High Risk of Acquiring Vaccine-Preventable Diseases
The prison population is mainly composed of young men from the lower social classes with low educational levels, family problems, poor work records and low use of health services. More than a third of prisoners remain sexually active in prison, mostly without protection. In surveys in Welsh prisons, the proportion of men having sex with men was 14%, of whom 20% only carried out this type of activity while in prison. More than half the prison inmates in the UK have a tattoo and 11% were tattooed during their imprisonment, generally using homemade, shared implements. The prevalence of illicit drug use in prisons, according to self-reports, ranges between 22 and 48% around the world. Injecting drug use is between 6 and 26%, of whom 25% began injecting while in prison.
The aforementioned risk factors entail a much higher prevalence of viral hepatitis among prisoners than in the general population. For example, the mean seroprevalence of hepatitis B is four- to five-times higher in prisoners than in the reference general population. In the USA, 40% of chronic viral hepatitis carriers were once imprisoned.
With respect to the prevention of the complications of chronic infectious diseases in prisons, one study found that the seroprevalence of HCV infection in Western European prisoners is approximately 25%, a figure that reaches 40% in some US states. In addition, some studies suggest that 25% of HIV-infected individuals are former prisoners and that in most prisons the rates of HIV and TB infection are systematically higher than those of the general population. In all of these cases, routine influenza, viral hepatitis or conjugate pneumococcal vaccination could prevent serious complications among carriers of these diseases.