Three quarters of one French prison population needed immunisation against hepatitis BBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7099.61 (Published 05 July 1997) Cite this as: BMJ 1997;315:61
- a INSERM U 379-ORS PACA, 13006 Marseilles, France
- b Centres for Free and Anonymous Screening, Conseil Général des Bouches du Rhone, 13008 Marseilles
- c Department of Hepatogastroenterology, Hôpital Saint Joseph, 13008 Marseilles
See pp 18, 21, 30, 65
Editor—From March to December 1995, 411 prisoners sent to Marseilles prison were invited to participate in a programme of vaccination against hepatitis B. A face to face questionnaire was administered by a doctor. In agreement with a previous study,1 injecting and sexual risk behaviours during the past 12 months were reported frequently by the 391 prisoners (95%) who participated in the study: 164 reported having had more than one sexual partner, 40/308 reported having had at least one injecting drug user as a sexual partner (especially women, 20/88); four declared that they had had homosexual intercourse; and 71 reported injecting drug use (89 over their lifetime)—of these, 19 reported sharing syringes and 27 reported sharing paraphernalia during the past 12 months. The 391 inmates were screened for hepatitis B surface antigen and antibody to hepatitis B core antigen. Five (1%) and 110 (28%) positive results, respectively, were obtained—that is, five times the rate in the French general population.2 Among injector inmates, three were positive for hepatitis B surface antigen on screening and 50 for antibodies to hepatitis B core antigen; 17 were positive for antibodies to hepatitis B core antigen but negative for antibody to hepatitis B surface antigen (<10 U/l).
Altogether 292 inmates were negative for antibody to hepatitis B surface antigen and were offered hepatitis B vaccination; 252 agreed to be vaccinated. However, only 175 received the three doses (at days 0, 30, and 60): 70 were discharged or transferred to another prison, 33 refused immediately, and 14 refused the second or third dose. The refusal rate was higher among injector inmates (25/89 (28%); 95% confidence interval 19% to 39%) than among non-injectors (42/302 (14%); 10% to 18%; P=0.04). Among the 89 injector inmates eight reported a previous vaccination against hepatitis B but two had actually been immunised. Shorter schedules (days 0, 7, and 30 or days 0, 30, and 180) could be useful, but their efficiency has not been shown in populations with high proportions of men (95%), smokers (80%), injecting drug users (20%), and people with coinfections (with HIV, hepatitis C virus, and tuberculosis).3 4 5
Validation studies of short immunisation schedules in populations at risk should be carried out before new immunisation strategies are implemented in prisons. These data emphasise that the prevalence of serological markers of hepatitis B virus infection and sexual and injecting risk behaviours among prisoners remains high. They also show that hepatitis B vaccination programmes are feasible in prisons and accepted by inmates.