Prisons show prophylaxis for close contacts may indeed help in next flu pandemic

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7458.173-c (Published 15 July 2004) Cite this as: BMJ 2004;329:173
  1. Niyi Awofeso (niyiawofeso{at}hotmail.com), conjoint associate professor of public health
  1. University of New South Wales, Sydney, Australia, Population Health Unit, NSW Corrections Health Service, PO Box 150, NSW 2036, Australia

    EDITOR—Balicer et al's editorial on tackling the next influenza pandemic highlights the potential of chemoprophylaxis of close contacts in managing community based influenza pandemics.1 One setting in which such a strategy shows promise is prisons.

    The influenza epidemic in San Quentin prison in April and May 1918, which presumably struck 26% of the 1900 prisoners, is thought to be one of the primary foci of the 1918-20 pandemic.2 Documented outbreaks of flu in prisons have been rare since then.3 However, our modelling studies and the limited experience with managing such a prison outbreak indicate that quarantining clinically ill inmates in their cells or a health facility and giving antiviral prophylaxis to inmates and frontline staff in the same “wing” of the prison in which the outbreak occurred provide a more favourable cost benefit than annual mass vaccination, or a “do nothing” approach.3

    In estimating such cost benefits, we took into consideration the rarity of influenza outbreaks in prisons (which means “wasteful” vaccination in the non-epidemic years), the high costs of maintaining prisoners' security in off site settings, the relative “worthlessness” of prisoners vis à vis economic valuations of epidemics,4 and the probably very low mortality among inmates because of average younger age.

    While the World Health Organization has developed formal strategies for managing diseases such as tuberculosis in prisons, currently no formal WHO endorsed guidelines exist for influenza. This issue requires urgent attention.


    • Competing interests None declared.


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