The Role of Vaccination in Prisoners' Health
Access to prisoners is simple. This should ensure that high vaccination coverages are easy to reach and satisfactory results easy to obtain.
The three reasons referred to above explain the importance of vaccination programs in prisons. However, the precarious structural and logistical conditions of prisons in some countries, which are associated with overpopulation, overcrowding, poor ventilation of cells, poor sanitation and hygiene, poor food quality and so on, are additional risk factors that should be considered per se as additional risk factors for the transmission of vaccine-preventable diseases.
Likewise, prisons often contain a substantial proportion of prisoners with chronic diseases (whether infectious or not) and of people aged 65 years or more. In these groups, specific vaccination programs are necessary, just as in the general population.
In prisons, vaccines are administered for various purposes or objectives. The most common is systematic vaccination, either as primary vaccination, as a booster dose or as postexposure treatment (e.g., booster doses of tetanus and diphtheria vaccine in adults or primary hepatitis B vaccination). In recent years, the prison population has undergone demographic changes that mirror those of the general population, such as the increase in the number of immigrants in prisons in Europe and the USA. This has resulted in the need to access and vaccinate a population coming from countries where vaccination coverage is poor or where there is little data, making catch-up or rescue vaccination strategies necessary to prevent outbreaks within prisons, as has been described for measles, mumps or chickenpox in several countries with high immigrant populations.
In addition to ensuring the completion of the recommended adult immunization schedule in prisoners, vaccinations that may be associated with the intrinsic epidemiological risk of each individual prison must be identified and then administered. This helps improve disease prevention, not only among prisoners but also among prison workers and, secondarily, their families and the wider community. Vaccination programs in prisons are therefore essential to achieve population-based health objectives, without ignoring other, more basic interventions that help to reduce the spread of infections and improve the quality of life in prisons, such as the quality of prison sanitation, drainage, ventilation or food, combined with programs to facilitate easy access to syringes or condoms, for example.
In the UK, one of the indicators of quality care in prisons is that 80% of all prisoners be immunized against hepatitis B in the first 30 days after incarceration. It is debatable whether offering immunization immediately after incarceration is the most appropriate strategy, when the mood and psychological state of a newly incarcerated prisoner is considered. This strategy could be a barrier to adherence to the recommended vaccination schedule and result in noncompletion. Prisoners may be less likely to reject vaccination if this is offered actively and continuously some time after incarceration, when the inmate's attitude may be more responsive and the environment may seem less alien. Therefore, ideally, the vaccination of prisoners should be seen as something that is not applied automatically, but rather is linked to ethical concerns and respect for the individual.
Given all this, the dynamic and constantly changing group of people who reside and work in prisons should be taken into account in the immunization programs of countries, regions and cities. Although immunization in prison may be designed as a strategy of preventive interventions focused on high-risk groups, this opportunity, which may be the only way that these persons can easily access the health system, should be based on a policy of permanent access to vaccination that is actively pursued. Completion of the recommended adult vaccination schedule should be the first priority, followed by vaccinations associated with the intrinsic risk posed by prison life and each individual prison. Such a policy makes it easier to prevent disease transmission in prisoners, prison staff, families and the wider community, and provides benefits for the health system in general and is also cost-effective. Therefore, it is essential to seek systematic, consensual guidelines for specific programs of vaccination and their management in prisons. These should not merely be independently applied actions but rather measures integrated and spelt-out in national or regional public health plans for the control of vaccine-preventable diseases.
Easily Accessible Population Susceptible to Vaccination
Access to prisoners is simple. This should ensure that high vaccination coverages are easy to reach and satisfactory results easy to obtain.
The three reasons referred to above explain the importance of vaccination programs in prisons. However, the precarious structural and logistical conditions of prisons in some countries, which are associated with overpopulation, overcrowding, poor ventilation of cells, poor sanitation and hygiene, poor food quality and so on, are additional risk factors that should be considered per se as additional risk factors for the transmission of vaccine-preventable diseases.
Likewise, prisons often contain a substantial proportion of prisoners with chronic diseases (whether infectious or not) and of people aged 65 years or more. In these groups, specific vaccination programs are necessary, just as in the general population.
In prisons, vaccines are administered for various purposes or objectives. The most common is systematic vaccination, either as primary vaccination, as a booster dose or as postexposure treatment (e.g., booster doses of tetanus and diphtheria vaccine in adults or primary hepatitis B vaccination). In recent years, the prison population has undergone demographic changes that mirror those of the general population, such as the increase in the number of immigrants in prisons in Europe and the USA. This has resulted in the need to access and vaccinate a population coming from countries where vaccination coverage is poor or where there is little data, making catch-up or rescue vaccination strategies necessary to prevent outbreaks within prisons, as has been described for measles, mumps or chickenpox in several countries with high immigrant populations.
In addition to ensuring the completion of the recommended adult immunization schedule in prisoners, vaccinations that may be associated with the intrinsic epidemiological risk of each individual prison must be identified and then administered. This helps improve disease prevention, not only among prisoners but also among prison workers and, secondarily, their families and the wider community. Vaccination programs in prisons are therefore essential to achieve population-based health objectives, without ignoring other, more basic interventions that help to reduce the spread of infections and improve the quality of life in prisons, such as the quality of prison sanitation, drainage, ventilation or food, combined with programs to facilitate easy access to syringes or condoms, for example.
In the UK, one of the indicators of quality care in prisons is that 80% of all prisoners be immunized against hepatitis B in the first 30 days after incarceration. It is debatable whether offering immunization immediately after incarceration is the most appropriate strategy, when the mood and psychological state of a newly incarcerated prisoner is considered. This strategy could be a barrier to adherence to the recommended vaccination schedule and result in noncompletion. Prisoners may be less likely to reject vaccination if this is offered actively and continuously some time after incarceration, when the inmate's attitude may be more responsive and the environment may seem less alien. Therefore, ideally, the vaccination of prisoners should be seen as something that is not applied automatically, but rather is linked to ethical concerns and respect for the individual.
Given all this, the dynamic and constantly changing group of people who reside and work in prisons should be taken into account in the immunization programs of countries, regions and cities. Although immunization in prison may be designed as a strategy of preventive interventions focused on high-risk groups, this opportunity, which may be the only way that these persons can easily access the health system, should be based on a policy of permanent access to vaccination that is actively pursued. Completion of the recommended adult vaccination schedule should be the first priority, followed by vaccinations associated with the intrinsic risk posed by prison life and each individual prison. Such a policy makes it easier to prevent disease transmission in prisoners, prison staff, families and the wider community, and provides benefits for the health system in general and is also cost-effective. Therefore, it is essential to seek systematic, consensual guidelines for specific programs of vaccination and their management in prisons. These should not merely be independently applied actions but rather measures integrated and spelt-out in national or regional public health plans for the control of vaccine-preventable diseases.
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