Dear Correctional Colleagues,

This week, the Pew Center on the States announced that an all-time high of more than one in 100 adult Americans are currently in jail or prison. In addition, the Center reported that more than $49 billion was spent on corrections last year, more than four times as much as twenty years ago. The U.S. continues to lead all other countries in both the number and percentage of incarcerated citizens.

Those of us who work in correctional public health certainly have little impact upon how many individuals this country chooses to incarcerate. We can, however, make an enormous difference in the health of this nation by ensuring that inmates who are entrusted to our care benefit from our best efforts at education, prevention, diagnosis, and treatment.

One area in which we can make a significant impact is chronic viral hepatitis. Hepatitis B virus (HBV) immunization efforts targeting infants, children, and adolescents have achieved significant success in the U.S. over the past two decades. As a result, non-immune adults now account for the overwhelming majority of new HBV infections in this country. In most jails and prisons the prevalence of HBV is markedly higher than that seen in the general U.S. population, and nearly 30% of persons with acute HBV have been incarcerated. Approximately 5% of adults who become infected with HBV will develop chronic hepatitis. Persons with chronic viral hepatitis are at risk for developing cirrhosis, end stage liver disease, and hepatocellular carcinoma.

Inmates continue to engage in behaviors that place them at risk for viral hepatitis both while incarcerated and after being released to the community. As a result, non-immune inmates comprise a group who would potentially benefit from hepatitis prevention initiatives. It has become increasingly clear that any effective comprehensive national strategy for the prevention, early diagnosis, and treatment of viral hepatitis must include jails and prisons.

The Advisory Committee on Immunization Practices (ACIP) has called for routine vaccination of all inmates who are not known to be immune regardless of their length of stay. Immunization of non-immune adults, diagnosis and treatment of those who are chronically infected, substance abuse treatment, and harm reduction education in the correctional setting can benefit our patients and the free community by reducing transmission and by decreasing costs associated with chronic viral hepatitis.

This month, Dr. Jennifer Cocohoba presents a comprehensive update regarding HBV. Dr. Cocohoba addresses the ongoing evolution of HBV treatment, including the particular challenges of treating those who are co-infected with HIV. Morris Jackson reviews some of the most useful information from last month’s Conference on Retroviruses and Opportunistic Infections (CROI), and the IDCR News and Reviews provides additional data from CROI 2008.

As always, we at IDCR thank you for your continued readership. We also encourage you to communicate with us regarding infectious diseases topics that you would like to see addressed in future issues.

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