Dear Corrections Colleagues,

As winter approaches, the near ubiquity of cold and flu symptoms reminds us all how easily infections may spread from person to person; in correctional medicine, the challenge to prevent an outbreak of communicable disease is that much greater. Close living quarters, community food preparation, and shared cleaning and toiletry facilities put inmates at greater risk for rapid spread of viral infections. This issue of IDCR focuses on preparing for pandemic flu in a correctional setting, controlling the spread of varicella zoster virus (VZV) infection, and includes the recently updated MMWR guidelines for adult vaccinations.

In her article focusing on pandemic flu in corrections, Rachel Schwartz introduces key concepts to help prepare for pandemic flu in a prison environment. Though important for any community, the advance development of specific plans to deal with a pandemic flu outbreak are crucial to maintaining the viability of a correctional facility, its staff, and its inmate population. The author outlines elements of preparedness unique to a correctional environment; these include increased surveillance of potential cases at commitment, the designation of specific areas which may serve as isolation and/or quarantine space in the throes of an outbreak, and the need to work closely with security personnel to formulate practical guidelines individualized to each facility. Such plans must be integrated into each facility's emergency response plan and should be adaptable to other potential infectious outbreaks (e.g. previous SARS experiences).

Joseph Bick's article updates us on important advances in the control of VZV. Vaccinations are available to protect against primary varicella and also to booster the immune system to minimize the development of zoster in those who had been previously infected. Cases of varicella in a correctional facility often incite fear among staff and inmates. Bick argues that an active employee immunization program including VZV helps minimize the crisis. This illuminates the facet of correctional medicine involved in protecting our staff.

MMWR recently published new guidelines for adult immunizations, including important recommendations especially relevant to inmate populations. The development of the human papillomavirus (HPV) vaccine has the potential to significantly decrease the cases of cervical cancer seen among our female inmates. Inmates have higher rates of sexually transmitted infections, including HPV, than the general population, and therefore will benefit from this vaccine series, which is recommended for women through 26 years of age. Also relevant to incarcerated populations is the new recommendation of including a pertussis component with tetanus vaccine. Pertussis can be spread easily in a facility such as a prison, where someone with a chronic cough can be contagious for a prolonged period of time prior to diagnosis. This vaccine should be encouraged among staff and inmates.

This issue will hopefully assist in developing key infection control programs in correctional facilities a pandemic flu plan and an active immunization program. Please contact me at michael.poshkus@doc.ri.gov with any questions or if you wish to share your individualized plans. I look forward to your responses.

Sincerely,

Michael T. Poshkus, M.D.
Associate Clinical Professor Brown University School of Medicine
Medical Program Director, RI Department of Corrections
Assistant Clinical Professor, Infectious Disease Division, Brown University

Back to Top