Corrections_Today_November_December_2019

Health Care Special Session & Luncheon

from 1-3.7%, than the general population, reflect- ing an overrepresentation of persons entering correctional facilities with risks for HBV infec- tion. According to the Advisory Committee on Immunization Practices (ACIP), these persons are at risk for receiving the virus, and should be given the vaccination: –– Persons at risk by sexual exposure. –– Persons at risk of infection by percutaneous/ mucosal exposure to blood, including cur- rent or recent injection drug users, household contacts of HBV-infected persons, residents and staff of facilities for developmentally dis- abled persons, health care and public safety workers and persons with diabetes or end- stage renal disease. Dr. Nelson stated that a new HBV vaccine for adults, Heplisav-B, is currently in use and is a two-dose vaccine given one month apart, which is quicker than the traditional three-dose vac- cine series given over six months. In correctional facilities, chronic HBV is more prevalent among inmates than among the general population. All adults in jails and prisons are assumed to be at risk for infection, Dr. Nelson stated, and should be of- fered the vaccination. Hepatitis C Lastly, Dr. Nelson covered hepatitis C, which has become emergent in correctional facilities.

The number of cases nationwide has increased dramatically from 2005, going from 0.3 per 100,000 cases to one per 100,000 in 2017, ac- cording to the CDC. In correctional facilities, HCV prevalence varies by state and region, how- ever according to Dr. Nelson, approximately 30% of all persons with an HCV infection in the U.S. spend at least part of the year in a correctional in- stitution, and most are unaware. In the U.S., only 56% of infected persons are aware that they have the HCV infection, which spotlights a drastic need for education and testing for those who are at risk. Injection drug use is the most common risk factor for HCV transmission for correctional populations, and it is mostly those aged between 20-50 who are the most affected. Dr. Nelson stated that given the high prevalence of the HCV infection in correctional settings, coupled with the fact that more than 10 million individu- als pass through jails and prisons each year, as many as one million persons with undiagnosed HCV infection might come into contact with the correctional system each year. Prevention and control of these infections are paramount, and in 2018, the American Association for the Study of Liver Disease released recommendations for screening and treatment of HCV infections in jails and prisons. Among the recommendations were implementing opt-out testing for HCV, antiviral therapy and treatment for those who are infected, and facilitating the continuation of HCV therapy upon release. The Federal Bureau of

149 th Congress of Correction

44 — November/December 2019 Corrections Today