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Infectious Disease Surveillance in Canadian Federal Penitentiaries 2002-2004
Infectious Disease Surveillance in Canadian Federal Penitentiaries 2002-2004 was prepared jointly by the Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada and the Correctional Service of Canada (CSC) and is published in both English and French.
This report may be quoted in whole or in part with the permission of the Correctional Service of Canada. The opinions expressed in this publication do not necessarily reflect the views of the Commissioner.
For more information, or to obtain copies of this report or other reports, please contact:
Epidemiologist
Public Health Branch
Correctional Service Canada
340 Laurier Avenue West
Ottawa, Ontario
K1A 0P9
Canada
Telephone: 613-943-2318
PS84-9/2004
978-0-662-49439-3
This report is also available on CSC's Internet site at: http://www.csc-scc.gc.ca
Table of Contents
- Acknowledgements
- Foreword
- Foreword
- List of Tables
- List of Figures
- Executive Summary
- PART I
- Introduction and Methods
- PART II
- RESULTS
- 1. Human immunodeficiency virus (HIV)
- 2. Hepatitis C (HCV)
- 3. Hepatitis A (HAV) and Hepatitis B (HBV)
- 4. Sexually Transmitted Infections (STI)
- 5. Tuberculosis Screening: Inmates
- Participation in TB Screening
- Initial Assessment – Inmates
- BCG Vaccination Status – Inmates
- Ongoing Nonsignificant Assessment – Inmates
- Converters and Conversion Rate – Inmates
- Ongoing Significant Assessments – Inmates
- Latent Tuberculosis Infection – Inmates
- Risk Factor and Symptoms Screening – Inmates
- LTBI Treatment – Inmates
- Active TB Disease Among Inmates
- 6. Tuberculosis Screening: Staff
- 7. Methadone Maintenance Treatment
- PART III
- DISCUSSION
Appendices: Surveillance Data Tables
- Appendix A: Human Immunodeficiency
Virus (HIV)
- Table A.1: Human immunodeficiency virus (HIV) antibody testing among inmates in Canadian federal penitentiaries, 2002–2004
- Table A.2: Human immunodeficiency virus (HIV) antibody testing among women offenders in Canadian federal penitentiaries, 2002–2004
- Table A.3: Human immunodeficiency virus (HIV) antibody testing among male offenders in Canadian federal penitentiaries, 2002–2004
- Table A.4: Cumulative number of HIV cases in Canadian Federal Penitentiaries, 2002–2004
- Table A.5: Treatment of HIV-positive inmates in Canadian federal penitentiaries, 2002–2004
- Appendix B: Hepatitis C (HCV)
- Table B.1: Hepatitis C virus (HCV) antibody testing among inmates in Canadian federal penitentiaries, 2002–2004
- Table B.2: Hepatitis C virus (HCV) antibody testing among women offenders in Canadian federal penitentiaries, 2002–2004
- Table B.3: Hepatitis C virus (HCV) antibody testing among male offenders in Canadian federal penitentiaries, 2002–2004
- Table B.4: Cumulative number of Hepatitis C virus (HCV) cases in Canadian Federal Penitentiaries, 2002–2004
- Table B.5: Treatment of HCV-positive inmates in Canadian federal penitentiaries, 2002–2004
- Appendix C: Hepatitis B (HBV)
- Appendix D: Sexually Transmitted Infections (STI)
- Appendix E: Tuberculosis Screening – Inmates
- Table E.1: Reported TST Results on Initial Assessment by Region – Inmates, 2002–2004
- Table E.2: BCG Vaccination Status by Origin and Region – Inmates, 2002–2004
- Table E.3: Reported TST Results on Ongoing Nonsignificant Assessment by Region – Inmates, 2002–2004
- Table E.4: LTBI by Age Group and Region – Inmates, 2002–2004
- Table E.5: LTBI by Origin and Region – Inmates, 2002–2004
- Table E.6: LTBI by Gender and Region – Inmates, 2002–2004
- Table E.7i: Reported Comorbidity / Risk Factors and Symptoms by TST Result – Inmates, 2002
- Table E.7ii: Reported Comorbidity / Risk Factors and Symptoms by TST Result – Inmates, 2003
- Table E.7iii: Reported Comorbidity / Risk Factors and Symptoms by TST Result – Inmates, 2004
- Appendix F: Tuberculosis Screening – Staff
- Table F.1: Reported TST Results on Initial Assessment by Region – Staff, 2002–2004
- Table F.2: BCG Vaccination Status by Origin and Region – Staff, 2002–2004
- Table F.3: Reported TST Results on Ongoing Nonsignificant Assessment by Region – Staff, 2002–2004
- Table F.4: LTBI by Age Group and Region – Staff, 2002–2004
- Table F.5: LTBI by Origin and Region – Staff, 2002–2004
- Table F.6: LTBI by Gender and Region – Staff, 2002–2004
- Table F.7i: Reported Comorbidity/Risk Factors and Symptoms by TST Result – Staff, 2002
- Table F.7ii: Reported Comorbidity/Risk Factors and Symptoms by TST Result – Staff, 2003
- Table F.7iii: Reported Comorbidity/Risk Factors and Symptoms by TST Result – Staff, 2004
- Appendix G: Methadone Maintenance Treatment
- Appendix H: Regional Infectious Disease Coordinators
- Appendix I: CSC Infectious Disease Surveillance Committee
- Appendix J: Inmate Populations 2002–2004
Appendices: Surveillance Data Tables
- Table I: Incarcerated Populations Under Surveillance, 2002–2004
- Table II: Total Number of HIV and HCV Tests Performed, CSC 2000–2004
- Table 1.1: New HIV Diagnosis Among New Admissions and General Population Inmates in Canadian Federal Penitentiaries 2000–2004
- Table 1.2: HIV Period Prevalence: Known Positive at Admission and Newly Diagnosed Cases, 2000–2004
- Table 1.3: HIV Frequency and Prevalence Rate Among New Admissions to Canadian Federal Penitentiaries, 2000–2004
- Table 1.4: HIV Treatment Initiation and Uptake, CSC Inmates, 2000–2004
- Table 1.5: Number of Known HIV Positive Inmates Released to the Community, CSC, 2000–2004
- Table 2.1: New HCV Diagnosis Among New Admissions and General Population Inmates, 1997–2004
- Table 2.2: HCV Period Prevalence: Known Positive at Admissions and Newly Diagnosed Cases, 2000–2004
- Table 2.3: HCV Frequency and Prevalence Rate Among New Admissions to Canadian Federal Penitentiaries, 2000–2004
- Table 2.4: HCV Treatment: Treatment Initiation and Uptake
- Table 2.5: Number of Known HCV Positive Inmates Released to the Community, CSC, 2000–2004
- Table 3.1: Reported Hepatitis B Infections among Inmates in Canadian Federal Penitentiaries, 2000–2004
- Table 4.1: Reported Frequency and Prevalence of Sexually Transmitted Infections in Canadian Federal Penitentiaries by Gender, 2000–2004
- Table 5.1: Participation in TB Screening, Inmates, 1998–2004
- Table 5.2: BCG Vaccination and Age at Vaccination at Initial Assessment, Inmates, 1998–2004
- Table 5.3: Newly Significant TST, Converters, and Conversion Rate, Inmates, 2002–2004
- Table 5.4: Number of Ongoing TST-Significant Assessments by Region, Inmates, 1998–2004
- Table 5.5: Average Monthly Number of Inmates on Therapy and LTBI Treatment Coverage by Region, 1999–2004
- Table 6.1: Participation in TB Screening, Staff, 1998–2004
- Table 6.2: BCG Vaccination and Age at Vaccination at Initial Assessment, Staff, 1998–2004
- Table 6.3: Newly Significant TST, Converters, and Conversion Rate, Staff, 2002–2004
- Table 6.4: Number of Ongoing TST-Significant Assessments by Region, Staff, 1998–2004
List of Figures
- Figure I: Administrative Regions in Correctional Service Canada
- Figure 1.1: Prevalence of HIV at Year-end 1989–2004 in Canadian Federal Penitentiaries
- Figure 1.2: Year-end Prevalence of HIV among Inmates by Gender, 2000–2004
- Figure 2.1: Prevalence of HCV at Year-end 1999–2004 in Canadian Federal Penitentiaries
- Figure 2.2: Year-end Prevalence of HCV by Gender, Inmates, 2000–2004
- Figure 3.1: Hepatitis A and B Vaccines Ordered by Region, Fiscal Year 2003–2004: Number of Inmates Immunized
- Figure 4.1: Syphilis Rates per 100,000 in Canada and CSC, 2000–2004
- Figure 5.1 – Selected Results: Initial Assessment, Inmates, 1998–2004
- Figure 5.2 – Selected Results: Ongoing Nonsignificant Assessment, Inmates, 1998–2004
- Figure 5.3: True Converters and TST Conversion Rate, Inmates, 1998–2004
- Figure 5.4: Latent Tuberculosis Infection by Region, Inmates, 1998–2004
- Figure 5.5: Latent Tuberculosis Infection by Origin, Inmates, 1998–2004
- Figure 5.6: Latent Tuberculosis Infection by Gender, Inmates, 1998–2004
- Figure 5.7: Active Tuberculosis Case Frequency and Rate, Inmates, 1998–2004
- Figure 5.8: Active TB in CSC vs Active TB in Canada by Origin, 1998–2004
- Figure 6.1: Selected Results: Initial Assessment, Staff, 1998–2004
- Figure 6.2: Selected Results: Ongoing Nonsignificant Assessment, Staff, 1998–2004
- Figure 6.3: True Converters and TST Conversion Rate, Staff, 1998–2004
- Figure 6.4: Latent Tuberculosis Infection among Staff by Region, 1998–2004
- Figure 6.5: Latent Tuberculosis Infection among Staff by Origin, 1998–2004
- Figure 6.6: Latent Tuberculosis Infection Among Staff by Gender, 1998–2004
- Figure 7.1: Average Monthly Number of Inmates on Methadone Maintenance Treatment by Region, CSC 2000–2003
Acknowledgements
Health Services Sector, Correctional Service of Canada
The production of this surveillance report would not have been possible without the collaboration of the Regional Infectious Disease Coordinators and Regional Directors of Health Services. They are responsible for the coordination and management of regional surveillance data. Special acknowledgement has to be made of the CSC nurses and Chiefs of Health Services within the federal penitentiaries across Canada for their efforts and commitment to surveillance data reporting.
Occupational Health and Safety Correctional Service of Canada
The national, regional, and institutional members of the occupational health and safety teams work to maintain the health of staff working in the institutions and in the regions, and are responsible for coordinating staff tuberculosis screening. In addition, OHS is responsible for training staff on infectious disease issues, a critical part of prevention and control of all communicable disease in Canadian penitentiaries.
Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada
This document was prepared with the assistance, advice, and support of staff at the Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada (PHAC). The increasing inter-departmental cooperation and collaboration between CSC and PHAC on a number of public health issues is a reflection of the importance of correctional health in the broader scope of public health in Canada.
Workplace Health and Public Safety Program, Health Canada
The collection of tuberculosis (TB) data among staff at CSC is but one component of the health service provided by Workplace Health and Public Safety Program (WHPSP) nurses. Coordinating the complex logistics of TB prevention and control for staff in federal penitentiaries is an essential function of a successful program.
Foreword
This report brings together surveillance data for 2002–2004 for a number of communicable diseases among inmates in Canadian federal penitentiaries. In this report, we not only have updated the data presented in the previously published report Infectious Diseases Prevention and Control in Canadian Federal Penitentiaries 2000-2001, but we have also included the data for 2002–2004 from our Tuberculosis Tracking System. Tuberculosis data were reported previously in 1998 and most recently in 2005 in the report Tuberculosis Prevention and Control in Canadian Federal Penitentiaries 1999-2001: Reported Results of the CSC Tuberculosis Tracking System.
Inmates are at increased risk of infectious diseases, including human immunodeficiency virus (HIV), hepatitis C (HCV), and tuberculosis (TB), due to the social and behavioural risk characteristics that define this population before they even enter the prison gates. Prevention and control of infectious diseases is thus a major objective of CSC Health Services. Reporting on case prevalence rates and examining trends over time is only one function of the program. Analyzing these data and using them to help guide and plan policies and programs and to evaluate prevention and control interventions are equally important.
The data presented in this report are the result of combined efforts of the front-line nursing staff, including the Chiefs of Health Services, the infectious disease nurses, staff nurses, and reception unit nurses working in the institutions. On a daily basis, these nurses are providing infectious disease screening, counselling, advice, teaching, and treatment. Similarly, occupational health nurses in the Workplace Health and Public Safety Program at Health Canada work with CSC Occupational Health and Safety staff to provide testing and screening data on tuberculosis for all of our staff.
We would like to recognize the collaboration between CSC and the Public Health Agency of Canada (PHAC) in producing this report. PHAC provided the technical and expert content that has made this report possible. Together, with all of our provincial, territorial, and federal colleagues, we are working to control the spread of infectious diseases among those incarcerated and those who work in our institutions.
Public Health Branch
Health Services Sector
Correctional Service of Canada
Foreword
This report is the result of significant collaboration between the Correctional Service of Canada (CSC) and the Public Health Agency of Canada (PHAC). Incarcerated persons in Canada represent an important population to include in the national efforts towards the prevention and control of infectious diseases in Canada.
The data presented in this report tell us many important things about infectious diseases including HIV, hepatitis, sexually transmitted infections, and tuberculosis. Inmate participation in screening allows infectious disease nurses in CSC to detect undiagnosed asymptomatic infections; trends in disease rates over time tell whether an infectious disease agent is becoming more or less prevalent; and treatment uptake and outcome are important pieces of an overall infectious disease strategy aimed at reducing and preventing the spread of disease.
This report is also a means of disseminating the results of data analysis to CSC nurses and health care staff who do the front-line work with inmates, and to other public health stakeholders in Canada. Just as important as collecting these surveillance data to answer questions about “who”, “when”, and “where” people are getting infected with infectious diseases, analyzing and interpreting these data are essential to complete the cycle of surveillance and help guide CSC program and policies to reduce disease transmission and provide improved care within Canadian federal penitentiaries.
The Public Health Agency of Canada is committed to providing technical assistance to Correctional Service Canada, and to all of our federal, provincial, and territorial partners.
Jonathan M. Smith, BA, Hon. BSc, MSc Epidemiologist, CSC Health Services National Infectious Disease Program (Seconded from Community Acquired Infections Division Centre for Infectious Disease Prevention and Control)
Dr. Tom Wong, MD, MPH, FRCPC Director, Community Acquired Infections Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada
Dr. Chris Archibald, MDCM, MHSc, FRCPC Director, Surveillance and Risk Assessment Division Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada
Dr. Rob Stirling, MD, MSc, MHSc, FRCPC Medical Specialist, Tuberculosis Prevention and Control Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada
Executive Summary
In 2003, Correctional Service Canada (CSC) and the Public Health Agency of Canada (PHAC) signed a Memorandum of Understanding (MOU) in order to enhance the interdepartmental collaboration on infectious disease prevention and control. This agreement includes the provision of epidemiological and data management services including surveillance. Two separate technical systems were in place between 2002 and 2004 to capture surveillance data – the CSC Infectious Disease Surveillance System (IDSS), an aggregate register of monthly tests and diagnoses of human immunodeficiency virus (HIV), hepatitis C (HCV), hepatitis B (HBV) and sexually transmitted infections (STI) reported by the 55 participating institutions (see Appendix J); and the CSC Tuberculosis Tracking System (TBTS) for tuberculosis (TB) screening among both inmates and staff.
This report presents the combined surveillance data for 2002–2004 on selected infectious diseases for CSC. This builds on published surveillance results for 2000–2001 (CSC, 2003), and on reports on tuberculosis for 1998 (CSC, 2001) and 1999–2001 (CSC, 2005). This is the first report combining the surveillance data for bloodborne and sexually transmitted infections, including HIV, HCV, HBV, Chlamydia, gonnoroea, syphilis and TB testing among both inmates and staff.
Results
The point-prevalence estimate for HIV infection was 2.04% in 2002, 1.92% in 2003, and 1.43% in 2004. The number of known HIV positive inmates released to the community was 235 in 2004. The point-prevalence (see glossary) estimate for HCV infection was 25.8% in 2002, 26.8% in 2003, and 25.2% in 2004 (although the total number of HCV positive inmates increased slightly in 2004). The number of known HCV positive inmates released to the community was 2,472 in 2004. Women had higher rates of both HIV and HCV infection; in 2004 the rates for women vs men were 3.44% vs 1.37% for HIV and 37.4% vs 24.8% for HCV.
In Canada, the rates of bacterial STI have been increasing dramatically in the last 5 years (PHAC, 2006a). The number of syphilis cases in CSC was zero in 2000 and in 2001, compared to 10 in 2004, corresponding to a rate of 71.1 cases per 100,000 – a rate 10 times that in the general population in Canada. Similar increases in overall reported rates were observed for gonorrhoea and chlamydia.
The number of incident tuberculosis cases reported in CSC varied from 0 – 6 between 1998 and 2004 with 4 cases in 2004. This represents an active TB case rate of 22.8 cases per 100,000, 5 times higher than that in the general population in Canada (PHAC, 2006b). The rate of latent tuberculosis infection (LTBI) among inmates was 16.7% in 2004. Overall, LTBI rates by origin were consistent with reported population- specific rates for sub-populations in Canada (Yuan, 2005). The estimated TST conversion rate among inmates for 2002–2004 was 1.51%, 1.35%, and 0.84% respectively. Among staff, the observed LTBI rate was 8.2% in 2004; the estimated TST conversion rates among staff for 2002-2004 were 0.28%, 0.45%, and 0.68% respectively. Together, these data are indicative of ongoing transmission of TB between inmates (and staff) and the potential for further transmission should converters develop active disease.
An electronic, integrated infectious disease application was developed in 2004. This application, ‘Web-IDSS’, replaces the legacy system, the Tuberculosis Tracking System (TBTS) for tuberculosis, and allows the data entry of forms introduced in calendar year 2005 for HIV/AIDS, STI, and hepatitis. Most tuberculosis surveillance data for inmates for 2002–2004 were entered into TBTS and migrated to the new system; however, the majority of the staff data were entered into Web-IDSS. Note that the surveillance data for HIV/AIDS, HCV, HBV and STI included in this report are drawn in entirety from the aggregate CSC IDSS.
Future Directions
In order to be of maximum benefit, surveillance data need to be reported to stakeholders in a timely fashion. Following this report, CSC will begin a process to report routine infectious disease surveillance data on an annual basis starting with the calendar year 2005. Routine evaluation of surveillance data will provide information to keep health education programs current by providing up to date information and trends. Disease prevention strategies and treatment guidelines need to be planned, implemented, and evaluated for the correctional setting. Comprehensive surveillance data with a good baseline and trend measures will assist in evaluating interventions. CSC is committed to working with other pan-Canadian stakeholders in improving the public health in all of our communities in Canada.
