2000 Dec;3(4):308-9. Commun Dis Public Health. 2000 Jun;3(2):84-5. Prisoners in eight of the 135 prisons in England and Wales were surveyed in 1997 and 1998 to study the prevalence of and risk factors for transmission of bloodborne viruses in prison. Subjects voluntarily completed a risk factor questionnaire and provided oral fluid specimens for unlinked anonymous testing for the presence of antibodies to HIV, hepatitis C virus (HCV), and the core antigen of hepatitis B virus (HBc). Almost 8% (4778) of the total of 60,561 prisoners were eligible and four fifths (3942) of those eligible took part. Among all those tested (3930) 0.4% (14) were positive for anti-HIV, 8% (308) for anti-HBc, and 7% (293) for anti-HCV (the anti-HBc and anti-HCV prevalences were not adjusted for assay sensitivities of 82% and 80%, respectively). Twenty-four per cent (777/3176) of adult prisoners reported ever having injected drugs, 30% of whom (224/747) reported having injected in prison. Three quarters of those who injected in prison (167/224) shared needles or syringes. Among adult injecting drug users, 0.5% (4/775) had anti-HIV, 31% (240/775) anti-HCV, and 20% (158/775) anti-HBc. The presence of anti-HCV and anti-HBc was associated with injecting inside prison and number of previous times in prison. The results suggest that hepatitis viruses are probably being transmitted in prisons through sharing non-sterile injecting equipment and that a risk of HIV transmission exists. Harm minimisation measures for the 6% of prisoners who continue to inject while in prison should be strengthened. PMID: 10902255 [PubMed - indexed for MEDLINE] 183. Commun Dis Public Health. 2000 Jun;3(2):84-5.

Preventing transmission of bloodborne virus infections in prisons. Goldberg D, Taylor A. Comment in Commun Dis Public Health. 2000 Dec;3(4):309. Comment on Commun Dis Public Health. 2000 Jun;3(2):121-6. PMID: 10902247 [PubMed - indexed for MEDLINE] 184. BMJ. 2000 Jul 8;321(7253):78-82. Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in Irish prisoners: results of a national cross sectional survey. Allwright S, Bradley F, Long J, Barry J, Thornton L, Parry JV. Department of Community Health and General Practice, Trinity College, Dublin 2, Republic of Ireland. sllwrght@tcd.ie Comment in BMJ. 2000 Dec 2;321(7273):1406-7. BMJ. 2000 Dec 2;321(7273):1406. BMJ. 2000 Dec 2;321(7273):1407. BMJ. 2000 Dec 2;321(7273):1407. OBJECTIVES: To determine the prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in the prison population of the Republic of Ireland and to examine risk factors for infection. DESIGN: Cross sectional, anonymous, unlinked survey, with self completed risk factor questionnaire and provision of oral fluid specimen for antibody testing. SETTING: Nine of the 15 prisons in the Republic of Ireland. PARTICIPANTS: 1366 prisoners, of whom 1205 (57 women) participated. In the smaller prisons all prisoners were surveyed, while in the three largest prisons one half of the population was randomly sampled. Three small prisons believed not to have a problem with injecting drug use were excluded. MAIN OUTCOME MEASURES: Prevalence of antibodies to hepatitis B core antigen, antibodies to hepatitis C virus, and antibodies to HIV. Self reported risk factor status. RESULTS: Prevalence of antibodies to hepatitis B core antigen was 104/1193 (8.7%; 95% confidence interval 7.2% to 10.5%), to hepatitis C virus, 442/1193 (37%; 34.3% to 39.9%), and to HIV, 24/1193 (2%; 1.3% to 3%). The most important

predictor of being positive for hepatitis B and hepatitis C was a history of injecting drug use. Thirty four women (60%) and 474 men (42%) reported ever injecting drugs. A fifth (104) of 501 injecting drug users reported first injecting in prison, and 347 (71%) users reported sharing needles in prison. CONCLUSIONS: Infection with hepatitis C secondary to use of injected drugs is endemic in Irish prisons. Better access to harm reduction strategies is needed in this environment. PMCID: PMC27426 PMID: 10884256 [PubMed - indexed for MEDLINE] 185. Rev Soc Bras Med Trop. 2000 Jan-Feb;33(1):27-30. Prevalence of HIV-1/2, HTLV-I/II, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum and Trypanosoma cruzi among prison inmates at Manhuau, Minas Gerais State, Brazil. Catalan-Soares BC, Almeida RT, Carneiro-Proietti AB. Fundao Hemominas, Manhuau, Belo Horizonte, MG, Brazil. The purpose of this study was to determine the seroprevalence of human immunodeficiency virus (HIV-(1/2)), human T-cell lymphotropic virus (HTLV-I/II), hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum and Trypanosoma cruzi among 63 male prisoners in Manhuau, Minas Gerais, Brazil and to compare this with data from eligible blood donors. The positive results were as follows: 11/63 (17.5%) for HBV, 5/63 (7.4%) for syphilis, 4/63 (6.3%) for HCV, 3/63 (4.8%) for Chagas' disease, 2/63 (3.2%) for HIV-1/2 and 1/63 (1.6%) for HTLV-I/II. The seroprevalence in prisoners was higher than among blood donors, mainly for antibodies to HIV-1/2, HCV and HBV. This is probably due to low social economic level, illiteracy, higher proportion with a prior history of intravenous drug use and/or unsafe sexual behavior. Therefore, these prisoners constitute a high-risk group and routine screening and counseling are recommended. PMID: 10881115 [PubMed - indexed for MEDLINE] 186. Bull Soc Pathol Exot. 2000 Feb;93(1):34-40. [Prevalence of hepatitis A, B, C virus markers in Runion (south hospital and Saint Pierre prison)]. [Article in French]

Michault A, Faulques B, Sevadjan B, Troalen D, Marais A, Barau G. Laboratoire de bactriologie-parasitologie-virologie, Centre hospitalier Sud Runion, Saint Pierre. We studied the prevalence of Hepatitis A, B, C in different groups in the population of the South of Reunion Island. The aims of this study were the following: to estimate the prevalence of Hepatitis C virus (HCV) (anti-HCV antibodies) and Hepatitis B virus (HBV) (anti-HBc, HBs Ag and anti-HBs) in a population of 1455 women, who delivered in the Centre hospitalier Sud Reunion (CHSR), to estimate the prevalence of these two viruses in a population selected for risk factors (100 prisoners), to estimate the prevalence of Hepatitis A in a group of 400 persons (aged 0 to 19) hospitalised in CHSR since 1st January 1998 (100 for each 5-year age bracket), to research risks factors in these populations and immunity. The overall prevalence of anti-HCV was 0.14% in pregnant women and risk factor associated was found in 28.9% of this population (2.9% history of transfusion, 0.21% drug users). In the group of prisoners seroprevalence was 2%, far below that of prisoners in France. Anti-HCV seroprevalence is weak in Reunion Island and very inferior to seroprevalence in the French population as in other Indian Ocean islands. This is due to the low risk of parenteral transmission. Anti-HBc was found in 90 serum samples from women (overall prevalence 6.35%) and of these 90 positive samples, 9 were positive for HBs Ag (overall prevalence 0.63%), 68 were positive for anti-HBs (4.81%) and 22 (1.54%) were anti-HBc isolated (without HBs Ag and anti-HBs). The overall prevalence of anti-HBs was 62.8%. In the population of 100 prisoners, 2 were HBs Ag positive, 10 anti-HBc positive (2 anti-HBc isolated, 2 associated with HBs Ag, 6 with anti-HBs). The prevalence of anti-HBs was 22%. The major risk factor observed in this population of prisoners was tattooing and/or piercing (46%). These results show that: Reunion island is an area of low endemicity for HBV virus. The measure of protective inoculation is well followed. i.v. drug abuse and previous transfusion are weak routes of transmission. In the group aged 0 to 19, overall prevalence of anti-HAV was 11.9% with the highest rate found among 15 to 19 year-olds (25%). Seroprevalence falls with socio-economic progress. At the present time, the endemic is intermediate in Reunion Island. Given immunity levels within the young population, there is a risk of outbreak. This risk is due to the conditions in Reunion Island, but also to people who travel to other Indian Ocean countries where endemicity is high. It is thus very important that a vaccination strategy be determined. PMID: 10774493 [PubMed - indexed for MEDLINE] 187. Eur Addict Res. 2000 Mar;6(1):20-30. Drug injectors and the cleaning of needles and syringes.

Hughes RA. Department of Social Policy and Social Work, University of York, Heslington, York, UK. rhidian.hughes@ukonline.co.uk When people share needles and syringes they risk transmitting human immunodeficiency virus (HIV) and other infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). Cleaning needles and syringes can help to reduce, although not eliminate, these risks. This article begins by engaging with some of the literature on the cleaning of needles and syringes. Drawing on qualitative research conducted with drug injectors in England, the article then goes on to explore drug injectors' perceptions and experiences of cleaning needles and syringes inside and outside prison. The article concludes by highlighting the implications for future research and policy making. Ultimately there should be a stronger policy response to reduce the risks associated with sharing needles and syringes inside prison, which should include the piloting of prison needle and syringe exchange schemes. Copyright 2000 S. Karger AG, Basel PMID: 10729739 [PubMed - indexed for MEDLINE] 188. Epidemiol Infect. 1999 Oct;123(2):271-5. Method used to identify previously undiagnosed infections in the HIV outbreak at Glenochil prison. Hutchinson SJ, Gore SM, Goldberg DJ, Yirrell DL, McGregor J, Bird AG, Leigh-Brown AJ. Scottish Centre for Infection and Environmental Health, Glasgow, UK. Four years after the occurrence of an outbreak of hepatitis B and HIV infection among injecting drug user inmates at Her Majesty's Prison Glenochil in Scotland, a study design was developed to complete the epidemiological account of the HIV outbreak. Our aim was to identify potential cases of (1) HIV transmission not diagnosed during the original outbreak investigation and (2) the source(s) of the outbreak. Scotland's HIV positive case register was searched for matches to a soundexed list of 636 Glenochil inmates imprisoned during January-June 1993. Eight HIV infections that may have been acquired in Glenochil and four possible sources of the outbreak were identified. The second stage of follow-up molecular epidemiological techniques used on stored sera samples from identified individuals is described in the companion paper. Without breach of medical or prisoner confidentiality, indirect and anonymous follow-up has proved possible for the Glenochil inmates.

PMCID: PMC2810759 PMID: 10579447 [PubMed - indexed for MEDLINE] 189. Eur J Epidemiol. 1999 Sep;15(8):699-704. Coinfections by HIV, hepatitis B and hepatitis C in imprisoned injecting drug users. Palls JR, Farias-Alvarez C, Prieto D, Delgado-Rodrguez M. Cuerpo Facultativo de Sanidad Penitenciaria, Centro Penitenciario de Santander, Santander, Spain. In order to know the prevalence and risk factors for coinfections by human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among injecting drug users (IDUs), a cross-sectional study was carried out in two prisons of the province of Cantabria, northern Spain. Three hundred and sixty-two IDU inmates were recruited. All inmates were interviewed and their blood tested for HIV, HBV and HCV. Crude and multiple risk factor adjusted for (by polychotomous logistic regression) odds ratios were calculated. Prevalence of HBV-HCV coinfection (42.5%) was higher than HIV-HBV-HCV coinfection (37.3%), whereas monoinfections were very uncommon (overall: 13%). Long-term injectors and reincarceration were the foremost risk factors for both coinfections, showing a trend between the degree of association and the number of viruses infecting a patient. No significant relationship between coinfection status and sexual practices was observed. The results related to coinfections are consistent with previous studies of prevalence and risk factors for HIV, HBV and HCV, in indicating that the high rates of coinfections among IDU inmates emphasise the need to harm-reduction policy across prisons in Spain. PMID: 10555612 [PubMed - indexed for MEDLINE] 190. J Public Health Med. 1999 Sep;21(3):348-54. Quarterly communicable disease review January to March 1999. From the PHLS Communicable Disease Surveillance Centre. Public Health Laboratory Service. Catchpole M, Hamilton G, Hawker J, Olowokure B, Ramsay M, Weinberg J, Weild A. PMID: 10528964 [PubMed - indexed for MEDLINE] 191. Fam Pract. 1999 Aug;16(4):366-8.

Is there room for general practice in penitentiary institutions: screening and vaccinating high-risk groups against hepatitis. Chatziarsenis M, Miyakis S, Faresjo T, Trell E, Vlachonikolis J, Lionis C. Clinic of Social and Family Medicine, Medical School, University of Crete, Greece. OBJECTIVE: The purpose of this study was to determine the prevalence of hepatitis markers in inmates and staff of the Penitentiary of Neapolis on Crete and discuss the role of GPs in identifying and vaccinating susceptible subjects. METHOD: Forty-five prisoners and 20 house workers were invited to participate in the study. Hepatitis B (HBV) markers (HBsAg and anti-HBc) and hepatitis C antibodies (anti-HCV) were tested. Vaccination against hepatitis B was administered to all susceptible subjects. RESULTS: Hepatitis B carriage was found in 10 people, six of whom were prisoners. Fifteen of the subjects tested were found to be positive for anti-HBc, six of whom were house workers. Anti-HCV were found to be positive in seven prisoners and one worker. A vaccination programme against hepatitis B was introduced in 27 susceptible subjects (58.7% of unexposed subjects) and was completed in 22. CONCLUSION: Prisoners and staff at Neapolis Prison constitute a high-risk group for hepatitis B and C. Compliance rate in screening was high and GPs were successful in having a desirable response rate in the administration of vaccines. PMID: 10493706 [PubMed - indexed for MEDLINE] 192. Commun Dis Public Health. 1999 Sep;2(3):193-5. How many drug rehabilitation places are needed in prisons to reduce the risk of bloodborne virus infection? Gore SM, Hutchinson SJ, Cassidy J, Bird AG, Biswas S. MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge. sheila.gore@mrc-bsu.cam.ac.uk Transmission of HIV and hepatitis B virus infection has been recognised in prisons, and injecting drug use is a major route of infection. Combined results of two pilot health care surveys showed that 47% of prisoners with a history of injecting drug use wanted help to give up class A drugs but only 11% of non-injecting drug users expressed a similar wish. It would therefore seem appropriate for prisons to estimate the number of inmates with a history of injecting drug use and provide drug rehabilitation places for half that number (47% rounded up). Data from three prisons in England and Scotland for which the

numbers of drug rehabilitation places were known showed that they provided less than quarter of the minimum requirement based on this formula. The proportion of inmates with a history of injecting or of non-injecting drug use who want help to give up class A drugs requires further investigation in order to refine the needs formula. PMID: 10491874 [PubMed - indexed for MEDLINE] 193. Epidemiol Infect. 1999 Aug;123(1):95-102. Risk factors for monoinfections and coinfections with HIV, hepatitis B and hepatitis C viruses in northern Spanish prisoners. Palls J, Farias-Alvarez C, Prieto D, Llorca J, Delgado-Rodrguez M. Provincial Prison, Santander, Spain. A cross-sectional study was conducted in prisons of Cantabria (northern Spain) from June 1992 to December 1994. Inmates were asked to participate in a survey on prevalence and risk factors for monoinfections and coinfections with HIV, HBV and HCV. Crude and multiple odds ratios of risk factors were calculated (by polychotomous logistic regression). Prevalence of coinfections was higher than that of monoinfections. IDU risk factors were the main independent variables associated with monoinfections and coinfections with these agents. The strength of association increased with the degree of coinfection for IDU risk factors and penal status, e.g. duration of injecting drug use for more than 5 years yielded an adjusted OR ranging from 1.3 (95% CI: 0.4-5.1) for HBV monoinfection to 180 (95% CI: 61.0-540.0) for HIV-HBV-HCV coinfection. In comparison, sexual behaviours were less important than IDU risk factors. PMCID: PMC2810732 PMID: 10487645 [PubMed - indexed for MEDLINE] 194. Lancet. 1999 Aug 28;354(9180):753. Inmates in Irish prisons face drug abuse and disease. Birchard K. PMID: 10475200 [PubMed - indexed for MEDLINE] 195. Aust N Z J Public Health. 1999 Aug;23(4):377-84.

Seroprevalence of markers for hepatitis B, C and G in male and female prisoners--NSW, 1996. Butler T, Spencer J, Cui J, Vickery K, Zou J, Kaldor J. New South Wales Health Department, Olympic Planning Unit, North Sydney, NSW. tbutl@doh.health.nsw.gov.au OBJECTIVES: 1. Establish the prevalence of markers for hepatitis B (HBV), C (HCV) and G (HGV) in a sample of male and female inmates. 2. Examine exposure to multiple viruses. 3. Compare risk factors for HGV infection with known risk factors for HBV and HCV. DESIGN: Cross-sectional random sample stratified by sex, age and Aboriginality. Inmates were screened for three hepatitis markers. Participants were 789 inmates (657 male, 132 female) in 27 correctional centres in New South Wales, 1996. RESULTS: Overall detection of each of the three screening markers was 35% for HBV, 39% for HCV and 10% for HGV. Exposure rates were higher in female prisoners than males. Increased rates of anti-HBc were observed in Aboriginal inmates compared with non-Aboriginals (54% cf. 27%); anti-HCV and HGV-RNA were comparable between the two groups (36% cf. 41% and 9% cf. 10%). Markers were significantly higher in female injecting drug users (IDU), particularly HCV (90% cf. 66%). Thirty-five per cent of inmates were unaware of their HCV status. For HBV, 72% did not self-report past or present exposure despite serological evidence to the contrary. The multivariate analysis identified Aboriginality, long-term injecting and injecting while in prison as risk factors for HBV. HCV risk factors were female sex, non-Aboriginality, institutionalisation and IDU-associated behaviours. For HGV, female sex and previous imprisonment were significant risk factors but IDU was not. CONCLUSIONS: Blood-borne hepatitis viruses are common in prison inmates, particularly females (HBV, HCV and HGV), Aboriginals (HBV) and IDU (HBV and HCV). Infection can be related to a number of risk factors, which appear similar for HBV and HCV, but distinct from HGV. PMID: 10462860 [PubMed - indexed for MEDLINE] 196. Int J STD AIDS. 1999 Jul;10(7):475-8. High prevalence of sexually transmitted and blood-borne infections amongst the inmates of a district jail in Northern India. Singh S, Prasad R, Mohanty A. Clinical Microbiology Division, Department of Laboratory Medicine, All India

Institute of Medical Sciences, New Delhi. ssingh@medinst.ernet.in Two hundred and forty male and 9 female jail inmates confined for various crimes in a district jail near Delhi were screened for sexually transmitted and blood-borne diseases including HIV, syphilis and hepatitis B and C viral infections, skin diseases etc. The inmates were aged 15-50 years with a mean of 24.8+/-0.11. Their alleged criminal background, period of stay in the jail, drug addiction, education, birth place, marital status, sexual activity, and clinical complaints were recorded by an anonymous questionnaire. Serum samples were tested for antibodies against HIV (1+2), hepatitis C (HCV), Treponema pallidum and for hepatitis B surface antigen (HBsAg). Sputum examination was done for acid-fast bacilli. Out of the 240 men, 115 were married and 125 unmarried. One hundred and eighty-four (76.6%) men gave history of penetrative sex. Of the 184, 53 (28.8%) were homosexuals or bisexuals and 131 (71.2%) had sex with women only. Sixty of the 131 (45.8%) were faithful to their partners while 124 gave a history of having multiple sexual partners and 100 of them (80.6%) had unprotected sex. Eighty-three of these 100 also had had sex with commercial sex workers (CSWs). One hundred and twenty-six were addicted for alcohol, 44 for smack/charas and 8 had a history of intravenous drug abuse. One hundred and seventy-four were not aware of AIDS. On examination 28 of the 240 (11.6%) had active hepatitis with or without a history of jaundice in the last 2 years, 25 (10.4%) active pulmonary tuberculosis (TB) and 11 (4.6%) had syphilitic ulcers on the penis. Four-fifths of the teenagers confined to a particular barrack had moderate to severe scabies. Three males (1.3%) were found to be Western blot confirmed HIV-1 positive while 28 (11.1%) men and 2 (22.2%) women were positive for HBsAg. Twelve (5.0%) men but no women, were found to be positive for anti-HCV antibodies. Out of the 3 HIV-positive persons, one was an intravenous drug user (IVDU), second was a drug addict and frequent CSW visitor while the third was a homosexual. This pilot study gives an indication that sexually transmitted and blood-borne infections are highly prevalent in jail premises and pose a threat of rapid spread of these infections through IVDU and homosexuality. PIP: This is a study conducted to establish the seroprevalence rate of sexually transmitted and blood-borne infections among district jail inmates in Northern India. The subjects (240 males and 9 female inmates), aged 15-50 years, were asked to answer a questionnaire comprising their background characteristics, alleged criminal background, period of confinement in jail, sexual activity, and sexual partners. Any history of blood transfusion, injury, injecting drug use and drug addiction were also noted together with the level of AIDS awareness . Out of the 240 men, 115 were married and 125 were unmarried. Serum samples were obtained from these inmates and were tested for antibodies against HIV (1+2), hepatitis C virus (HCV), Treponema pallidum, and hepatitis B surface antigen (HBsAg). The results indicated that 76.6% gave a history of penetrative sex with their wives or other females including casual sex partners and commercial sex workers (CSWs). 71.2% had had sex only with women, while 28.8% were homosexual or bisexual. Out of 131, 60 (45.8%) had been faithful to their partners, while 124 had experienced

multiple sexual partners and 80.6% had had unprotected sex. Of the 100 who had had unprotected sex, 83 did so with CSWs. 126 inmates (52.75%) were addicted to alcohol, 44 (18.33%) to smack/charas, and 8 (3.33%) used intravenous drugs. On examination, 11.6% had active hepatitis, 10.4% with active pulmonary tuberculosis, 4.6% had syphilitic ulcers on the penis, and four-fifths of the teenagers had moderate to severe scabies. 1.3% of the subjects were HIV-1 positive, while 11.1% men and 22.2% women were positive for HBsAg. These results indicate a high prevalence of sexually transmitted and blood-borne infections in the studied area. PMID: 10454185 [PubMed - indexed for MEDLINE] 197. Int J STD AIDS. 1999 Jul;10(7):464-6. Survey of risk behaviour and HIV prevalence in an English prison. Edwards A, Curtis S, Sherrard J. Department of Genitourinary Medicine, The Radcliffe Infirmary NHS Trust, Oxford, UK. An anonymous, voluntary, linked cohort study was undertaken to determine the prevalence of HIV infection and identify risk factors for the spread of infection in an English prison. Three hundred and seventy-eight (68%) of the inmates participated. The HIV point prevalence was 0.26%. Injecting drug use (IDU) was the most significant HIV risk factor within 20% admitting IDU at any time, of whom 58% injected whilst in prison. Of those injecting in prison 73% shared needles. Two inmates admitted having sex with a male partner in prison. This study demonstrates that the potential exists in this setting for an outbreak of blood-borne virus infection; hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infection. Injecting drug use and needle sharing represent the greatest risk. PMID: 10454182 [PubMed - indexed for MEDLINE] 198. J Adolesc Health. 1999 Jul;25(1):46-51. Hepatitis infection among adolescents resident in Melbourne Juvenile Justice Centre: risk factors and challenges. Ogilvie EL, Veit F, Crofts N, Thompson SC. Melbourne Juvenile Justice Centre, Parkville, Australia. OBJECTIVE: To describe patterns of infection with, and risks for, hepatitis A, B and C viruses (HAV, HBV, and HCV) in male adolescents detained in the Melbourne

Juvenile Justice Centre (MJJC). METHODS: A cross-sectional serosurvey for HAV, HBV, and HCV among 90 male adolescents aged 15-18 years who were resident in MJJC for more than 1 week in 1996. RESULTS: Nine percent had been exposed to HAV, 8% were positive or equivocal for exposure to HBV, and 21% were antibody positive for HCV. All those with hepatitis markers except one positive for HAV had been injection heroin users for more than 1 year. Of those who were not HBcAb positive, only 28% were immune to HBV. For most respondents, sexual and drug-using risks began in the early teens and were associated with leaving school prematurely. CONCLUSIONS: Respondents were vulnerable to exposure to blood-borne viruses from an early age, posing a challenge for health education programs. An opportunity exists for harm minimization and prevention of spread of blood-borne viruses within the first year of injection drug use in this population. PMID: 10418885 [PubMed - indexed for MEDLINE] 199. Gesundheitswesen. 1999 Apr;61(4):207-13. [Transmission of infectious diseases during imprisonment--results of a study and introduction of a model project for infection prevention in Lower Saxony]. [Article in German] Keppler K, Stver H. Carl von Ossietzky-Universitt, Oldenburg. The increasing imprisonment rate of drug users is linked to a spread of infectious diseases in prisons (HIV and Hepatitis B and C). Several studies indicate a close correlation of imprisonment and transmission of infectious diseases. An analysis of international studies showed that worldwide in several cases transmissions of HIV-infection during imprisonment have been discovered. The cross-sectional examination presented here is describing the situation in the women's prison of Vechta (Lower-Saxony). Empirical data on the prevalence of infections with HIV, HBV, HCV and Lues of the years 1992 to 1994 were recorded. Moreover the scientific interest also included on the diagnosis of seroconversions. Discovered seroconversions were examinated on a possible transmission in custody. The spread of infectious diseases in prisons led to the demand for an alignment of internal drug aid services with external, tried and tested prophylaxis models. The availability of sterile syringes is included. The basic comparability of health care inside and outside prison (principle of equivalence) is not only demanded and recommended by the prison law [4] but also by international organisations [27]. As the first provencial government, the state of Lower Saxony in Germany has started to develop infection prophylaxis

offers in two prisons (in the women's prison in Vechta since April 15th 1996 and in the men's prison of Lingen I, department Gross Hesepe since July 15th 1996) in 1996. These offers include the provision of sterile injection equipment to intravenous drug addicts (ivDA). Modalities of the practice and first experiences documented by the schientific evaluation are presented. PMID: 10408149 [PubMed - indexed for MEDLINE] 200. West J Med. 1999 Mar;170(3):156-60. Prevalence and correlates of hepatitis C virus infection among inmates entering the California correctional system. Ruiz JD, Molitor F, Sun RK, Mikanda J, Facer M, Colford JM Jr, Rutherford GW, Ascher MS. California Department of Health Services, Office of AIDS, Sacramento 95814, USA. To estimate the prevalence and predictors of hepatitis C virus (HCV) infection among inmates, a cross-sectional survey was conducted in 1994 among inmates entering six reception centers of the California Department of Corrections. Discarded serum samples were tested for antibodies to human immunodeficiency virus (HIV), HCV, hepatitis B core, and hepatitis B surface antigen (HBsAg). Of 4,513 inmates in this study, 87.0% were men and 13.0% were women. Among male inmates, 39.4% were anti-HCV-positive; by race/ethnicity, prevalences were highest among whites (49.1%). Among female inmates, 53.5% were anti-HCV-positive; the prevalence was highest among Latinas (69.7%). In addition, rates for HIV were 2.5% for men and 3.1% for women; and for HBsAg, 2.2% (men) and 1.2% (women). These data indicate that HCV infection is common among both men and women entering prison. The high seroprevalence of anti-HCV-positive inmates may reflect an increased prevalence of high-risk behaviors and should be of concern to the communities to which these inmates will be released. PMCID: PMC1305533 PMID: 10214102 [PubMed - indexed for MEDLINE] 201. Vaccine. 1998 Nov;16 Suppl:S27-9. Hepatitis B vaccination of adolescent and adult high-risk groups in the United States. Mast EE, Williams IT, Alter MJ, Margolis HS. Hepatitis Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Substantial progress has been made in implementing routine infant hepatitis B vaccination in the United States. However, in 1996, an estimated 65,000 acute hepatitis B cases occurred, the majority of which were among young adults in high-risk groups. Recent surveys have found very low vaccination coverage among several high-risk groups, including men who have sex with men and patients with sexually transmitted diseases (STDs). Targeted vaccination of persons with risk factors for hepatitis B virus (HBV) infection can be provided in a variety of settings including family planning clinics, STD clinics, drug treatment centres, detention centres, jails and prisons. However, vaccination programmes have been infrequently implemented in these settings and the majority of persons with acute hepatitis B cases have had a missed opportunity for vaccination in the past. Thus, in order to accelerate elimination of HBV transmission in the United States, increased efforts are needed to implement effective hepatitis B vaccination programmes targeted to adolescents and adults in high-risk groups. PMID: 9915029 [PubMed - indexed for MEDLINE] 202. J Infect. 1998 Sep;37(2):166-72. Early mortality of undiagnosed but prevalent (in 1983-1984) HIV infection in Lothian injectors who tested hepatitis B surface antigen positive (group A) or negative but were high risk for blood-borne virus transmission (group B) in 1983-1984. Gore SM, Brettle RP, Burns SM, Lewis SC. MRC Biostatistics Unit, Cambridge, U.K. OBJECTIVE: To estimate the early death-rate in HIV infected injectors whose HIV infection was during the injection-related HIV outbreak in Lothian region in Scotland in 1983-1984, which was coincident with Hepatitis B transmissions. SETTING: Regional Virus Laboratory in Edinburgh. SAMPLES: Sera from 1983-1984, originally received for Hepatitis B surface antigen testing, from individuals aged 15-55 years who were positive for Hepatitis B surface antigen in 1983-1984 (group A: census) or tested negative but were at high risk for blood-borne virus transmission according to their reason for testing (group B: 50% sample). METHODS: Survival status of individuals in groups A and B who had not been diagnosed with HIV disease by the end of December 1995 was checked against the deaths' records of the Registrar General for Scotland. Stored sera from 1983-1984 for patients who had died early (that is: in 1983-1984) were tested anonymously for HIV and Hepatitis C antibodies; and prior to testing, causes of death were scored by RPB according to the likelihood of their being HIV or drugs related. RESULTS: Three early deaths were found in group A patients who were not known to

be HIV infected. None of the deaths was likely to be HIV-related; the sera were not tested in order not to risk deductive disclosure. Twenty-four early deaths were found in group B patients who were not known to be HIV-infected, five of whom were both HIV and Hepatitis C antibody positive, and one other was HIV antibody negative but Hepatitis C positive. Reclassification after unlinked anonymous testing and multiplying up of the group B results (to account for 50% sample) gave the early death rate (that is: in 1983-1986) as 15/155 (10%) for HIV-infected drug users (95% CI: 6%-13%). CONCLUSION: Injection-related outbreaks of HIV infection in Lothian in 1983-1984 and at Glenochil Prison in 1993 were each associated with substantial--estimated 10%--early death-rate in HIV-infected injectors. Both HIV outbreaks were coincident with Hepatitis B transmissions, which may be relevant. Further investigations of the death-rate within 2 years of HIV infection are warranted in other exposure categories than injection-related and for injectors who have been immunized against Hepatitis B. PMID: 9821092 [PubMed - indexed for MEDLINE] 203. Epidemiol Infect. 1998 Aug;121(1):185-91. Hepatitis B outbreak at Glenochil prison during January to June 1993. Hutchinson SJ, Goldberg DJ, Gore SM, Cameron S, McGregor J, McMenamin J, McGavigan J. MRC Biostatistics Initiative for AIDS and HIV in Scotland, Centre for HIV Research, Edinburgh. This data linkage study examined the extent of hepatitis B transmission and co-infection with HIV among 636 former inmates of Glenochil prison, Scotland, during an outbreak of bloodborne diseases in 1993 which was related to needle sharing. Eleven inmates imprisoned during the first half of 1993 presented with hepatitis B infection, of whom co-infection with HIV was detected in six. Based on dates of test results in relation to time of imprisonment, seven definitely acquired their hepatitis B infection within the prison. Only two infections were reported to Scotland's hepatitis B register and neither could be prison-linked. This outbreak of hepatitis B is the first of its kind to be reported but not the first to have occurred. It not only highlights the urgency for measures to prevent further spread of infection among prisoners but also illustrates the need for comprehensive surveillance of hepatitis B infection, and the need for a protocol on how to manage such outbreaks and on how to establish the extent of transmissions when acute hepatitis B occurs in prison. PMCID: PMC2809490 PMID: 9747771 [PubMed - indexed for MEDLINE]

204. Addiction. 1998 Feb;93(2):243-51. A survey of bloodborne viruses and associated risk behaviours in Greek prisons. Malliori M, Sypsa V, Psichogiou M, Touloumi G, Skoutelis A, Tassopoulos N, Hatzakis A, Stefanis C. Department of Psychiatry, University of Athens, Greece. AIMS: To determine HIV and hepatitis infection prevalence and correlates with risk behaviour. DESIGN: Cross-sectional study: voluntary, anonymous HIV, hepatitis (HCV, HBV and HDV) surveillance and questionnaire on risk factors. SETTING: Korydallos Prison, Athens and Ag. Stefanos Prison, Patra, Greece. PARTICIPANTS: Of 544 drug users imprisoned for drug related offences, all completed the questionnaire and 533 blood samples were collected. MEASUREMENTS: HIV (by anti-HIV-1), HCV (by anti-HCV), HBV (by anti-HBc, HBsAg) and HDV (by anti-HDV) prevalence. Data on demography, legal status, drug use, sharing of injecting equipment. FINDINGS: Of the 544 drug users, 375 (68.9%) had injected drugs (IDUs) at some time, 35% of whom had injected whilst in that prison. Of the 533 blood samples tested, one was positive for anti-HIV-1 (0.19%), 310 for anti-HCV (58.2%), 306/531 (57.6%) for anti-HBc, 34/527 (6.5%) for HBsAg and 12/527 (2.3%) for anti-HDV. Prevalence rates for IDUs only were 0.27% for HIV-1, 80.6% for hepatitis C, 62.7% for hepatitis B and 3.3% for hepatitis D. Ninety-two per cent of IDUs injecting in prison shared needles, indicating that IDUs inject less but share more during incarceration. Multiple logistic regression revealed needle-sharing as the most important risk factor for HCV infection in IDUs. Prior knowledge of a positive hepatitis result did not appear to inhibit IDUs from practising risky behaviours in prison. CONCLUSIONS: The epidemic of hepatitis B and C among imprisoned IDUs identified by this study constitutes a major public health problem. Prevention programmes, such as counselling, HBV vaccination, community-based methadone maintenance treatment and syringe exchange schemes, are necessary in order to prevent a further spread. PMID: 9624725 [PubMed - indexed for MEDLINE] 205. Rev Esp Salud Publica. 1998 Jan-Feb;72(1):43-51. [Seroprevalence of hepatitis C virus infection at the time of entry to prison in the prison population in the north-east of Spain].

[Article in Spanish] Martn Snchez V, Ferrer Castro V, Pallas lvarez JR, Alonso Herrero LE, Andrs Honorato M, Coterillo Gonzlez MJ, Garca Marcos LS, Gonzlez Mrquez J, Hernndez Alonso I, LLanos Gallegos M, Mallada Garca E, Martnez Martnez ML, Morillo Prez M, Prez Martnez I, Valles Martnez J. BACKGROUND: Spanish prisons have a high number of inmates whose behaviour puts them at risk of being infected by hepatitis C virus (HCV). The object of this study was to establish the prevalence of this infection and its associated factors in the prison population of the north-east of Spain. METHODS: Inmates in seven prisons in the north-east of Spain were studied. Socio-demographic and prison variables were gathered, as well as risk factors for infection by HCV. Antibodies against HCV were determined (EIA and INNO-LIA HCV III), Hepatitis B virus (VHB) (EIA), and human immunodeficiency virus (HIV) (EIA and Western-Blott). The analysis of associated factors was based on logistic regression. RESULTS: Of the total number of inmates studied, 47.9% presented HCV antibodies. There was greater prevalence in the case of the following: UDVP (89.6%); those who shared needles (94%); those infected by HIV (92.7%); carriers of Australia antigen (65.1%) and antibodies to the HBV core antigen (79.8%); those who had been in prison before (60.9%); unmarried men (54.8%); gypsies (52%); unqualified workers (50.4%); those who had no basic school qualifications (50.9%); those with tattoos (66.7%); and those with a background of self-inflicted injuries (79.3%). In the logistic regression analysis the variables associated to infection by HCV were: UDVP (OR = 33.3; I.C. 95% = 25-50), HBcAc (+) (OR = 4.1; I.C. 95% = 1.1-5.3), age (OR = 0.98; I.C. 95% = 0.96-1.00), months in prison (OR = 1.011; I.C. 95% = 1.004-1.019) and a background of previous prison sentences (OR = 2.3; I.C. 95% = 1.5-3.6). CONCLUSIONS: The prevalence of infection by HCV in prison inmates is very high. It is therefore recommended that preventive measures be increased (harm reduction programmes) and that clinical and analysis protocols be drawn up for those infected and for treatment in cases of chronic active hepatitis in order to control this serious public health problem. PMID: 9477715 [PubMed - indexed for MEDLINE] 206. Int J STD AIDS. 1998 Jan;9(1):25-30. A lasting public health response to an outbreak of HIV infection in a Scottish prison? Goldberg D, Taylor A, McGregor J, Davis B, Wrench J, Gruer L.

Scottish Centre for Infection and Environmental Health, Ruchill Hospital, Glasgow, UK. Between April and June 1993, 8 cases of acute clinical hepatitis B infection and 2 seroconversions to HIV infection were detected among drug injecting inmates of HM Prison Glenochil in Scotland. To prevent the further spread of infection, an initiative which involved counselling and voluntary attributable HIV testing was conducted over a 10-day period commencing at the end of June. A team of 18 counsellors and phlebotomists was brought together rapidly as part of a unique organizational exercise in the field of public health. Fourteen cases of HIV infection were identified of which 13 were almost certainly infected in Glenochil. Following the exercise, a range of harm reduction measures for injecting prisoners was introduced; these included the availability of hepatitis B vaccine, provision of bleach tablets which could be used to clean injecting equipment, a methadone detoxification programme, increased training for prison officers and improved access to drug and harm minimization counselling for inmates. By mid-1996 all these measures had been sustained and several could be found in many other prisons throughout Scotland. Follow-up investigations showed no evidence of epidemic spread of HIV during the 12 months after the initiative. While the frequency of injecting and needle/syringe sharing may have decreased over the last 3 years, these activities are still being reported and it is highly likely that transmissions of bloodborne infections, in particular hepatitis C, continue to occur. The surveillance and prevention of infections associated with injecting drug use in the prison setting remain a high public health priority. PMID: 9518011 [PubMed - indexed for MEDLINE] 207. Int J Epidemiol. 1997 Dec;26(6):1359-66. History of syringe sharing in prison and risk of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection among injecting drug users in Berlin. Stark K, Bienzle U, Vonk R, Guggenmoos-Holzmann I. BACKGROUND: Injecting drug users (IDU) are at risk of parenterally transmitted diseases such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection. We investigated whether a history of syringe sharing in prison is a risk factor for these infections. In the longitudinal part of the study, HBV, HCV, and HIV seroincidence rates were determined. METHODS: The participants were recruited by multisite-sampling at different agencies for IDU. Data on risk behaviour were obtained by a standardized questionnaire. Serological markers for HBV, HCV, and HIV were determined. Logistic regression analysis was performed to adjust for confounding effects.

RESULTS: A history of syringe sharing in prison was significantly associated with HBV (adjusted prevalence odds ratio [POR] = 3.9, 95% confidence interval [CI]: 2-10), HCV (POR = 9.7, 95% CI: 3-33), and HIV infection (POR = 10.4, 95% CI: 4-29). The HIV seroincidence rate was 5.9 per 100 person-years. None of the IDU receiving methadone maintenance treatment (MMT) seroconverted whereas the HIV incidence was 8.5 among IDU not in MMT (P = 0.01). CONCLUSIONS: The increased risk of HBV, HCV, and HIV infection among IDU who had shared syringes in prison warrants specific preventive action. The longitudinal data suggest that IDU in MMT have a lower risk of HIV infection. PMID: 9447418 [PubMed - indexed for MEDLINE] 208. Int J STD AIDS. 1997 Dec;8(12):753-9. HBV and HIV screening, and hepatitis B immunization programme in the prison of Marseille, France. Rotily M, Vernay-Vaisse C, Bourlire M, Galinier-Pujol A, Rousseau S, Obadia Y. Observatoire Rgional de la Sant PACA, INSERM U 379, Marseille, France. This study estimated the prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) serological markers among inmates and evaluated inmates' compliance with an HBV immunization programme. During the mandatory consultation at the sexually transmitted disease (STD) clinic of the Marseille Prison (HIV counselling, and syphilis/HIV screening), physicians offered serological testing (anti-HBs, anti-HBc, HbsAg, anti-HIV) and Engerix B vaccination to each entrant. The number participating in the survey is 391/411 (89%); 75% were aged 18 to 35 years and 79% were men; 42% reported having had multiple sexual partners during the last 12 months. Report of an intravenous drug user (IDU) sexual partner was more frequent among women than men (22% vs 8%). Injecting drug use over lifetime was reported by 23%; 27% declared having shared their injection equipment during the last 12 months. 124/267 (32%) had an HBV marker: anti-HBs + only (immunized): 2.3%; anti-HBs + and anti-HBc +: 21.7%; anti-HBc + only: 6.4%; HBsAg +: 1.3%. The HIV seroprevalence was 6% (21% among IDUs). This survey underlines the high HBV and HIV seroprevalence among prisoners and the high proportion of inmates at risk for these infections. There is an urgent need for immunization and education programmes in this population. It demonstrates an HBV immunization programme is feasible and accepted by inmates and staff members. PMID: 9433949 [PubMed - indexed for MEDLINE]

209. BMJ. 1997 Jul 5;315(7099):61. Three quarters of one French prison population needed immunisation against hepatitis B. Rotily M, Vernay-Vaisse C, Bourlire M. PMCID: PMC2127053 PMID: 9233352 [PubMed - indexed for MEDLINE] 210. BMJ. 1997 Jul 5;315(7099):21-4. Harm reduction measures and injecting inside prison versus mandatory drugs testing: results of a cross sectional anonymous questionnaire survey. The European Commission Network on HIV Infection and Hepatitis in Prison. Bird AG, Gore SM, Hutchinson SJ, Lewis SC, Cameron S, Burns S. Churchill Hospital, Oxford. OBJECTIVES: (a) To determine both the frequency of injecting inside prison and use of sterilising tablets to clean needles in the previous four weeks; (b) to assess the efficiency of random mandatory drugs testing at detecting prisoners who inject heroin inside prison; (c) to determine the percentage of prisoners who had been offered vaccination against hepatitis B. DESIGN: Cross sectional willing anonymous salivary HIV surveillance linked to a self completion risk factor questionnaire. SETTING: Lowmoss prison, Glasgow, and Aberdeen prison on 11 and 30 October 1996. SUBJECTS: 293 (94%) of all 312 inmates at Lowmoss and 146 (93%) of all 157 at Aberdeen, resulting in 286 and 143 valid questionnaires. MAIN OUTCOME MEASURES: Frequency of injecting inside prison in the previous four weeks by injector inmates who had been in prison for at least four weeks. RESULTS: 116 (41%) Lowmoss and 53 (37%) Aberdeen prisoners had a history of injecting drug use but only 4% of inmates (17/395; 95% confidence interval 2% to 6%) had ever been offered vaccination against hepatitis B. 42 Lowmoss prisoners (estimated 207 injections and 258 uses of sterilising tablets) and 31 Aberdeen prisoners (229 injections, 221 uses) had injected inside prison in the previous four weeks. The prisons together held 112 injector inmates who had been in prison for more than four weeks, of whom 57 (51%; 42% to 60%) had injected in prison in the past four weeks; their estimated mean number of injections was 6.0 (SD 5.7). Prisoners injecting heroin six times in four weeks will test positive in random mandatory drugs testing on at most 18 days out of 28. CONCLUSIONS: Sterilising tablets and hepatitis B vaccination should be offered to all prisoners. Random mandatory drugs testing seriously underestimates injector

inmates' harm reduction needs. PMCID: PMC2127021 PMID: 9233321 [PubMed - indexed for MEDLINE] 211. Bull Acad Natl Med. 1997 Jun-Jul;181(6):1177-85; discussion 1186-9. [Effectiveness of measures taken in France to reduce the risks of heroin addiction via intravenous route]. [Article in French] Henrion R. French policy towards illicit drug use is based on abstinence, and on withdrawal for drug-dependent users. Its basis is the December 31, 1970 law, which is still applicable, and prohibits the use of theses drugs, even in private. It provides for prison sentences for users who do not accept to be treated. Under the pressure of new events, in particular the epidemics of AIDS, hepatitis B and C, the reappearance of tuberculosis, and an increasing marginalization of drug users, a harm reduction policy was developed. The first measure taken was to authorize over-the-counter sale of syringes and needles in pharmacies in May 1987. It was only in 1993 that programs were established: needle exchange, methadone maintenance centers, drop-in centers, sleep in, and bus for care, involvement of general practitioners, improved access to hospitals, better medical care of prisoners, participation of associations of former users, and licensing of buprenorphine high dosage for the treatment of drug dependency. The results have been clear: the number of consultations in specialized treatment centers increased, the incidence of HIV decreased spectacularly, overdoses decreased substantially, and arrests for heroin use and misdemeanours declined. However, harm reduction policies do not solve all the problems. They are applicable only to intravenous heroin users, and don't avoid using others licit or illicit drugs. Substitute drugs can be injected or resold. Finally, the prevalence of hepatitis C infection has not significantly decreased and the decrease in HIV infections is less marked among young users and women. PMID: 9453840 [PubMed - indexed for MEDLINE] 212. Med J Aust. 1997 Feb 3;166(3):127-30. Hepatitis B and C in New South Wales prisons: prevalence and risk factors. Butler TG, Dolan KA, Ferson MJ, McGuinness LM, Brown PR, Robertson PW.

New South Wales Health Department, AIDS/Infectious Diseases Branch, Sydney. OBJECTIVES: To determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among inmates entering the New South Wales correctional system and to examine risk factors for infection. DESIGN: Cross-sectional survey. SETTING: Reception Centre at Long Bay Correctional Centre, Sydney, New South Wales, June to December 1994. PARTICIPANTS: 408 adult male inmates received at the Reception Centre (28% of the 1450 new inmates eligible for compulsory HIV testing). OUTCOME MEASURES: Presence of HBV core and surface antibody and surface antigen; HCV antibody; risk factors; inmates' knowledge about risk factors. RESULTS: 37% of inmates tested positive for HCV antibody, 31% for HBV core antibody and 3.2% for HBV surface antigen (indicating recent infection or carrier status). Among those who reported a history of injecting illegal drugs, rates rose to 66% for HCV antibody and 43% for HBV core antibody. Prevalence of HBV and HCV antibodies was similar in Aboriginal and non-Aboriginal inmates, but HBV antigen carrier rate was significantly higher among Aboriginals (12% versus 2.2%). Knowledge about hepatitis risk factors was poor (only 20% named injecting drug use), although recidivists were significantly better informed than those new to the correctional system. Multivariate analysis identified injecting drug use, past exposure to hepatitis B virus and previous imprisonments as significant predictors for HCV infection, and age over 25 years and HCV antibodies for HBV infection. CONCLUSIONS: Results suggest that about a third of adult male prisoners entering the NSW correctional system may have been infected with HBV or HCV. Measures such as education about hepatitis risk factors and HBV vaccination are needed to reduce hepatitis transmission in this population. PMID: 9059433 [PubMed - indexed for MEDLINE] 213. Nihon Koshu Eisei Zasshi. 1997 Jan;44(1):55-60. [Prevalence of hepatitis C virus and human immunodeficiency virus infection among female prison inmates in Japan]. [Article in Japanese] Nara K, Kawano M, Igarashi M. Department of Emergency and Critical Care Medicine, Jichi Medical School, Tochigi, Japan. To investigate the prevalence of hepatitis C virus and human immunodeficiency

virus infection in female inmates, 504 out of 513 female inmates in a certain female prison in Japan were tested for anti-hepatitis C virus, anti-hepatitis B virus, anti-hepatitis A virus and anti-human immunodeficiency virus makers. They were also interviewed with regard to past history of blood transfusion, tattooing, acupuncture, intravenous drug abuse, and psychiatric disease. Prevalence of seropositives for anti-hepatitis C virus antibody was found to be significantly higher in prisoners who had a history of intravenous drug abuse (63%) compared to the controls (4.5%). There was no difference between the two groups in prevalence of seropositivity for anti-hepatitis B, anti-hepatitis A and anti-human immunodeficiency virus. Of all inmates who had a history of intravenous drug abuse, anti-hepatitis C positives used drugs longer and in greater quantities than anti-hepatitis C negatives. From these results it is concluded that intravenous drug abuse is a predominant risk factor for hepatitis C virus infection. PMID: 9094854 [PubMed - indexed for MEDLINE] 214. Pediatr AIDS HIV Infect. 1996 Oct;7(5):346-9. HIV-1 and hepatitis B virus infections in adolescents lodged in security institutes of Buenos Aires. Avila MM, Casanueva E, Piccardo C, Liberatore D, Cammarieri G, Cervellini M, Gojman I, Libonatti O. Department of Microbiology, University of Buenos Aires School of Medicine, Argentina. The goal of this study was to determine the prevalence of human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) infections in street youth lodged in security institutes, from February 1992 to March 1995, to correlate these infections with nontherapeutic drug use, and to compare these results with a previous study done in a similar population. A total of 1460 white adolescents, 276 females and 1184 males, were enrolled (mean age 16.6 years). Prevalence of HIV-1 was 4.58% and of HBV was 6.78%. The prevalence of dual HIV-1/HBV infection was 1.91%; the prevalence of HBV infection was significantly higher in HIV-positive subjects (p < 0.0000000, chi 2 = 136.17, OR = 13.37) than in those not infected with HIV-1. Prevalences were higher in males. Intravenous drug addiction proved to be a significant risk factor for both viruses (HIV-1, p < 0.0000000, chi 2 = 171.34, OR = 16.84; HBV, p = 0.000044, chi 2 = 16.67, OR = 3.17); 6.43% of the total population were intravenous drug users. Comparison of the current results with our previous study (1989-1992) showed that the prevalence of HIV-1, HBV, and concurrent HIV/HBV as well as intravenous drug addiction has decreased significantly in our current cohort (chi 2 = 134.85, p < 0.0000000; chi 2 = 126.62, p < 0.0000000; chi 2 = 110.05, p < 0.0000000; and chi

2 = 158.3, p < 0.0000000) respectively. Progress appears to have been made in the fight against acquired immunodeficiency syndrome (AIDS), and promising results have been obtained. However, if further viral spread is to be avoided, the emphasis on prevention should be energetically maintained. PMID: 11361493 [PubMed - indexed for MEDLINE] 215. AIDS Policy Law. 1996 Jul 26;11(13):9. Needle exchange ends HIV transmission in Swiss jail. [No authors listed] AIDS: According to Swiss researchers, making drug injection equipment available to inmates in a low-security prison has prevented new HIV infections without disrupting prison life. Inmates often shared smuggled drug equipment, creating an enormous potential for HIV infection. During a 12-month pilot project, the prison distributed more than 5,000 sterile syringes through 6 needle-exchange machines and offered inmates counseling and information about HIV risks. The prison detected no new cases of HIV or hepatitis B, and only one instance of needle-sharing was reported. According to Swiss Federal Office of Public Health researchers, fears that the project would encourage drug consumption or needles would be used as weapons against guards proved unfounded. As a result of the findings, the prison is continuing the HIV prevention program. In another study, researchers at Canada's Matsqui Institution in Abbottsford, British Columbia, found that a pilot project of bleach distribution to prison inmates who share injection-drug equipment proved successful. A total of 305 bleach kits was distributed. Results were so positive that the pilot program is being extended to all Federal prisons in Canada by the end of September. PMID: 11363673 [PubMed - indexed for MEDLINE] 216. AIDS. 1996 Mar;10(3):311-7. Frontloading: a risk factor for HIV and hepatitis C virus infection among injecting drug users in Berlin. Stark K, Mller R, Bienzle U, Guggenmoos-Holzmann I. Institute of Tropical Medicine, Free University of Berlin, Germany. OBJECTIVE: To determine whether frontloading (i.e., syringe-mediated drug-sharing) is a risk factor for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among injecting drug users (IDU). DESIGN: Cross-sectional study. Data on sociodemographic and behavioural

characteristics were obtained by a standardized questionnaire. Serum samples were tested for seromarkers for HIV, HBV and HCV. SETTING AND PARTICIPANTS: IDU were recruited at 'low-threshold' storefront agencies (out-of-treatment sample), and at a centre for long-term drug use treatment (in-treatment sample). Individuals were included in the study if they had injected drugs within the previous 3 months. MAIN OUTCOME MEASURES: Serological evidence for HIV, HBV, HCV exposure. RESULTS: Of all IDU (n = 324), 84% had ever practised frontloading with non-sterile injecting equipment, and 46% had done so more than 100 times; 32% had front-loaded during the 6 months prior to the interview. The crude seroprevalence rates for HIV, HBV and HCV increased with the overall frequency of frontloading, and reached 22, 71 and 94%, respectively, among IDU who had frontloaded more than 100 times. After controlling for confounding effects by logistic regression, having practised frontloading more than 100 times was significantly associated with HIV infection [adjusted prevalence odds ratio (POR) 3.5; 95% confidence interval (CI), 1.4-9], and HCV infection (adjusted POR, 5.4; 95% CI, 2.3-12), but not with HBV infection. Another independent risk factor for all three virus infections was needle-sharing in prison. CONCLUSIONS: In communities where sterile injection equipment is readily available, and IDU have substantially reduced their overall levels of needle-sharing, the practice of frontloading appears to be a major risk factor for infections by blood-borne viruses among IDU. Prevention activities should specifically address this risk behaviour. PMID: 8882671 [PubMed - indexed for MEDLINE] 217. AIDS Alert. 1996 Feb;11(2):23. HIV rate in CA prisons higher than in community. [No authors listed] AIDS: Health officials in California have found that the HIV rate among the state's prison population has remained relatively stable since 1988. The most recent figures, which were gathered during a massive communicable disease screening of 118,000 inmates and employees of the state correctional system, indicate that 2.5 percent of male inmates and 3.2 percent of female inmates are HIV-positive. The health care workers were particularly concerned because both hepatitis B virus (HBV) and hepatitis C virus (HCV) are at significant levels in the prison population. HBV was found in 47 percent of the women and 32 percent of the men, while HCV was in 54 percent of the women and 39 percent of the men. Because both hepatitis and HIV are spread through sex and needles, the high hepatitis infection rate may indicate a future increase in the rate of HIV infection and AIDS cases. PMID: 11363237 [PubMed - indexed for MEDLINE]

218. Med Law. 1996;15(3):391-8. Illegal drugs policy, AIDS and hepatitis: from prohibition to harm reduction. Oscapella E. Canadian Foundation for Drug Policy, Ottawa, Canada. PMID: 9009587 [PubMed - indexed for MEDLINE] 219. J Orthop Trauma. 1996;10(5):366-70. Hazards to the orthopaedic trauma surgeon: occupational exposure to tuberculosis. Risk reduction, testing, and treatment (a review article). Esterhai JL Jr, Reynolds MR, Chou L. Department of Orthopedic Surgery, Veterans Administration Hospital, Philadelphia, Pennsylvania, USA. Infection with tuberculosis (TB) in the United States has risen over the last decade. In the past 5 years, health care worker exposure to multidrug-resistant TB has lead to more than 100 skin-test conversions, 17 cases of active TB, and at least six deaths. As with human immunodeficiency virus, hepatitis B virus, and hepatitis C virus, the orthopaedic traumatologist is at risk of exposure and infection because, in many cases, the medical histories of patients encountered in the trauma bay cannot be determined until well into the course of care. Risk depends principally on two factors: (a) likelihood of exposure (large urban settings, prisons, concentration of persons from countries with high TB prevalence), and (b) immune status of the surgeon. Prompt recognition, isolation, and appropriate treatment of patients with infectious TB; engineering controls; and the use of personal protective respiratory equipment can help prevent the transmission of TB to health care workers. PMID: 8814582 [PubMed - indexed for MEDLINE] 220. Int J STD AIDS. 1995 Nov-Dec;6(6):387-91. HIV in UK prisons: a review of seroprevalence, transmission and patterns of risk. Curtis SP, Edwards A.

Prisons contain individuals at high risk of HIV infection, notably through intravenous drug use. For complex political, social and legal reasons penal institutions in the UK are unable to provide condoms and clean needles. The outbreak of HIV and hepatitis B that occurred in a Scottish prison in 1993 focused attention on the potential problems. Debate about the issue is hampered by a lack of useful information. Current data about risk behaviour and seroprevalence is reviewed, and compared with experience in other countries. Injecting drug use in prison appears to be common, and the majority who inject in prison share equipment, which can be used many times. Sexual activity may be a smaller risk factor, but does occur between men in prison. In addition, prisoners appear to have high rates of partner change between sentences. The true prevalence of HIV in UK prisons is difficult to assess, but the available data suggest it is between 0.1 and 4.5%, lower than in Southern Europe and the USA. A window of opportunity still exists to prevent further outbreaks of HIV in UK penal institutions and to maintain these low prevalence rates. Strenuous, and possibly unpalatable measures are needed now. PMID: 8845394 [PubMed - indexed for MEDLINE] 221. Gastroenterol Hepatol. 1995 Oct;18(8):405-9. [Comparative study of the prevalence of hepatitis B virus infection and human immunodeficiency virus type 1 infection in the prison population between 1985 and 1992]. [Article in Spanish] del Olmo JA, An C, Llovet F, Serra MA, Wassel A, Rodrigo JM. Unidad de Hepathologa, Hospital Clinico Universitario, Equipo de Salud del Centro Penitenciario de Preventivos, Picassent, Valencia. The prisoner population of the penitentiaries presents an elevated prevalence of hepatitis B virus (HBV) and human immunodeficiency type 1 (HIV-1) infection markers. In the last few years different measures have been developed to prevent infection. This study evaluates whether there have been changes in the prevalence of infection by these virus over the last few years within a penitentiary. A group of prisoners (n = 163) studied in 1985 were therefore compared with another group (n = 750) studied in 1992. Demographic, social, risk and penitentiary factors were included. In each of the subjects studied alanine aminotransferase (ALT), hepatitis B virus (HBsAG, antiHBs and antiHBc) and anti-HIV-1 markers were determined. It was globally observed that following the 7 years between the two studies there was a decrease in the prevalence of HBV (X = 14.63, p = 0.0001, OR = 2; CI 95%: 1.38-2.9), which was mainly observed in the group of prisoners with no drug addiction habits. No differences were observed with regard to the

prevalence of anti-HIV-1 which remained similar among the IV drug consumers and not consumers (64% and 66.6% in 1985 and 1992, respectively). In conclusion, from 1985 to 1992 a decrease has been observed in the prevalence of hepatitis B virus infection in the penitentiary population while the prevalence of anti-HIV-1 has remained unchanged. PMID: 7584778 [PubMed - indexed for MEDLINE] 222. Natl Med J India. 1995 Jul-Aug;8(4):180-1. HIV and prisons. Kohli HS. Department of Public Health, University of Glasgow, Scotland. PMID: 7633315 [PubMed - indexed for MEDLINE] 223. An Med Interna. 1995 Apr;12(4):175-81. [The demand for emergency medical care by the prison population]. [Article in Spanish] Miret C, Miro O, Pedrol E, Gmez-Angelats E, Casademont J, Camp J, Milla J, Urbano-Mrquez A. Servicio de Medicina Interna General, Hospital Clnic i Provincial, Barcelona. BACKGROUND: Urgent medical claim from recluse population shows some special traits due to firstly, the reclusion situation itself and the high prevalence of certain diseases in this population, as the infections ones, such as HIV infection, hepatitis B and tuberculosis. Moreover, emergency rooms constitute for this patients, a common previous admission place. Thus, a high and a complex medical care claim must be expected from this population in hospital emergency rooms. METHODS: Consultations from ill prisoners examined in emergency room of Hospital Clinic Internal Medicine department during 1993, were checked: Age, sex, date, time of visit, serology and HIV risk factor, stage infection among positive HIV subjects, cause of complaint. age o symptomatology, number and the kind of complementary examinations done, the consulting time, the diagnosis and its link to the HIV infections, the consulting recurrence, and its relation with the initial cause, and the patient final destiny. RESULTS: 394 patients, from 598 who consulted, were visited (1.8% total

consultings). The mean age was 32.4 years and 92% were men. A 68% (268 patients) realized that had HIV infection, and among these, a 37% (99 patients) were AIDS. The most frequent cause of complaint were related to respiratory, digestive, neurologic and non foci fever, which caused the higher number of admissions. The tuberculosis diagnosis was done in 39 patients (9.9%). Sixty wine patients discharged from hospital on first examination came again one or more times to the emergency room because of the same complaint. The number of complementary examinations done was 1,370 (a mean of 2.4 per visit), and were significantly higher among the HIV patients than in negative or unknown (p < 0.001). The overall admissions average was 37%, which increased to 71% among patients visited repeatedly. The HIV recluse patients required admission in the 46.3% of visits, and the HIV negative ones, in the 20.6% (p < 0.001). The duration of the visit among the patients that were discharged was 4 hours and 54 minutes. CONCLUSION: Recluse population generates an important urgent medical care claim. The number of admissions among this population is elevated and higher than the respective to the general one, related to the age. This high number of consulting, the increased number of admissions and the complex assistance (high number of complementary examinations that often requires high technology, and the repetitive urgent visits, etc.), are caused, mainly by the high prevalence of HIV infections among this population. PMID: 7620062 [PubMed - indexed for MEDLINE] 224. Nurs Times. 1995 Feb 15-22;91(7):10-1. HIV infection among prison inmates. Taylor A, Goldberg D, Emslie J. PMID: 7885879 [PubMed - indexed for MEDLINE] 225. BMJ. 1995 Feb 4;310(6975):293-6. Drug injection and HIV prevalence in inmates of Glenochil prison. Gore SM, Bird AG, Burns SM, Goldberg DJ, Ross AJ, Macgregor J. MRC Biostatistics Unit, Institute of Public Health, Cambridge. Comment in BMJ. 1995 May 13;310(6989):1264. BMJ. 1995 May 13;310(6989):1264-5. OBJECTIVE: To determine prevalence of HIV infection and drug injecting behaviour

among inmates of Glenochil Prison on a specified date a year after an outbreak of hepatitis B and HIV infection. DESIGN: Cross sectional: voluntary, anonymous HIV salivary antibody surveillance and linked self completion questionnaire on risk factors. SETTING: Glenochil prison, Scotland, a year after an outbreak of hepatitis B and HIV transmission related to drug injection. SUBJECTS: 352 prisoners, of whom 295 (84%) took part; 284 questionnaires (96%) passed logical checks. MAIN OUTCOME MEASURES: HIV prevalence; proportion of all inmates who had ever injected drugs, had ever injected inside prison, had started injecting drugs while inside prison. RESULTS: More than half (150/284) the current inmates were also in Glenochil Prison during the critical period of January to June 1993, when hepatitis B and HIV were transmitted. Similar proportions of current inmates and men who were also in Glenochil during the critical period were drug users (27% (75/278) v 30% (44/149)). A quarter of injecting drug users (18/72) had first injected inside prison, irrespective of whether they were in Glenochil in January to June 1993 and regardless of the calendar period when they first injected. Significantly more inmates from Glasgow (41%; 56/138) than from Edinburgh (21%; 7/34) or elsewhere (11%; 12/106) were injecting drug users. On testing for HIV, seven saliva samples out of 293 gave positive results--four were presumed to be from inmates known to be infected with HIV, and the others from injecting drug users from Glasgow, all of whom had been in Glenochil during January to June 1993, when two of the three had injected drugs and had been tested for HIV, with negative results. The ratio of overall (2.4%) to disclosed (1.4%) HIV prevalence was 1.7. For men who had injected drugs in Glenochil during January to June 1993, HIV prevalence was estimated at 29%. CONCLUSION: Between a quarter and a third of prisoners who injected drugs in Glenochil in January to June 1993 were infected with HIV. There is widespread ongoing risk of bloodborne virus infection within prisons, which is probably long standing but demands urgent attention. PMCID: PMC2548681 PMID: 7866170 [PubMed - indexed for MEDLINE] 226. BMJ. 1995 Feb 4;310(6975):289-92. Outbreak of HIV infection in a Scottish prison. Taylor A, Goldberg D, Emslie J, Wrench J, Gruer L, Cameron S, Black J, Davis B, McGregor J, Follett E, et al. Scottish Centre for Infection and Environmental Health, Ruchill Hospital, Glasgow.

Comment in BMJ. 1995 May 13;310(6989):1264. BMJ. 1995 May 13;310(6989):1264-5. OBJECTIVE--To investigate the possible spread of HIV infection and its route of transmission among prison inmates. DESIGN--In response to an outbreak of acute clinical hepatitis B and two seroconversions to HIV infection, counselling and testing for HIV were offered to all inmates over a two week period in July 1993. Information was sought about drug injecting, sexual behaviour, and previous HIV testing. SETTING--HM Prison Glenochil in Scotland. SUBJECTS--Adult male prisoners. MAIN OUTCOME MEASURES--Uptake of HIV counselling and testing; occurrence and mode of HIV transmission within the prison. RESULTS--Of a total 378 inmates, 227 (60%) were counselled and 162 (43%) tested for HIV. Twelve (7%) of those tested were positive for antibody to HIV. One third (76) of those counselled had injected drugs at some time, of whom 33 (43%) had injected in Glenochil; all 12 seropositive men belonged to this latter group. Thirty two of these 33 had shared needles and syringes in the prison. A further two inmates who injected in the prison were diagnosed as positive for HIV two months previously. Evidence based on sequential results and time of entry into prison indicated that eight transmissions definitely occurred within prison in the first half of 1993. CONCLUSION--This is the first report of an outbreak of HIV infection occurring within a prison. Restricted access to injecting equipment resulted in random sharing and placed injectors at high risk of becoming infected with HIV. Measures to prevent further spread of infection among prison injectors are urgently required. PMCID: PMC2548692 PMID: 7866169 [PubMed - indexed for MEDLINE] 227. BMJ. 1995 Feb 4;310(6975):285-8. Spread of bloodborne viruses among Australian prison entrants. Crofts N, Stewart T, Hearne P, Ping XY, Breshkin AM, Locarnini SA. Epidemiology and International Health Unit, Macfarlane Burnet Centre of Medical Research, Fairfield, Victoria, Australia. OBJECTIVES: To assess spread of bloodborne viruses among prison entrants in Victoria, Australia. DESIGN: Voluntary confidential testing of all prison entrants for markers of exposure to bloodborne viruses with collection of minimal data on demography and risk factors over 12 months. SETTING: Her Majesty's Prisons, Pentridge and Fairlea, Victoria, Australia.

SUBJECTS: 3429 male and 198 female prison entrants (> 99% of all prison entrants); 344 entered prison and were tested more than once. MAIN OUTCOME MEASURES: Prevalence and incidence of antibodies to HIV, hepatitis B, and hepatitis C viruses, and minimal data on risk factors. RESULTS: 1562 (46%) gave a history of use of injected drugs, 1171 (33%) had antibody to hepatitis B core antigen, 1418 (39%) were anti-hepatitis C positive including 914 (64%) of the men who injected drugs, 91 (2.5%) were positive for hepatitis B surface antigen, and 17 (0.47%) were positive for antibody to HIV. Incidence rates for infection with hepatitis B and C virus were 12.6 and 18.3 per 100 person years, respectively; in men who injected drugs and were aged less than 30 years (29% of all prison entrants) these were 21 and 41 per 100 person years. Seroconversion to hepatitis B or C was associated with young age and shorter stay in prison. Only 5% of those who were not immune to hepatitis B reported hepatitis B immunisation. CONCLUSIONS: Hepatitis B and C are spreading rapidly through some populations of injecting drug users in Victoria, particularly among men aged less than 30 years at risk of imprisonment in whom rates of spread are extreme; this group constitutes a sizeable at risk population for spread of HIV. This spread is occurring in a context of integrated harm reduction measures outside prisons for prevention of viral spread but few programmes within or on transition from prisons; it poses an urgent challenge to these programmes. PMCID: PMC2548691 PMID: 7866168 [PubMed - indexed for MEDLINE] 228. Scand J Infect Dis. 1995;27(4):331-7. Prevalence and determinants of anti-HCV seropositivity and of HCV genotype among intravenous drug users in Berlin. Stark K, Schreier E, Mller R, Wirth D, Driesel G, Bienzle U. Institute of Tropical Medicine, Free University, Berlin, Germany. A cross-sectional study was carried out to identify risk factors for seropositivity for antibodies against hepatitis C virus (HCV) and to assess to the distribution and determinants of HCV genotypes among intravenous drug users (IVDUs). The study population consisted of 405 IVDUs. Serum specimens were tested for seromarkers for HCV, for human immunodeficiency virus (HIV), for hepatitis B virus (HBV) and for syphilis. HCV RNA determination by polymerase chain reaction (PCR) and virus typing were performed in a subsample of anti-HCV-positive specimens (n=135). Of the IVDUs, 83% were anti-HCV-positive, 18% HIV-infected, and 58% HBV (anti-HBc)-positive. Longer duration of intravenous drug use, syringe sharing in prison, and higher number of IDVU sex partners were independent risk

factors for anti-HCV positivity. GCV RNA was detected in 76% of anti-HCV-positive IVDUs. HCV genotypes 1 (49%) and 3 (44%) were most commonly found. All the type 3 isolates were identified as subtype 3a, and 95% of the type 1 isolates as subtype 1b. In logistic regression analysis, HCV type 3a viraemia was significantly associated with lack of HIV infection and a higher number of sex partners. The results indicate that preventive measures are needed to reduce syringe sharing among IVDUs in prisons. Sexual contacts with other IVDUs may play a role in the HCV epidemic among IVDUs. In Germany, HCV type 3a infection appears to be much more common among IVDUs than among other HCV risk groups such as transfusion recipients or haemophiliacs. PMID: 8658065 [PubMed - indexed for MEDLINE] 229. Eur J Epidemiol. 1994 Dec;10(6):687-94. Blood-borne virus infections among Australian injecting drug users: implications for spread of HIV. Crofts N, Hopper JL, Milner R, Breschkin AM, Bowden DS, Locarnini SA. Macfarlane Burnet Centre for Medical Research, Fairfield, Victoria, Australia. To describe the epidemiology of infection with hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among injecting drug users (IDUs) in Australia, in relation to the potential for further spread of HIV in IDUs, a cross-sectional analysis was performed on data from a sample of injecting drug users, correlating markers of exposure to blood-borne viruses with sex, age, sexual orientation, primary current drug injected and duration of injecting in rural and metropolitan Victoria, Australia. The subjects were currently active IDUs from a wide spectrum of age, sex, sexual orientation, geographical location and social background, contacted and recruited through their social networks and from community agencies and prisons by trained peer workers who interviewed and collected blood from them in the field. Sera were tested for antibody to HIV, HCV and hepatitis B core antigen (HBcAg), for hepatitis B surface antigen (HBsAg), and for HCV RNA using reverse transcription and polymerase chain reaction (RT-PCR). At entry to the study, 4.5% (14/311) had antibody to HIV, 47% (146/308) to HBcAg and 68% (206/303) to HCV. Prevalence of HBsAg was 1.8% overall (5/282), and 50% (84/168) were positive for HCV RNA. By multivariate analysis, HIV seropositivity was strongly associated with a history of homosexual contact in males and with exposure to HBV but not to HCV. Those who reported their current primary injected drug to be amphetamines were at greater and continuing risk of HIV infection than were current heroin injectors, while the reverse applied for HCV.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 7672048 [PubMed - indexed for MEDLINE]

230. Nurs Times. 1994 Jun 15-21;90(24):30-2. Nursing in prisons. Fighting addiction in prisons. Burrows R. This paper examines the steps which nurses and other health care staff can take to lessen the likelihood that prisoners will take ilicit drugs--both during their sentences and following release. It presents a range of possible approaches, ranging from the relatively straightforward to the sophisticated, from which nurses can choose the most appropriate intervention to use with a particular client. PMID: 8029054 [PubMed - indexed for MEDLINE] 231. J R Soc Med. 1994 Jan;87(1):13-4. Drug misusers in police custody: a prospective survey. Payne-James JJ, Dean PJ, Keys DW. Group IV Forensic Medical Research, Metropolitan Police Service, London, UK. Comment in J R Soc Med. 1994 Nov;87(11):720-1. Approximately 11% of individuals seen by forensic medical examiners in police custody in London are drug misusers. This prospective survey using an anonymized structured questionnaire attempted to define some of the characteristics of this selected group of drug misusers. The study was undertaken in Metropolitan Police Service stations (London, UK) within the area covered by Group IV Forensic Medical Examiners. One hundred and fifty consecutive drug misusers in police custody were assessed. Of these individuals 77% used heroin; 30% used both heroin and cocaine regularly; 72% were injecting drugs; 32% were being prescribed drugs (e.g. methadone) by general practitioners or drug agencies. Those individuals prescribed drugs spent a similar amount per day on illicit drugs as those who were not (100.30 pounds versus 106 pounds). Four per cent of individuals were HIV-positive; 25.7% were hepatitis-B positive. Only 9.7% were aware that prophylaxis for hepatitis-B was possible. Seventy-four per cent had served previous prison sentences and of those 82% had used class A controlled drugs whilst serving the sentence. It is concluded that drug misusers seen in police custody tend to be recidivists. It seems that some clear means of identifying and ensuring referral and attendance at an appropriate agency may be the only way to

break the cycle of drug misuse, prison and further drug misuse in this highly (self) selected group of patients. PMCID: PMC1294272 PMID: 8308821 [PubMed - indexed for MEDLINE] 232. BMJ. 1993 Nov 6;307(6913):1212. Transmission of infectious diseases in prison. Mathe C, van Damme P, Meheus A. PMCID: PMC1679284 PMID: 8251857 [PubMed - indexed for MEDLINE] 233. Vaccine. 1993 Nov;11(14):1441-4. Hepatitis B vaccination in prisons: the Catalonian experience. Bayas JM, Bruguera M, Martin V, Vidal J, Rodes J, Salleras LY. Servicio de Medicina Preventiva, Hospital Clinic i Provincial, Barcelona, Spain. A pilot programme of hepatitis B vaccination was set up in three prisons to assess the feasibility and results of this method of reaching a high-risk population. Hepatitis B vaccine was offered to all inmates who lacked serological markers for hepatitis B virus. The antibody response was assessed in those who received two or three doses of vaccine. Candidates for vaccination were 41% of 1755 imprisoned men (20% of intravenous drug users (IVDU) and 63% of non-IVDU), but complete vaccination could be given to only 33% of candidates. A further 29% received two doses. Seroconversion to anti-HBs (titres > 10 IU l-1) occurred in 33% of vaccinees after two doses and in 76% after three doses. The overall rate of susceptible inmates who became protected for hepatitis B was 34%. The seroconversion rate was higher when the interval between the first two doses was shorter than 3 weeks (91%), than in cases with an interval of 3-6 weeks (79%) or longer than 6 weeks (33%). Age greater than 35 years and history of IVDU were associated with a lower response to the vaccine, while anti-HIV seropositivity did not influence the response. In conclusion, vaccination of prisoners susceptible to HBV may achieve protection in at least a third of cases. Shortening intervals between the priming doses of vaccine may improve compliance and increases the response. PMID: 8310764 [PubMed - indexed for MEDLINE]

234. BMJ. 1993 Sep 4;307(6904):622. Transmission of HIV prison. Prevention depends on enlightened approach. Riley A. Comment on BMJ. 1993 Jul 17;307(6897):151-2. BMJ. 1993 Jul 17;307(6897):147-8. BMJ. 1993 Jul 24;307(6898):228-31. PMCID: PMC1678914 PMID: 8401026 [PubMed - indexed for MEDLINE] 235. Lakartidningen. 1993 Jun 9;90(23):2225-7. [Offer hepatitis B vaccination to the addicts. Transmission of hepatitis B among intravenous drug abusers]. [Article in Swedish] Struve J, Kll K, Oksanen A, Stendahl P. Infektionskliniken, Huddinge sjukhus. Comment in Lakartidningen. 1993 Oct 6;90(40):3419. Structured interviews with 75 intravenous drug abusers (IVDAs) in Stockholm showed that, despite their having had several contacts with various medical institutions or prisons, none had been offered vaccination against hepatitis B virus (HBV) infection as recommended by the National Board of Health and Welfare. We conclude that, as failure to offer HBV vaccination to IVDAs contributes to be continued spread of HBV infection in this category, at admission all IVDAs should undergo serological HBV-testing and vaccination be offered to HBV-negatives. PMID: 8502085 [PubMed - indexed for MEDLINE] 236. Gesundheitswesen. 1993 May;55(5):246-9. [Hepatitis A, B and C as desmoteric infections]. [Article in German]

Gaube J, Feucht HH, Laufs R, Polywka S, Fingscheidt E, Mller HE. Justizvollzugsanstalt Wolfenbttel, Universitt Hamburg. There is a distinct spectrum of infectious diseases in prisons, known as desmoteric infections. We investigated the incidence of HIV, hepatitis A, B, and C in a group of 539 prisoners and compared them with the incidences of these infections in the normal population. The incidence of HIV was 928 out of 100,000. This figure is similar to that of the normal population. Hence, HIV infection does not seem to be a desmoteric disease. In contrast to AIDS the incidences of hepatitis A, B, and C among prisoners were 2968, 1670, and 20,000, respectively. Of course, hepatitis A, B, and C occur 100-200 times more often among prisoners and thus seem to be desmoteric infections. Moreover, especially hepatitis C is correlated strongly with intravenous drug abuse. About 80% of drug abusers were HCV positive and 50% of the total of HC infections are due to drug abusers. PMID: 8334312 [PubMed - indexed for MEDLINE] 237. Nursing. 1993 Apr;23(4):22. Hepatitis B: on-the-job exposure? [No authors listed] PMID: 8265032 [PubMed - indexed for MEDLINE] 238. Ann Intern Med. 1993 Jan 15;118(2):139-45. Correctional health care: a public health opportunity. Glaser JB, Greifinger RB. Division of Infectious Diseases, Staten Island University Hospital, NY 10305. Comment in Ann Intern Med. 1993 Jul 1;119(1):93. The approximately 1.2 million inmates in U.S. correctional institutions have a high prevalence of communicable diseases, such as human immunodeficiency virus (HIV) infection, tuberculosis, hepatitis B virus infection, and gonorrhea. Before their incarceration, most inmates had limited access to health care, which, together with poor compliance because of lifestyle, made them difficult to identify and treat in the general community. Because of the high yearly turnover

(approximately 800% and 50% in jails and prisons, respectively), the criminal justice system can play an important public health role both during incarceration and in the immediate postrelease period. A public policy agenda for criminal justice should include an epidemiologic orientation, as well as resources for education, counseling, early detection, and treatment. Taking advantage of the period of confinement would serve both the individual and society by controlling communicable diseases in large urban communities. PMID: 8416310 [PubMed - indexed for MEDLINE] 239. Drug Alcohol Rev. 1993;12(2):185-91. Alcohol and drug treatments in Australian correctional services. Westmore B, Walter G. The Northside Clinic, 2 Greenwich Rd, Greenwich, New South Wales, 2065, Australia. A comprehensive literature review on the subject of drug and alcohol treatments in correctional services reveals the size of the drug and alcohol problem within the prison population and reconfirms the positive correlation between drugs, alcohol and criminal activity. Disturbingly few comprehensive ongoing assessment and treatment services are available for the prison population. Special drug and alcohol-related issues such as HIV and hepatitis B infection, and high drug-related post-release prisoner mortality rates demand an urgent review of the policies and procedures concerning the assessment and treatment of drug and alcohol problems in correctional facilities. PMID: 16818328 [PubMed] 240. Scand J Infect Dis. 1993;25(1):8-13. Prevalence of hepatitis B virus markers among intravenous drug abusers in Stockholm: impact of heterosexual transmission. Struve J, Kll K, Stendahl P, Scalia-Tomba G, Giesecke J, Weiland O. Department of Infectious Diseases, Karolinska Institute, Huddinge Hospital, Sweden. In order to study the importance of sexual transmission of hepatitis B virus (HBV) among intravenous drug abusers (IVDAs), and from IVDAs to others, we consecutively interviewed 171 IVDAs detained at the Stockholm Remand Prison

during 4 months in 1990. Sexual histories revealed that 77% reported > or = 3 sexual partners during the last 3 years, 64% had had a sexual partner who did not inject drugs, and 61% reported a prior STD. The prevalence of HBV markers was 75%. In a multiple logistic regression analysis, a high risk for HBV markers was associated with an increasing duration of drug abuse, a high prevalence of hepatitis A markers, and an increasing number of drug injecting sexual partners during the last 3 years, indicating that sexual transmission, along with sharing of needles, may contribute to the high prevalence of HBV markers within this group. It is suggested that an adequate sexual history must be obtained from IVDAs with acute viral hepatitis in order to identify sexual partners who should be offered postexposure prophylaxis, and that non-immune IVDAs should be vaccinated against viral hepatitis A and B. PMID: 8460353 [PubMed - indexed for MEDLINE] 241. Enferm Infecc Microbiol Clin. 1993 Jan;11(1):8-13. [Infection by HIV and the hepatitis B, C, and D viruses in intravenous drug addicts. Seroprevalence at 1 year and its follow-up]. [Article in Spanish] Delgado-Iribarren A, Wilhelmi I, Padilla B, Caedo T, Gmez J, Elviro J. Servicio de Microbiologa, Hospital Severo Ochoa, Legans, Madrid. BACKGROUND: The aim of the present article was to study the serology of intravenous drug user patients against the hepatitis B, C, D, and HIV, during 1990 and the follow-up during the same year, and 1991. METHODS: A study of 265 patients (mean age: 25 years, range: 16-45; 206 males and 59 females) was carried out. Forty-two percent came because of detoxication treatment, 30% requested diagnosis for hepatic disturbances and the only data provided in 28% were that they were intravenous drug users. None of the patients was an inmate from prisons. RESULTS: Seroprevalences were 67.5% for the HBV, 75.6% for HCV, 17% for HDV and 50.2% for HIV. In the patients seronegative for HBV (65%) and HIV (58%) no new serologic controls were performed during the study period, while in those who underwent controls the rates of seroconversion were 43.3% and 32%, respectively. In 30% of all seroconversions to HBV coinfection with HDV was found and in 23% antibodies against HIV were observed. CONCLUSIONS: Due to the high rates of infection obtained, the authors believe that serologic follow up of intravenous drug users is advisable. PMID: 8384891 [PubMed - indexed for MEDLINE]

242. Ann Ig. 1992 Sep-Oct;4(5):289-92. [The possible risks of transmission of hematogenous viroses in a prison community]. [Article in Italian] Liguori G, Rossano F, Perrella O, Iannucci F, Tempone G, Marinelli P. Ist. di Igiene e Medicina Preventiva, Fac. di Medicina e Chirurgia, II Universit degli Studi di Napoli. PMID: 1284901 [PubMed - indexed for MEDLINE] 243. Health Bull (Edinb). 1992 Mar;50(2):156-62. Socio-economic factors associated with HIV infection in pregnant women. Johnstone F, Hamilton B, Gore SM. Department of Obstetrics, University of Edinburgh. The HIV epidemic in women in Edinburgh has characteristics which enable a total population study. We studied retrospectively all women with a known history of injection drug use or with a seropositive drug-using partner in a five year period from 1985-1990. We sought to quantitate lifestyle and environmental factors associated with HIV infection in pregnant women and to test two hypotheses: that infected women would have more adverse socio-economic features, and that there would be a change in these factors with time. There were 244 pregnant women in the study. They were slightly younger than all Edinburgh City women and much less likely to be married. They were much more likely to live in areas of multiple housing deprivation. Only 16% of women, and 28% of partners, were in paid employment; 90% of women smoked and 76% had a history of injection drug use. Some 28% of previous children were in the care of another, often a relative, 8% of women had a recent prison admission, and 58% of those tested had antibodies to Hepatitis B. Univariate analysis showed that none of these factors was significantly different in HIV seropositive women except for prison admission, previous infection with Hepatitis B, which probably all related to type of drug use. Linear logistic regression suggested two other variables which distinguished between groups, but because these are composite, and dependent on incomplete data, this must be interpreted with caution. The same overall associations were found when only women with a history of injection drug use were considered. There was no statistically significant change in these factors with

time.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 1517089 [PubMed - indexed for MEDLINE] 244. Ann Ig. 1992 Mar-Apr;4(2):73-6. [Control of the diffusion of viral hepatitis in detention and penal institutions: a problem not to be underrated]. [Article in Italian] Patti AM, Pompa MG, Santi AL. Ist. di Igiene G. Sanarelli, Universit degli Studi di Roma, La Sapienza. PMID: 1283946 [PubMed - indexed for MEDLINE] 245. J Hosp Infect. 1991 Aug;18(4):313-8. Phlebotomy in inoculation risk patients: a questionnaire survey of knowledge and practices of hospital doctors in Liverpool. Parry CM, Harries AD, Beeching NJ, Rothburn MM. Regional Infectious Diseases Unit, Fazakerley Hospital, Liverpool. To assess the knowledge of hospital doctors about patients at increased risk of infection with human immunodeficiency virus (HIV) or hepatitis B virus, and the precautions they took during phlebotomy in such patients, an anonymous postal questionnaire was sent to all 307 hospital doctors working at two District General Hospitals in Liverpool, UK. Two hundred and thirty-eight (77.5%) of the questionnaires were returned. More than 90% of respondents considered a history of male homosexuality, intravenous drug abuse, prostitution or a child of a prostitute to indicate an inoculation risk. There was uncertainty about a previous prison sentence in the 1980s, residence in a home for the mentally handicapped, previous residence in the tropics and hospital treatment in the tropics. Thirty-eight percent of doctors would never enquire about sexual preference, 54.1% about a previous prison sentence and 15.7% about intravenous drug abuse in their clinical history. Although 97.4% of doctors would sometimes or always wear gloves during phlebotomy of an inoculation risk patient, 25.5% always resheathed the needle after phlebotomy and 20.8% would never take the sharps box to the patient. More effort is required to identify accurately inoculation risk patients and greater care is needed in phlebotomy techniques.

PMID: 1682370 [PubMed - indexed for MEDLINE] 246. J Virol Methods. 1991 Jun;33(1-2):27-38. Determination of HBsAg subtypes in different high risk populations using monoclonal antibodies. Swenson PD, Riess JT, Krueger LE. Seattle-King County Department of Public Health, University of Washington. Monoclonal antibodies with restricted specificity were used in a modified commercial enzyme immunoassay for detection of HBsAg to subtype HBsAg in sera from 122 Southeast Asian refugees entering the United States, 62 inmates of a correctional facility, and 19 homosexual men. This method was able to classify HBsAg as aywl-2, ayw3, ayw4, ayr, adw2, adw4, or adr. The HBsAg subtype was identified in 183 (90.1%) of the serum samples, but the serum HBsAg concentration was too low to determine the subtype for the 20 (9.9%) remaining samples. Among the Southeast Asian refugees, aywl-2 was demonstrated in 35 (33.0%) of the subtyped serum samples, the adw2 subtype was identified in 33 (31.1%) sera, adr was detected in 37 (34.9%) sera, and the adw 4 subtype as found in 1 (0.9%). The most common subtypes in Vietnam, Laos, and Cambodia were aywl-2, adw2, and adr, respectively. In prison inmates, the ayw3 subtype accounted for 31 (52.5%) of the subtyped serum samples, an ayw2 variant and the adw2 subtype were each found in 13 (22.0%) sera, and the aywl-2 subtype was detected in 2 (3.4%) sera. Many of these inmates admitted intravenous drug use. Among homosexual men, the adw2 subtype was identified in 16 (88.9%) of the subtyped serum samples and the ayw3 subtype was detected in 2 (11.1%) sera. This subtyping method can distinguish between most of the nine major HBsAg subtypes and can be easily performed with these monoclonal antibodies and commercially available reagents. PMID: 1939511 [PubMed - indexed for MEDLINE] 247. Am J Public Health. 1991 May;81 Suppl:35-40. HIV infection among women entering the New York State correctional system. Smith PF, Mikl J, Truman BI, Lessner L, Lehman JS, Stevens RW, Lord EA, Broaddus RK, Morse DL. Human immunodeficiency virus infection is the leading medical problem among prison inmates in several states. In 1988 a blinded seroprevalence study was conducted on 480 New York female prison entrants to determine the prevalence of and risk factors for HIV infection in this population. Ninety (18.8 percent)

women were HIV-seropositive. Seroprevalence was highest among women ages 30-39 (25.0 percent) and varied by ethnicity (Hispanics, 29.4 percent; Blacks, 14.4 percent; Whites, 7.1 percent) and residence (New York City, 23.8 percent; Upstate, 5.1 percent). Nearly half (44.9 percent) of the 136 acknowledged intravenous drug users and one-third (33.8 percent) of the 71 women with a positive syphilis serology were HIV-seropositive. There was no difference in fertility histories between seropositive and seronegative women, and two of 21 pregnant women were seropositive. This study led to increased clinical and prevention services for this high-risk population. PMCID: PMC1404753 PMID: 2014882 [PubMed - indexed for MEDLINE] 248. Minerva Med. 1991 Mar;82(3):125-30. [Serologic study on the prevalence of HIV, HBV infection and on the false positive reaction of VDRL at a prison]. [Article in Italian] Capoccia A, Ranieri R, Busnelli M, Passaretti B, Milella AM, Vecchi L. Servizio Sanitario, Casa Circondariale di Monza. Prisoners are considered to be a high risk population for HIV and HBV infection. Aim of this study was to determine the prevalence of HIV, HBV infection and of the VDRL false positivity by performing screening tests in 496 prisoners of Monza in 1987. About a third of prisoners was HIV infected (with a high prevalence in drug addicts) and about a half had a contact with HBV virus. We observed a very common association between HIV and HBV infections. About ten per cent of HIV infected presented a false positivity for VDRL while one per cent of not infected did. Our data show that in Italian prison HIV and HBV infections are spreadly diffused. False positivity for VDRL may be due not only to drug addiction but also to the immunological variations connected with AIDS. PMID: 2006031 [PubMed - indexed for MEDLINE] 249. Scand J Infect Dis. 1991;23(5):535-41. Prevalence of antibodies against hepatitis A virus, hepatitis B virus, and Treponema pallidum in Mauritius. Schwarz TF, Kam CC, Min GL, Jilg W, Wilske B, Grtler L, Deinhardt F.

Max von Pettenkofer Institute for Hygiene and Medical Microbiology, Ludwig-Maximilians-University, Munich, Federal Republic of Germany. A seroepidemiological study on the prevalence of antibodies against hepatitis A virus (HAV), hepatitis B virus (HBV) and Treponema pallidum was conducted in various groups of the population of the state of Mauritus (Islands of Mauritus and Rodrigues). 618 sera were tested. The overall prevalence of anti-HAV was 86.1% and yielded and age-dependent increase. Serological evidence for acute or chronic HBV infection was found in 3.8%; 4.5% were positive for anti-HBc alone, and in 12.6% past HBV infection was detected. No age- or sex-dependent increase in the prevalence of anti-HBc was found. There were differences in the anti-HBc prevalence among the various groups of population ranging from 5.9 (flight personnel) to 58.3% (prison inmates). Treponemal antibodies were detected in 6.0% and showed a fairly marked age-dependent increase. Our study suggests that vaccination programmes against HAV and HBV would be beneficial for the Mauritian population. PMID: 1662829 [PubMed - indexed for MEDLINE] 250. Can Dis Wkly Rep. 1990 Dec 29;16(52):265-6. Seroepidemiologic study of hepatitis B and C viruses in federal correctional institutions in British Columbia. [Article in English, French] Prfontaine RG, Chaudhary RK. Correctional Services of Canada, Abottsford, British Columbia. PMID: 1963577 [PubMed - indexed for MEDLINE] 251. Zhonghua Liu Xing Bing Xue Za Zhi. 1990 Oct;11(5):267-70. [A prospective serological epidemiological investigation of hepatitis B virus infection in a prison]. [Article in Chinese] Lu Q. Lab of Viral Hepatitis, Nanfang Hospital, First Military Medical College. 2,443 male prisoners were under investigation, most of them were youth, and

followed up for 12-36 (mean 23.7 +/- 11.4) months. Sera HBV markers were detected every year. The positive rate of HBsAg was 25.1%, in which transient HBV carriers were 14.7% and chronic asymptomatic HBV carriers (AsC) were 85.3%. Seroconversion rate of HBsAg in AsC was 1.4% per year. The positive rate of anti-HBs was 46.3%, anti-HBs diminished in 6.0% per year. It was suggested that the antibody response to frequent exposure to HBV persisted for a long time. HBeAg seroconversion was 22.3% per year, and its reoccurrence was 7.9% per year, indicating the fluctuation and stability of infection status. The prevalence rate of HBV infection (with one or more than one of HBsAg, anti-HBs or anti-HBc) was 81.1%. Incidence of HBV infection among those susceptible persons found at first investigation was 22.3% per year. PMID: 2261613 [PubMed - indexed for MEDLINE] 252. Ann Ig. 1990 Sep-Oct;2(5):359-63. [Prevalence of hepatitis virus (HBV and HCV) and HIV-1 infections in a prison community]. [Article in Italian] Pinducciu G, Arnone M, Piu G, Usai M, Melis A, Pintus L, Pitzus F. Ist. di Igiene e Medicina Preventiva, Universit di Cagliari. PMID: 1715727 [PubMed - indexed for MEDLINE] 253. Klin Wochenschr. 1990 Apr 17;68(8):415-20. HIV infection in intravenous drug abusers in Berlin: risk factors and time trends. Stark K, Mller R, Guggenmoos-Holzmann I, Deininger S, Meyer E, Bienzle U. Landesinstitut fr Tropenmedizin. To investigate the epidemiology of HIV infection among intravenous drug abusers (IVDA) in Berlin (West), from October 1984 to October 1988, 741 heterosexual IVDA were recruited from facilities for drug treatment and counseling. In this group 22.8% were seropositive for antibodies against HIV, representing 21.1% of the females and 23.5% of the males. Seroprevalences of hepatitis B, hepatitis A, and lues were 67.7%, 40.1%, and 4.0%, respectively. Seropositivity for HIV antibodies correlated with positive seromarkers for hepatitis B and A, and with certain behavioral and social features such as sharing of injection equipment,

imprisonment, and intravenous drug use in prison. The crude time trend of HIV seroprevalence shows an increase from 17.1% in those subjects who discontinued i.v. drug abuse in 1983 or earlier to 31.5% in 1985, and a decrease over the past 3 years to 14.1% in 1988. After adjusting for temporary changes in the study group, the estimated HIV seroprevalence odds show an almost steady increase and were significantly higher for those who were injecting drugs in 1987 and 1988 compared with those who stopped i.v. drug use before 1984. Thus IVDA with a persistent risk profile are at a still-increasing risk of acquiring HIV infection. PMID: 2348645 [PubMed - indexed for MEDLINE] 254. Am J Public Health. 1990 Apr;80(4):471-3. Prevalence of markers for hepatitis B and hepatitis D in a municipal house of correction. Barry MA, Gleavy D, Herd K, Schwingl PJ, Werner BG. Community Infectious Disease Epidemiology Program, Boston Department of Health and Hospitals, MA. Following an outbreak of hepatitis B (HBV) in a municipal house of correction, HBV markers were detected in 173/406 (43 percent) inmates and 10/129 (8 percent) staff. Of the 173 HBV-infected inmates, 14 (8 percent) had hepatitis D (HDV) markers compared to 0/10 staff members. Intravenous drugs use (IVDU) was most strongly associated with HBV marker presence. Increasing duration of imprisonment, history of hepatitis B and especially IVDU were associated with the prevalence of HDV markers. PMCID: PMC1404596 PMID: 2316772 [PubMed - indexed for MEDLINE] 255. Med Clin (Barc). 1990 Feb 10;94(5):164-8. [Hepatitis B and hepatitis delta in young inmates]. [Article in Spanish] Bayas JM, Bruguera M, Martn V, Mayor A, de la Fuente ML, Laliga A, Salleras L. Servicios de Medicina Preventiva y de Hepatologa, Hospital Clnic i Provincial, Barcelona.

The prevalence of infection by hepatitis B (HBV) and delta (HDV) viruses and presumably related variables were evaluated in a prison for young male convicts, aged 16-21 years (n = 686), 55.1% of convicts were positive for one or more VHB markers, and 7.1% were positive for HBsAg; 89.7% of these were negative for IgM anti-HBc (chronic carriers), while 36.6% were positive for HBeAg. Anti-delta antibodies were detected in 37.5% of chronic carriers. The seropositivity of HVB markers was much higher in parenteral drug abusers (PDA) as compared with non PDA (76.3% vs 26.7%, p less than 0.0000001, OR = 8.82). Among PDA, it was higher in regular users than in occasional ones (83.3% vs 62.9%, p = 0.0001, OR = 2.95) and in those who had acquired the habit at an early age (p = 0.035). The stratified analysis also showed an association of VHB infection with other variables, basically ethical and prison-related. The possibility to develop active immunization programs is evaluated. PMID: 2325476 [PubMed - indexed for MEDLINE] 256. Med Microbiol Immunol. 1990;179(1):43-8. Prevalence of liver disease and infection by hepatitis B, delta virus, and human immunodeficiency virus in two Spanish penitentiaries. del Olmo JA, Llovet F, Rodrigo JM, Molina J, Aparisi L, Serra MA, Wassel A, Bixquert MA. Gastroenterology Unit, Hospital Clnico Universitario, Valencia, Spain. We studied the prevalence of liver disease and the carrier state for hepatitis B (HBV), delta virus (HDV) and HIV-1 infection in two Valencian penitentiaries, one for males and the other for females. Serological results were correlated with history of intravenous drug addiction, alcohol abuse, homosexuality or prostitution (high-risk groups), and duration and number of internments. A high prevalence of increased transaminase levels (52.2%) and serological markers for HBV infection (66.5%) was observed amongst the inmates, figures being higher amongst high-risk individuals and inmates confined for more than 6 months. No signs of HDV or HIV-1 infection were found amongst the prison staff. Anti-HIV-1 positivity was observed most frequently amongst individuals combining both drug abuse and homosexuality/and prostitution. PMID: 2329961 [PubMed - indexed for MEDLINE] 257. Can Dis Wkly Rep. 1989 Aug 19;15(33):168-70. HIV-1 infection in a medium security prison for women--Quebec.

[Article in English, French] Hankins C, Gendron S, Richard C, O'Shaughnessy M. Erratum in Can Dis Wkly Rep 1989 Sep 2;15(35):180. PMID: 2766390 [PubMed - indexed for MEDLINE] 258. Lancet. 1989 Jul 22;2(8656):226. HIV infection, hepatitis, and syphilis in Spanish prisons. Acedo A, Campos A, Bauz J, Ayala C, Jover M, Herrero L, Caigral G, Tascn A. PMID: 2568559 [PubMed - indexed for MEDLINE] 259. Am J Public Health. 1989 Jul;79(7):840-2. HIV testing in prisoners: is mandatory testing mandatory? Andrus JK, Fleming DW, Knox C, McAlister RO, Skeels MR, Conrad RE, Horan JM, Foster LR. Division of Field Services, Center for Disease Control, Atlanta, Georgia 30333. We studied 977 newly incarcerated Oregon inmates to compare voluntary versus mandatory human immunodeficiency virus antibody (HIVAb) testing in the prison setting. All inmates were offered HIVAb counseling and testing. Blood drawn for routine syphilis serology from those who declined this offer was also tested for HIVAb after personal identifiers had been removed. Only 1.2 percent (12) prisoners were HIV positive. However, 62.5 percent (611) inmates were at risk for HIV infection by being an intravenous drug user, a male homosexual, or hepatitis B core antibody (HBcAb) positive. The ratio of at-risk, as yet uninfected inmates to those already HIV infected was 53 to 1. Two-thirds of all inmates including those at-risk chose to receive counseling and testing. In areas where most at-risk inmates are not yet infected, it may be more appropriate for HIV prevention activities in prison to focus on voluntary programs that emphasize education and counseling rather than mandatory programs that emphasize testing. PMCID: PMC1349661 PMID: 2735469 [PubMed - indexed for MEDLINE]

260. Hell Stomatol Chron. 1989 Apr-Jun;33(2):101-5. [Findings from the clinical examination of the oral cavity of one hundred drug addicts]. [Article in Greek, Modern] Donta AN, Lampadakis J, Pilalitos P, Spyropoulos ND. The authors studied the findings from the clinical examination of the oral cavity of one hundred drug addicts that were prisoners at Korydalos prison, in order to evaluate the incidence and the possible correlation of these findings to the drug abuse. This study revealed that drug addicts present lesions of the oral mucosa such as redness of the pharyngeal mucosa (57%), melanchromatic spots on the lips (35%) and hairy tongue (57%). Also, a high incidence of carious lesions was found (46%), of missing teeth (42%) and of periodontal disease (57%). These percentages are much higher than those found in a random population. It was also revealed that in the above group there was a high incidence of serum hepatitis (23%) and of AIDS (8%), while other systemic diseases were also found. PMID: 2519151 [PubMed - indexed for MEDLINE] 261. Infection. 1988 Mar-Apr;16(2):91-4. Hepatitis A in young Norwegian drug addicts and prison inmates. Holter E, Siebke JC. Department of Virology, National Institute of Public Health, Oslo. Prevalence of antibodies against hepatitis A (anti-HAV) among young Norwegian drug addicts in 1983 and the relative incidence of specific IgM against hepatitis A (anti-HAV IgM) during the years 1973-1983 have been studied. The survey is based on 1,689 serum samples from 561 persons submitted to hepatitis B screening or clinical hepatitis testing. The prevalence of anti-HAV in such groups was 43% in 1983 versus about 5% in corresponding age groups in the general population and 1% in the Norwegian U.N. soldiers in Lebanon. Presence of anti-HAV clearly correlated with presence of hepatitis B markers. Considerable fluctuations in the incidence of hepatitis A seemed to occur among drug addicts, with pronounced epidemic peaks in 1975 and 1979, coinciding with epidemics in Malm, Sweden. Though the incidence varied, hepatitis A may have persisted among addicts for some years after 1979 in a semi-endemic manner. Although relatively young, most of them seem to have been in the milieu for some time before catching the infection. Drug addicts seem to be a target group for future hepatitis A vaccination programs.

PMID: 2836313 [PubMed - indexed for MEDLINE] 262. N Z Med J. 1988 Jan 27;101(838):25-6. Hepatitis B at Mt Eden prison. Cullen R. PMID: 3380411 [PubMed - indexed for MEDLINE] 263. Bull Soc Pathol Exot Filiales. 1988;81(2):173-82. [Prevalence of parasitic diseases and HBV and HIV viruses among black Africans in prison. (Study of 116 subjects)]. [Article in French] Boure P, Espinoza P, Coco Cianci O, Lou P. Dpartement des Maladies Tropicales, C. H. U. Bictre, Kremlin Bictre. A prospective survey among 116 subjects native of Black Africa and residing in prison was carried on, in order to estimate the prevalence of parasitosis, HB Virus and HI Virus infections. These subjects, all males, were selected at random among Black Africans, which were representative of 6.5% of the prisoners in the prison of Fresnes. The average age and stay in France were respectively of 25.7 and 3.3 years. 34% had regular drug-habit (I.V. heroin intake for 8 subjects). 54% were carriers of parasites: 33 subjects for intestinal nematode (whipworm: 19; hookworm: 5; Strongyloides stercoralis: 5; ascaris: 3; pinworm: 1); 2 for filariasis (loaiasis: 1: onchocerciasis: 1); 11 subjects for bilharziosis and 43 carriers of intestinal protozoosis (mild form amebiasis principally); also, 11 scabies were noticed. By another way, 8 subjects (6.9%) were HIV1 +, and none HIV2+; 11 (9.5%) were HBs+. In relation to parasitosis, practical attitude hesitate between systematic evaluation of infections (more satisfying but expensive), systematic treatment (easier but less suitable), and prescription of well-fixed tests according to the conclusions of a specialized advice. In relation to virosis, a systematic serological determination is not justified for this population, in actual economical conditions, and because there is no specific treatment. PMID: 3416405 [PubMed - indexed for MEDLINE]

264. Klin Wochenschr. 1987 Apr 15;65(8):376-9. Risk factors for HIV infection in German i.v. drug abusers. Clinical, serological and epidemiological features. Harms G, Laukamm-Josten U, Bienzle U, Guggenmoos-Holzmann I. A series of 320 German i.v. drug abusers (32.2% female, 67.8% male) were tested in a cross-sectional study for antibodies against HIV. Seroprevalence increased from 0 in those who discontinued i.v. drug abuse before 1982 to 37.2% in those who stopped injecting drugs in 1985/1986 or who were still addicted. Antibodies to HIV were significantly associated with lymphadenopathy and clinical symptoms (fever, weight loss, diarrhea, fatigue, night sweat, dermal lesions) and with markers of hepatitis A and hepatitis B virus infection. Participants of the study admitted in 92.5% of cases to "needle sharing" and in 83.1% of cases to sexual contacts among drug abusers. Prostitution and drug abuse in prison were significantly correlated with seropositivity. No antibodies to HIV infection were detected in 131 subjects of a control group of household contacts. PMID: 3495695 [PubMed - indexed for MEDLINE] 265. Gastroenterol Clin Biol. 1987 Apr;11(4):288-92. [High prevalence of infection by hepatitis B virus and HIV in incarcerated French drug addicts]. [Article in French] Espinoza P, Bouchard I, Buffet C, Thiers V, Pillot J, Etienne JP. This clinical and biological study was undertaken to assess the prevalence of infection by HIV, HBV and HDV in male drug abusers entering a prison. One hundred and thirteen drug users accepted to be tested: 14 (12 p. 100) were homosexual; 12 (11 p. 100) consumed more than 80 g per day of alcohol. The mean duration of drug addiction was 5 +/- 2.9 years; 50 (44 p. 100) declared having used a personal syringe while 63 (56 p. 100) usually shared their syringe. Serum activity of transaminases higher than twice the normal value was noted in 36 cases (32 p. 100). One hundred and two (90 p. 100) drug abusers had a HBV marker, 17 (15 p. 100) were HBs Ag carriers, 9 had anti-HBc antibody alone. The prevalence of antibodies to the HDV was 23 p. 100 and was higher among the HBs Ag carriers (65 p. 100). There were no cases of AIDS. Clinical examination showed lymphadenopathy in 49 cases (43 p. 100), a weight loss of more than 10 p. 100 in 47 cases (42 p. 100), and in 69 cases (61 p. 100), HIV positive serology, confirmed by Western blot. The duration of drug addiction was longer in the 102 drug users with HBV markers. Long duration of drug abuse and the use of a shared syringe increased

the risk of HIV infection. No relation was noted between the presence of HBV markers and HIV positive serology. In this population the prevalence of HIV, HDV markers and HIV infection was high, but no relation with the duration of previous incarceration or homosexuality was found.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 3582884 [PubMed - indexed for MEDLINE] 266. Bull Acad Natl Med. 1987 Feb;171(2):215-8. [AIDS and hepatitis B in the prison population: an unavoidable epidemiologic reality]. [Article in French] Bnzech M, Rager P, Beylot J. PMID: 3304554 [PubMed - indexed for MEDLINE] 267. Postgrad Med J. 1987;63 Suppl 2:21-6. Epidemiology and economic importance of hepatitis B in the Federal Republic of Germany. Lange W, Masihi KN. Robert Koch Institute, Department of Virology, Berlin, Federal Republic of Germany. Hepatitis is among the five most important notifiable infectious diseases in the Federal Republic of Germany where 15,000-20,000 new cases are reported annually. A total of 60,000 cases per year may actually occur when the presumed high incidence of unreported hepatitis is taken into consideration. Hepatitis B probably represents 35%-40% of these hepatitis cases. When considering the reported (7000/year) and unreported cases, 30,000 new infections may occur each year. Drug addicts with infection rates of over 80% and prison inmates with up to 72% of hepatitis B markers are the most important risk groups as well as patients from haemodialysis units (60%), haemophiliacs, and newborns of mothers who are HBV carriers. Medical personnel, with an infection rate of 15%-26%, are at significantly greater risk than the general public. Hepatitis B results in enormous annual health costs. Calculations based on 30,000 new cases per year indicate that the costs for therapy, rehabilitation, as well as loss of work-hours and income lie between 842 and 1113 million DM. The frequency of hepatitis B, its potential for temporary or prolonged health impairment, and the

significant economic implications make it imperative to develop meaningful strategies for control. PMCID: PMC2428350 PMID: 3684845 [PubMed - indexed for MEDLINE] 268. Clin Ther. 1987;9(6):622-8. Seroepidemiology of hepatitis D (delta agent) and hepatitis B among Virginia State prisoners. Tucker RM, Gaffey MJ, Fisch MJ, Kaiser DL, Guerrant RL, Normansell DE. Department of Pathology, University of Virginia, Charlottesville. A serosurvey of hepatitis D (HDV) and hepatitis B (HBV) was conducted in an asymptomatic population of newly incarcerated prison inmates in Virginia. Of 459 men entering the prison, 445 provided both sera and demographic and personal information. Six (1.3%) had antibody to HDV (anti-HDV). Evidence of past infection with HBV was found in 146 (32.8%); 9 (2.0%) were positive for HBV surface antigen (HBsAg). HBV seropositivity correlated with intravenous drug abuse, nonwhite race, and tattoos acquired in prison. Sera obtained after an interval of seven to ten months revealed seroconversion to anti-HDV in one of two HBsAg-positive men who admitted to parenteral drug use while incarcerated. Because he had been incarcerated elsewhere for more than one year before entering this prison, it is concluded that HDV transmission occurred in prison. The association of HDV infection with progression to chronic active and fulminant hepatitis suggests that serologic surveillance of HBsAg-positive inmates may be indicated for identification of possible HDV index cases. PMID: 3440274 [PubMed - indexed for MEDLINE] 269. N Engl J Med. 1986 May 8;314(19):1255-6. Hepatitis B in a general psychiatric hospital. Smith DA. PMID: 3702923 [PubMed - indexed for MEDLINE] 270. Dtsch Med Wochenschr. 1986 Apr 11;111(15):567-70. [Increase in the prevalence of antibodies against LAV/HTLV III in drug addicts in

West Germany]. [Article in German] Zoulek G, Grtler L, Eberle J, Lorbeer B, Deinhardt F. Sera obtained from 927 drug addicts in 1983 to 1985 were tested for antibodies against LAV/HTLV-III. There was a steadily rising proportion of positive results: 10.1% in 1983, 17.6% in 1984 and 23.9% in 1985. In each year the prevalence of anti-LAV/HTLV-III was higher among female than male addicts. No increased proportion of positive results was demonstrable in relation to age. Among 152 sera from 1983/84, hepatitis-B markers were found in 72 (43.7%), of whom 10 (14%) were also anti-LAV/HTLV-III positive. Among hepatitis-B marker-negative sera there were 8 (6%) which were also anti-LAV/HTLV-III positive. The prevalence of anti-LAV/HTLV-III in drug addicts in prisons, rehabilitation centres, hospitals and medical practices was similar. There is a danger that prostitution by addicts for obtaining drugs will cause a penetration of LAV/HTLV-III in the rest of the population. PMID: 3007065 [PubMed - indexed for MEDLINE] 271. Biomed Pharmacother. 1986;40(7):248-51. Hepatitis B in prisons. Bader TF. Prisoners have been thought to be at high risk of contracting hepatitis B. Prevalence studies throughout the world show a similar hepatitis B marker rate of 28 to 51%. Seroconversion studies have shown a 0.8 to 1.4% incidence in male prisoners. These results are far less than the predicted 5 to 10% annual attack rate for a similar non-incarcerated population. Cost considerations prevent universal vaccination of prisoners, but IV drug abusers and female prisoners seem to be at especially high risk and should be targeted for immunization now. Prisoners who are chronic carriers of HBsAg and who are also "e" antigen positive or delta antibody positive should be segregated. PMID: 3814756 [PubMed - indexed for MEDLINE] 272. Boll Ist Sieroter Milan. 1986;65(6):487-93. [Seroepidemiologic case finding in HTLV III infection, lues and HBV in a prison]. [Article in Italian]

Borroni G, Panuccio A, Ballerini P, Gelosa L. We report serological screening of 1217 prisoners for HTLV III antibodies, HBV markers and lues tests. The prevalence for HTLV III Abs on the whole of prisoners controlled is 30.8%, among the drug-users is 60.7%, with a relative risk (RR) of 1.18 between males and females in this group. It is been observed a significant association between aspecific positivity to VDRL and HTLV III Abs in the serum. PMID: 3580142 [PubMed - indexed for MEDLINE] 273. Am J Public Health. 1985 Oct;75(10):1213-4. Incidence of hepatitis B in the penitentiary of New Mexico. Hull HF, Lyons LH, Mann JM, Hadler SC, Steece R, Skeels MR. A study was conducted to determine the incidence of hepatitis B (HB) in a prison population. Forty-seven per cent of 455 male prisoners had evidence of past HB infection. HB seropositivity was most strongly correlated with: 1) a history of IV drug abuse; 2) age; 3) total time in any prison; and 4) race. During a one-year study period there were no clinical cases of HB in the prison and the seroconversion rate was 0.8 per cent among prisoners still incarcerated. PMCID: PMC1646375 PMID: 4037165 [PubMed - indexed for MEDLINE] 274. Am J Public Health. 1985 Oct;75(10):1182-5. Hepatitis B in Wisconsin male prisoners: considerations for serologic screening and vaccination. Anda RF, Perlman SB, D'Alessio DJ, Davis JP, Dodson VN. To develop a protocol for prevention of hepatitis B virus (HBV) transmission in Wisconsin prisons, we interviewed 619 male prisoners at incarceration to obtain information on hepatitis B risk factors. We defined previous infections by the presence of hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), or antibody to hepatitis B core antigen (anti-HBc). Logistic regression was used to develop a model of relative risk (RR) of HBV infection. Use of illicit intravenous (IV) drugs was the most important risk factor because of a high prevalence of IV drug use and an RR which ranged from 2.93-7.47. Other important risk factors were: prior hepatitis or jaundice (RR = 6.28), race (RR = 2.54 for Blacks, RR = 3.28 for Latinos), transfusion (RR = 3.00), and age.

Previous imprisonment was not an independent risk factor for HBV, hence selective serologic screening and vaccination of prisoners are justified rather than mass screening and vaccination. Based upon prevalence of hepatitis B markers in subgroups, it is necessary to screen prisoners with prior hepatitis or jaundice, prior transfusion, and users of IV drugs. The identification of HBsAg carriers by such screening could prevent infection of "household" contacts. Users of IV drugs who are susceptible to HBV infection should be vaccinated. The remaining prisoners constitute a low-risk group for HBV infection and do not require serologic screening or vaccination. PMCID: PMC1646381 PMID: 4037160 [PubMed - indexed for MEDLINE] 275. Ann Intern Med. 1985 Sep;103(3):391-402. Recommendations for protection against viral hepatitis. Recommendation of the Immunization Practices Advisory Committee. Centers for Disease Control, Department of Health and Human Services. [No authors listed] This following statement updates all previous recommendations on use of immune globulins for protection against viral hepatitis and use of hepatitis B vaccine and hepatitis B immune globulin for prophylaxis of hepatitis B. Recommendations cover hepatitis A; hepatitis B; non-A, non-B hepatitis; and delta hepatitis. Specific indications are included for use of immune globulin, hepatitis B immune globulin, and hepatitis B vaccine for high-risk groups, including medical and dental personnel, hemodialysis patients, workers at daycare centers, workers at institutions for the mentally retarded, prison inmates, homosexual men, intravenous drug abusers, international travelers, household and sexual contacts of persons at risk, and heterosexually active persons. Recommendations are given for maternal and fetal screening for serologic markers of hepatitis B virus, and guidelines for treatment are provided. PMID: 3161440 [PubMed - indexed for MEDLINE] 276. J Infect Dis. 1984 Sep;150(3):450-9. Seroepidemiology of hepatitis B in Tennessee prisoners. Decker MD, Vaughn WK, Brodie JS, Hutcheson RH Jr, Schaffner W. A prevalence serosurvey was performed on an 11.7% sample of the 6,503 adult male inmates in Tennessee prisons. On the basis of the sample, 0.9% of the prisoners

possessed hepatitis B surface antigen, and 29.5% had one or more serum markers for hepatitis B virus (HBV). Thirty-two possible risk factors were analyzed for association with possession of HBV serum markers. The significant risk factors for possession of HBV markers in this population were found to be age, intravenous drug use while not incarcerated, intravenous drug use while incarcerated, race, education, military service history, and duration of prior and current imprisonments, in that order of importance. Given the modest contribution of incarceration to overall risk, mass immunization of prisoners against HBV seems unwarranted. Prisoners with unusually long sentences or who use intravenous drugs in prison are subgroups at particularly high risk. The logistic model can be used to target a serological screening and immunization program. PMID: 6481188 [PubMed - indexed for MEDLINE] 277. Rev Fr Transfus Immunohematol. 1984 Sep;27(4):537-41. [Hepatitis B virus markers, beta 2 microglobulin and anti HTLV in a population of blood donors from a prison environment]. [Article in French] Nol L, Messian O, Grand M, Lambotin B, Courouc AM, Saint-Paul B. 212 male prisoners were collected at the prison in March 1983. Anti-HBc and HBs Ag were detected by a combined test (AUSRIA-CORE, Abbott Laboratories). 67 sera (31,5%) were anti-HBc positive, 7 of them HBs Ag positive. Screening for anti-HTLV (anti-p24) was negative for all the donors. Beta 2 microglobulin levels were determined on 115 sera (B2-micro RIA 100, Pharmacia Laboratories). 8 had levels above 2,6 mg/l (greater than 2 SD). These 8 sera were anti-HBc positive and one of them HBs Ag positive 3 HBs Ag positive donors had non elevated Beta 2 microglobulin levels. This survey confirms that prisoners as blood donors should be regarded as carrying a high risk of transmission of HBV and probably other infectious agents with similar epidemiology. The signification of elevated Beta 2 microglobulin levels deserves further investigations since this determination could be of value as an additive test to increase the safety of blood products. PMID: 6095414 [PubMed - indexed for MEDLINE] 278. Rev Fr Transfus Immunohematol. 1984 Sep;27(4):525-9. [Biological studies and research of immunologic deficiencies in blood donors from a prison environment]. [Article in French]

Falkenrodt A, Schwartz G, North ML, Schwartz M, Weill D, Schmitthauesler R, Hun H, Malgras J, Mayer S. The prison population may be considered as a population at risk for AIDS. Biological parameters were studied in order to detect significant anomalies commonly observed in AIDS patients. With respect to are age matched control population of donors, there are no statistically significant differences concerning the nutritional and inflammatory states of the two populations. The investigation of the humoral immunity shows comparable levels of circulating antibodies in the two groups: a high level of anti-cytomegalovirus and anti-herpes antibodies is more frequently found in the penal population. The markers for hepatitis B were also studied. None of the individuals is a carrier of the HBs antigen. The percentage of individuals having biological markers of hepatitis B is higher in the at risk group (45%) than in the control group (10%). The evaluation of the cell-mediated immunity shows that there are no significant differences between the mean values found in the two groups for OKT3, T11, OKT4 and OKT8. There is no inversed OKT4/OKT8 ratio in the at risk group while one donor in the control group shows an inversed OKT4/OKT8 ratio. PMID: 6095413 [PubMed - indexed for MEDLINE] 279. N Engl J Med. 1983 Feb 3;308(5):281. Hepatitis B carriers in the prison population. Bader T. PMID: 6848945 [PubMed - indexed for MEDLINE] 280. J Hyg (Lond). 1982 Aug;89(1):53-8. Hepatitis B virus infection in prisons. A seroepidemiological survey in prisoners and attending staff. Chiaramonte M, Trivello R, Renzulli G, Zampieri L, Fanecco A, Floreani A, Naccarato R. Prisoners and attending staff from six houses of detention were screened for serum HBsAg, anti HBs, antiHBc and transaminases. Both prisoners and warders showed an increased prevalence of HBV serum markers with respect to age- and sex-matched general population control groups. The HBsAg carrier rate was 6.7% in prisoners and 6.6% in staff. Sixty-five per cent of the HBsAg-positive subjects were antiHBe-positive. When the blood samples were taken, all the HBsAg-positive

subjects were asymptomatic; transaminases were normal in 80% and only slightly elevated in 20%. Illicit drug abuse was found to be a relevant risk factor for HBV infection among prisoners under 35 yearts of age, but not in the older group, whereas no correlation emerged between presence of HBV serum markers and tattoos or admitted homosexuality. A high prevalance of HBV serum markers as also found among young warders who had been in service for a short time: most of them, however, come from areas of Italy with a particularly elevated HBV circulation. Although the results suggest that many of the HBV infections are not recently acquired within the institution, this survey confirms that prisons should be regarded as high risk areas for HBV infection, both for prisoners and warders. PMCID: PMC2134178 PMID: 7097002 [PubMed - indexed for MEDLINE] 281. Am J Epidemiol. 1982 Feb;115(2):185-91. Prevalence of hepatitis A antibodies in a normal population and some selected groups of patients in Norway. Siebke JC, Degr M, Ritland S, Enger SC. The prevalence of hepatitis A virus antibodies was tested by radioimmunoassay in Norway in healthy blood donors, in patients without clinical signs of liver diseases and in two selected groups of patients. The presence of hepatitis A antibodies was highly age-dependent in 625 normal persons. A major reduction occurred from 50 per cent or more in those born before 1938 to 10 per cent or less among those born after 1943. The decline of hepatitis A antibody prevalence was correlated to the history of infectious hepatitis epidemics in the entire country during World War II. The prevalence was not different from controls in a group of patients with various liver disorders. Hepatitis A antibodies were more prevalent in males than in females in blood donors, patients with chronic liver disorders and their controls. Hepatitis A antibodies were frequently present in prison inmates; their presence was associated with the presence of antibodies against hepatitis B virus and with anamnestic data on drug addiction. PMID: 7058777 [PubMed - indexed for MEDLINE] 282. N Engl J Med. 1982 Jan 21;306(3):175. Prevalence of hepatitis B among men admitted to a federal prison. Kibby T, Devine J, Love C. PMID: 7054667 [PubMed - indexed for MEDLINE]

283. NIPH Ann. 1980 Dec;3(2):129-32. Viral hepatitis among prisoners in Norway. Hurlen B, Siebke JC, Stensland A. The present survey reveals high frequencies of hepatitis B surface antigen and antibody in criminals committed to prison in Norway compared to the general population. The high rate of antigen carriers and the intramural supply of illicit drugs constitute a threat to fellow prisoners regarding viral hepatitis as well as drug addiction. PMID: 7219839 [PubMed - indexed for MEDLINE] 284. J Infect Dis. 1978 Apr;137(4):505-6. Prevalence of hepatitis B surface antigen and antibody at a state prison in Kansas. Koplan JP, Walker JA, Bryan JA, Berquist KR. PMID: 649994 [PubMed - indexed for MEDLINE] 285. Br J Vener Dis. 1976 Jun;52(3):155-60. A 10-year study of homosexually transmitted infection. Fluker JL. A 10-year survey is presented of male cases of homosexually acquired infection seen between 1962 and 1971 at Charing Cross Hospital (West London Branch). Tables showing the number of cases of syphilis, gonorrhea, and other conditions in homosexual and heterosexual males and in females are considered. Tables of other relevant data are also presented. The reasons underlying the changes illustrated, including the Act legalizing homosexual practices between consenting adult males, which became effective in 1968, are discussed. Certain pathological conditions apparently connected with homosexual practices, such as serum hepatitis, local rectal disease, and mucous colitis, are included and also some relevant manifestations of herpes genitalis and genitral warts. Homosexually acquired infection in prisoners is described. Some of the psychiatric effects of homosexuality on clinic patients and also their fears of treatment at clinics are considered, as well as the behavioral differences in response to infection

between exclusively homosexuals, bi-sexuals, and married homosexuals. PMCID: PMC1045244 PMID: 946948 [PubMed - indexed for MEDLINE] 286. P N G Med J. 1975 Mar;18(1):1-7. Impaired humoral immunity in PNG Highlanders. Grove DI, McGregor A, Forbes IJ. Immunological function was investigated in 42 adult Papua New Guinea villagers and 38 adult males who had been inmates of the Goroka prison for more than three months. Serum IgG, IgA, IgM and IgE levels were all significantly elevated in both Papua New Guinea groups when compared to Australians. Antibody responses to tetanus toxoid immunization were greatly impaired in both Papua New Guinea (PNG) groups. The impairment was greater in the villagers. Antibody responses to immunization with typhoid vaccine were also impaired in both P.N.G. groups compared with Australians. Some evidence was obtained to indicate that unresponsiveness was associated with lower serum albumin levels, suggesting a relationship to protein deprivation. Antibody response after first immunization was predominantly in the IgM class for both tetanus and typhoid vaccines, with conversion to the IgG class on re-immunization. This indicates that most P.N.G. highlanders have not been exposed to these antigens previously. The prevalence of autoantibodies (mitochondrial, gastric parietal cell and antinuclear) was similar to that of a normal Australian population. The prevalence of smooth muscle antibodies, although higher, was probably not remarkable. Australia antigen was found in 9%, compared with less than half of 1% in the Australian population. Cellular immune function, as measured by delayed hypersensitivity reactions, was not impaired. The implications of these findings for mass immunization programmes are discussed. PMID: 1061441 [PubMed - indexed for MEDLINE] 287. Am J Med Sci. 1974 Mar;267(3):171-7. Reduction of post-transfusion hepatitis by exclusion of Australia antigen from donor blood in an urban public hospital. Senior JR, Sutnick AI, Goeser E, London WT, Dahlke MB, Blumberg BS. PMID: 4825959 [PubMed - indexed for MEDLINE]

288. Gut. 1973 May;14(5):365-8. Liver disease and cell-mediated immunity in hepatitis-associated antigen (HAA) carriers. Bolin TD, Davis AE, Liddelow AG. As the incidence of liver disease in hepatitis-associated antigen (HAA) carriers has not been defined and it has been postulated that continuing liver disease is associated with incompetence of the cell-mediated immune system, a prospective study was undertaken to examine both these points.An increased incidence of HAA carriers was found in a prison population (1.3%). Eighteen of these subjects gave informed consent to further study with liver function tests, liver biopsy, and testing of cell-mediated immunity with dinitrochlorobenzene (DNCB) skin sensitization. Liver function tests were normal in 10 subjects, mildly abnormal in six (SGPT < 100 IU/litre), and abnormal in two. Serum proteins were normal in all. Liver biopsy showed that five subjects had chronic aggressive hepatitis, three of whom had normal liver function tests. Eight subjects had persistent hepatitis, three with normal liver function tests. The remainder had acute hepatitis (1), evidence of residual hepatitis (1), or non-specific changes (2). Only one subject had normal histology. Drug addicts, who comprised 56% of the group, had more severe liver disease then those who were not addicts. The hypothesis that persisting liver disease is associated with impaired cell-mediated immunity was not confirmed in that nine of the 12 subjects with persistent or chronic aggressive hepatitis had a positive response to dinitrochlorobenzene skin sensitization, thus implying normal cell-mediated immunity. The findings of this study suggest that in the presence of continuing antigenaemia liver biopsy is mandatory in order to disclose treatable liver disease. PMCID: PMC1412686 PMID: 4716503 [PubMed - indexed for MEDLINE] 289. Am J Dis Child. 1972 Apr;123(4):388-90. Drug abusers in Copenhagen prisons and Vestre hospital. Special reference to hepatitis associated antigen and epidemic hepatitis associated antigen. Jersild T, Jakobsen LH. PMID: 5027551 [PubMed - indexed for MEDLINE] 290. N Engl J Med. 1972 Feb 3;286(5):267.

Distribution of Australia antigen. Cherubin CE. PMID: 5007219 [PubMed - indexed for MEDLINE] 291. N Engl J Med. 1972 Jan 20;286(3):159. Hepatitis in prisoner blood donors. Krotoski WA. PMID: 5007158 [PubMed - indexed for MEDLINE] 292. Med J Aust. 1971 May 1;1(18):950-4. The incidence of Australia antigen in blood donors and in certain high-risk patient populations. Nelson M, Cooke B. PMID: 5577256 [PubMed - indexed for MEDLINE] 293. N Engl J Med. 1971 Jan 14;284(2):109. Australia antigen in volunteer and paid blood donors. Kliman A. PMID: 5538632 [PubMed - indexed for MEDLINE] 294. Appl Microbiol. 1970 Jul;20(1):6-10. Australia antigen in a closed adult population monitored for serum glutamic oxalacetic transaminase. Hok KA, Nieman R, Lackey JO, Cabasso VJ. A study of the presence of Australia antigen (Au/SH) was conducted over a period of 21 weeks among volunteer plasma donors living in a prison and being monitored for serum glutamic oxalacetic transaminase (SGOT). A good correlation was observed between the level of SGOT and presence of Au/SH, the latter being

present in 33% of donors with SGOT values higher than 101 Karmen units and in 12% of those with SGOT values of 41 to 100 units. Furthermore, none of the 87 donors with all SGOT values below 40 was found positive for Au/SH. It should be noted, however, that single specimens only were tested from 72 of the 87 individuals. Au/SH was detected with equivalent efficiency by both agar gel precipitation and complement fixation procedures. Implications of these findings in the prognostication of hepatitis carrier state are discussed. PMCID: PMC376856 PMID: 4989670 [PubMed - indexed for MEDLINE] 295. Br Med J. 1968 Mar 23;1(5594):727-30. Morbidity and mortality from heroin dependence. 2. Study of 100 consecutive inpatients. Bewley TH, Ben-Arie O. PMCID: PMC1985441 PMID: 5641435 [PubMed - indexed for MEDLINE] 296. Transfusion. 1967 Nov-Dec;7(6):436-9. Prisoner blood donors and posttransfusion (icteric) viral hepatitis. Koff RS, Chalmers TC. PMID: 6073346 [PubMed - indexed for MEDLINE] 297. Calif Med. 1966 Apr;104(4):293-9. Post-transfusion hepatitis, a serious clinical problem. Allen JG. Serum hepatitis and infectious hepatitis may have a common pathogen and their few clinical differences the result only of a difference in portal of entry. The risk of serum hepatitis from transfusions derived from prison and Skid Row populations is at least 10 times that from the use of volunteer donors. For every 100 patients receiving a single transfusion, the attack rate is 0.3 per cent when the donor is of the family or volunteer type and 3.2 per cent when the donor is from a prison or Skid Row population. The most practical methods of reducing the hazard of serum hepatitis from blood are to limit the use of blood by giving one

transfusion instead of two, two instead of three, etc., and especially by excluding, if possible, all prison and Skid Row donors. It is urged that state and federal control of the quality of blood used for blood transfusions be studied with the possibility that measures may be taken to increase its safety. If it is necessary that blood from prison and Skid Row donors be used to meet the demands, such blood should be labeled as carrying a significantly increased hazard of transmitting serum hepatitis in order that the physician prescribing blood may take the necessary precautions. PMCID: PMC1516378 PMID: 5909643 [PubMed - indexed for MEDLINE]