Corrections_Today_November_December_2019

Hepatitis A Dr. Nelson started her lecture with the hepati- tis A infection, which was first reported in 1966. Reported cases of HAV dropped dramatically after its discovery due to improvement in hygiene and in water supplies. The HAV vaccine was intro- duced in 1996, further dropping the reported rate of infections until 2011, when cases involving adults started to increase. Dr. Nelson informed the crowd that persons in the age range of 20-59 are the most affected, with 20-29-year-old persons twice as likely to be infected. In total, the HAV outbreak is in more than 25 states, with 22,295 total cases, 13,184 hospitalizations (60% of those infected are hospitalized) and 216 deaths, ac- cording to the CDC. Many factors go into the reported deaths of those with HAV, including poor underlying health conditions and the severity of the infection increasing with age. Co-infections with HBV and HCV are also contributing fac- tors to consider. Many of the cases driving this outbreak are people who use drugs or experience homelessness, due to person-to-person contact, overcrowding and poor hygiene. Dr. Nelson then explained how hepatitis infections can spread in correctional facilities due to the representa- tion of those populations in correctional facilities combined with the before-mentioned factors. Information concerning HAV cases in correctional facilities are limited, however, Dr. Nelson pro- vided the number of cases in Michigan (66), Utah (40) and Indiana (278), which accounted for 8%, 14.2% and 15.2% of

vaccination programs have played a major role in limited HAV transmission inside correctional facilities and mitigating community-wide out- breaks in the United States, the United Kingdom and Australia. The HAV vaccine is given in a two-dose series, given six months apart. According to the CDC, the following groups are the most at-risk for HAV, and should be offered the vaccination: 1. People who use drugs (injection or non-injection). 2. People experiencing homelessness. 3. Men who have sex with men. 4. People who are, or were recently, incarcerated. 5. People with chronic liver disease, includ- ing cirrhosis, HBV or HCV. Dr. Nelson then noted that one dose of the vac- cine is known to provide protection for 11 years or longer, and that one dose is all that is needed to stop an outbreak. Hepatitis B For the hepatitis B virus, the rate of reported acute viral cases have been steady since 2009 with about one case per 100,000. The age group most affected by the virus are within 30-59 years of age. According to Dr. Nelson, the prevalence of chronic HBV infection in correctional facilities has been higher among prison inmates, ranging

total cases, respectively. Ongoing drug use and shared hygiene facilities can increase hepatitis A transmission. A way to combat this is to offer HAV vaccines in correc- tional facilities. This is an effective approach to reach high-risk individu- als who are difficult to reach in the community, and corrections-based

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