Family Practice Vol. 16, No. 4, 366-368
© Oxford University Press 1999
Is there room for general practice in penitentiary institutions: screening and vaccinating high-risk groups against hepatitis
a Clinic of Social and Family Medicine, Medical School, University of Crete, 71 409 Heraklion, Crete,
b Hospital-Health Center of Neapolis, Lassithi, Crete, Greece,
c Department of Medicine and Care, Faculty of Health Sciences, University of Linkoping, S-581 85 Linkoping, Sweden and
d Laboratory of Biostatistics, Medical School, University of Crete, 71 409 Heraklion, Crete, Greece.
Dr C Lionis, Clinic of Social and Family Medicine, University of Heraklion, P.O. Box 1393, Heraklion, Crete, Greece.
Chatziarsenis M, Miyakis S, Faresjo T, Trell E, Vlachonikolis J and Lionis C. Is there room for general practice in penitentiary institutions: screening and vaccinating high-risk groups against hepatitis. Family Practice 1999; 16: 366–368.
Received 16 July 1998; Revised 11 December 1998; Accepted 29 March 1999.
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Abstract |
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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.
Keywords. Family medicine, Greece, hepatitis B and C, prisoners, vaccination..
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Introduction |
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The use of applied epidemiology to assess and improve the health of the population, and to identify the main determinants of health in defined areas, is a basic element of the approach known in the literature as Community-Oriented Primary Health Care (COPC). An agreement between the Hospital-Health Centre of Neapolis (HHCN) on Crete, Greece and the Department of Social Medicine, University of Crete was made with the purpose to develop further Primary Health Care and COPC in this district. The needs assessment of the population under the responsibility of the HHCN constituted the first step in the identification of the population health problems and health planning.1
In the catchment area of HHCN there exists a small penal institution which serves as ‘holding place’ for those awaiting trial. Prisoners and staff in this institution could be considered at high risk of contracting hepatitis B and C. It should be noted that immunization for hepatitis B has been included in the infant schedule in Greece since 1997, and hepatitis C screening in blood transfusion centers was introduced since 1991. There are no special health services in distant prison institutions such as Neapolis, making family practice involvement even more important. Thus it was of interest to assess the prevalence of hepatitis B and C markers among inmates and staff of Neapolis Penitentiary as well as to discuss the role of GPs in such a screening and immunization programme.
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Subjects and method |
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The survey was carried out at the Neapolis Penitentiary House. A consensus with the Ministry of Justice was ensured and all subjects imprisoned from August 1996 until February 1997 were invited to participate after being informed of the survey's scope. All of the inmates (95 subjects) responded to the invitation, but only 45 (8 females and 37 males) eventually participated in the study, as the remainder were transported from the institution during the study period. All of the prison staff (20 subjects, two of whom were women) agreed to participate. An epidemiological form was completed by every participant which included socio-demographic data, health-risk behaviours and medical history.
A serum sample of 20 cc was tested for hepatitis B and C markers by Microparticle Capture Enzyme Immunoassay (MEIA, kits from Abbott Laboratories) at the Agios Nikolaos Hospital, specifically HBsAg (hepatitis B surface antigen), anti-HBc (hepatitis B core antibody) and anti-HCV (hepatitis C antibody). The vaccines against hepatitis B were administered to all susceptible subjects.
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Results |
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Six of the inmates (13.3%) and four of the house personnel (20%) were found to be positive for HBsAg (Table 1
). One of the prisoner carriers was an intravenous drug abuser and another had undergone a blood transfusion, while two had experienced at least one surgical operation. Among seropositive workers, no one gave a history of using injected drugs, however, three had received blood transfusions. The presence of anti-HBc was detected in 23.1% of subjects examined. Six of the house workers were found to be positive for anti-HBc.
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Antibodies to HCV were found in seven inmates (15.5%), two of them female. Five out of the seven seropositive inmates were injecting drugs, while two had undergone blood transfusion and four surgical operations. One HCV seropositive case (female) was identified among the house workers.
Thirty-four inmates were found to be susceptible for hepatitis B, and vaccination was introduced in 15. In 11 cases of the total susceptible inmates (32.4%), vaccination were completed. Among the institution's staff, 12 subjects were found to be at risk of HBV infection and 11 of these were fully vaccinated during the study period. None of the differences between seropositive prisoners and staff in any of the hepatitis markers studied was statistically significant.
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Discussion |
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Seropositivity to HBsAg in prisoners was found to be considerably higher in our study in comparison with the general population in Crete2 and with data reported in other studies.3,4 The prevalence of HBsAg was found to be high in the house staff too, higher than that reported in an Italian study (6.6%).4 Our findings on hepatitis B carriage support further that prisons should be regarded as high-risk areas for HBV infection, both for prisoners and personnel.
With regard to hepatitis C, eight subjects were found positive to anti-HCV (12.3% of the participants), a rate that was found to be higher than that of the general population.2 This rate probably underestimates the precise number of infected inmates, since measure of HCV-RNA, using the PCR method has not been performed. Our study results on anti-HCV are in accordance with those reported in an Italian study5 but lower than those reported elsewhere.6 Differences are probably due to abnormally high levels of risk behaviour by inmates, especially in the use of injected drugs. In our study, five out of the inmates positive for anti-HCV were drug abusers. The underreporting of intravenous drugs can not be excluded.
Inmates of long-term correctional facilities are included among high-risk persons in which hepatitis B vaccine is recommended.7 Thirty-four inmates (75.5%) and 12 workers (60%) were found to be at risk for hepatitis B. Only two of the house workers were vaccinated against hepatitis B before our intervention. High rates (91.7%) of complete vaccination have been achieved for house staff during the study period, while only 32.4% of inmates were fully vaccinated. This can be explained by the short interval for which inmates were imprisoned.
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Acknowledgments |
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We would like to thank the medical doctors E Kokkini, M Matheaki, E Makri and I Giotaki for their assistance with this research project.
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References |
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1 Chatziarsenis M, Lionis C, Faresjo T, Fioretos M, Trell E. Community-based systems advancement in a hospital-primary health centre in Crete, Greece: concepts, methods, and the new role of the general practitioner. J Med Systems 1998; 22: 173–188.[Medline]
2 Lionis C, Koulentaki M, Biziagos E, Kouroumalis E. Current prevalence of hepatitis A, B and C in a well-defined area in rural Crete, Greece. J Viral Hepat 1997; 4: 55–61.
3 Butler TG, Dolan KA, Ferson MJ, McGuiness LM, Brown PR, Robertson PW. Hepatitis B and C in New South Wales prisons: prevalence and risk factors. Med J Aust 1997; 166: 127–130.[ISI][Medline]
4 Chiaramonte M, Trivello R, Renzulli G et al. Hepatitis B virus infection in prisons. A seroepidemiological survey in prisoners and attending staff. J Hyg (Lond) 1982; 89: 53–58.[Medline]
5 De Mercato R, Cantiello JP, Celentano U et al. Hepatitis C virus in prisoners. Minerva Med 1995; 86: 89–91.[Medline]
6 Holsen DS, Harthug S, Myrmel H. Prevalence of antibodies to hepatitis C virus and association with intravenous drug abuse and tattooing in a national prison in Norway. Eur J Clin Microbiol Infect Dis 1993; 12: 673–676.[ISI][Medline]
7 Zimmerman RK, Ruben FL, Ahwesh ER. Hepatitis B Virus Infection, Hepatitis B Vaccine, and Hepatitis B Immune Globulin. J Fam Pract 1997; 45: 295–316.[ISI][Medline]
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