Infectious Diseases Prevention and Control in Canadian Federal Penitentiaries 2000-01

Publications

Infectious Diseases
Prevention and Control
in Canadian Federal
Penitentiaries 2000-01

RESULTS

Hepatitis B

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Hepatitis B is a vaccine-preventable viral infection of the liver, accounting for approximately 700 cases of hepatitis disease per year in Canada.¹ The prevalence of hepatitis B virus (HBV) has been estimated to be between 0.5% and 1.0%, with much variation according to patient age, ethnicity, and risk factors.^2,3 In Canada, the major modes of HBV transmission include percutaneous routes and sexual transmission.1 Persons at risk include those who share contaminated needles for injecting drugs, have multiple sexual partners, or have sexual contact with HBV-infected individuals.

Acute HBV infection is asymptomatic in 50-70% of adolescent and adult cases.⁴ The clinical severity of HBV infection increases in the presence of co-infections such as hepatitis A and hepatitis C.⁵

Hepatitis B is reported at a higher rate among inmates of correctional facilities than in the general population.^6-8 Reducing the incidence of HBV infection is considered to be an integral part of preventing the transmission of and sequelae related to bloodborne pathogens such as HIV and hepatitis C in correctional settings.^8,9

Hepatitis B infection rates

In 2001, 43 cases of HBV (0.3% of total inmate population) were identified by blood tests for the virus (this figure includes both acute and chronic HBV infections). Fifty-six per cent of these infections were among men offenders in Quebec Region (Figure 8). Women offenders were reported in Prairie Region only.

During 2000, 13 cases (0.1%) of HBV infection were reported in CSC facilities. All identified cases were among men offenders. Nearly two-thirds of HBV cases were reported from Ontario and Quebec Regions.

IN SUMMARY

• The number of newly identified hepatitis B infections (includes acute and chronic infections) rose from 13 in 2000 to 43 in 2001.
• Nearly all hepatitis B cases reported during this two-year period (95% in 2001, 100% in 2000) involved men offenders.

Hepatitis B prevention and control

In 1989, the Correctional Service of Canada (CSC) instituted a program for hepatitis B immunization of inmates, based on Canadian recommendations.10 The hepatitis B vaccine is a safe and effective means of preventing HBV infection. Vaccination is encouraged for all incoming offenders and is available on request throughout an inmate's sentence. Regional reports indicate that most facilities rely on vaccination rather than active testing for reducing transmission rates of HBV. Information on the proportion of inmates immunized annually for hepatitis B was unavailable at the time of this report.

Integrating immunization, education and treatment continues to be the most commonly used strategy to prevent the spread of hepatitis B among inmates of federal correctional facilities.

Conclusion

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The high rate of hepatitis B infection in CSC inmates points to the need for continued emphasis on inmate immunization against HBV. Incarceration is likely the best opportunity to provide testing and vaccination to persons at risk. Public health action through tracing and notification of possible contacts may provide additional benefits in HBV prevention and control in Canadian penitentiaries.

In the absence of routine screening for HBV among inmates, it will be important to capture data on immunization for HBV through the CSC-IDSS.

References

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