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National Commission on Correctional Health Care



National Commission on Correctional Health Care
1300 W. Belmont Ave. 
Chicago, IL 60657 
Phone (773) 880-1460  |  Fax (773) 880-2424 
E-mail:   http://www.ncchc.org  
 

Poor Health Status of Prison Inmates A Threat To Public Health 

NCCHC Calls for Better Correctional Health Care to Improve Community Health 

SAN ANTONIO, Jan. 28 /PRNewswire/ -- 

Inadequate health care in U.S. correctional facilities poses a serious threat to the nation's public health, announced the National Commission on Correctional Health Care (NCCHC) today at this year's National Hepatitis Coordinators' Conference, calling for improved health care delivery and access in the corrections system. 

The findings are part of a landmark report commissioned by Congress to assess the health status of prison inmates, which concluded that serious diseases affecting inmates, such as hepatitis, if left undiagnosed and untreated, can be easily transmitted to the thousands of daily visitors, the half million correctional employees, other inmates, and members of the larger community once infected inmates are released. 

"Prisons and jails offer uniquely important opportunities for improving  disease control in the community by providing health care and disease prevention programs to a large and concentrated population of individuals at high risk for disease," noted Robert B. Greifinger, M.D., co-author of the report. "We are confident that if all state correctional facilities implement certain improvements in the delivery of health care, such as instituting vaccination programs to prevent hepatitis and other communicable diseases, it will have a profound effect on theoverall public health." 

The NCCHC recommends that correctional facilities conduct surveillance of communicable and chronic diseases and mental illness. 

Prisons and jails should follow nationally accepted clinical guidelines for preventing, diagnosing, and treating diseases among inmates. They should link with programs that support continuity of care on release to reduce costs and limit the transmission of disease in the community. Moreover, in order to protect prison inmates and the public from vaccine-preventable communicable diseases, such as hepatitis A and B, the NCCHC calls for a federally funded national vaccine program in corrections facilities. 

A Closer Look at "The Health Status of Soon-to-be-Released Inmates" 

With more than 11.5 million inmates released in 1998 alone, Congress instructed the U.S. Department of Justice to determine whether existing concerns that ex-offenders may be contributing to the spread of communicable disease in the community was well founded. The resulting study, which was conducted under a cooperative agreement between the National Institute of Justice (NIJ), the research and evaluation arm of the U.S. Department of Justice, and the NCCHC, revealed disturbing findings: 

* A significant proportion of prisons and jails do not adhere to the recommendations of the Centers for Disease Control and Prevention (CDC) with regard to screening for communicable diseases and most systems do not follow nationally accepted guidelines for chronic disease and mental illness. 

Despite the 1982 recommendations of the CDC's Advisory Committee on Immunization Practices to vaccinate all long-term inmates against hepatitis B, few state systems have implemented vaccination programs. As a result, in 1996 alone, more than 155,000 prison inmates with current or chronic hepatitis B were released into the community. 

* Many correctional agencies are not doing enough to address communicable disease, chronic disease, and mental illness.  Despite the fact that the prevalence of AIDS is five times greater in jails and prisons than in the U.S. population, few systems have implemented comprehensive HIV prevention programs. 

On average, less than one quarter of jail inmates undergo routine laboratory testing for syphilis while incarcerated. In some jails, only 2 to 7 percent of inmates are actually tested. 

More than 90 percent of State and Federal prisons, and about half of jails, routinely screen at intake for latent TB infection and active TB disease. However, particularly in jails, many inmates are released before skin tests can be read. Most prisons and jails report they isolate inmates with suspected or confirmed TB disease in negative pressure rooms. However, some facilities do not test the rooms to ensure that the air exchange is working properly or continue to use the rooms even when the air exchange is known to be out of order. 

* Less than half of the state departments of corrections surveyed reported having surveillance data on the number of inmates with chronic diseases. 

The NCCHC estimates that the prevalence of asthma among Federal, State, and local inmates to be between 8 and 9 percent, for a total that exceeds 140,000 cases nationwide, making the prevalence rates for asthma higher among inmates than in the total U.S. population. 

The prevalence of diabetes is estimated to be about 5 percent, for a total of nearly 74,000 inmates with diabetes. 

Over 18 percent of inmates are estimated to have hypertension, or a total of over 283,000 inmates. 

* Prevalence of mental illness is significant among incarcerated persons. 

An estimated one percent of offenders booked into jails have schizophrenia or other psychotic disorders; about 8 to 15 percent have major depression 

An estimated 2 to 4 percent of inmates in State prisons have schizophrenia or other psychotic disorders, over 18 percent have major depression and between 22 and 30 percent have an anxiety disorder. 

* A significant proportion of prisons and jails neither measure nor adhere to national standards for access and quality care. 

Only 24 state correctional systems reported they had protocols for diabetes, 25 for hypertension, and 26 for asthma. A content analysis revealed that many of these "guidelines" were incomplete or out-of-date. 

In addition, 40 percent of jails and 17 percent of prisons do not provide recommended mental health evaluations. 

Approximately 58 percent of jails do not provideychiatric medications, 57 percent do not have crisis intervention services, and 28 percent of jails do not have access to inpatient hospitalization. 

About NCCHC 

The NCCHC is a not-for-profit, 501 (c)(3) organization committed to improving the quality of care in our nation's jails, prisons, and juvenile detention and confinement facilities. The Commission is supported by 36 national organizations representing the fields of health, law, and corrections. 

For more information regarding the NCCHC or the hNational Commission on Correctional Health Care 
1300 W. Belmont Ave. 
Chicago, IL 60657 
Phone (773) 880-1460  |  Fax (773) 880-2424 
E-mail  ncchc@ncchc.org  
 

Poor Health Status of Prison Inmates A Threat To Public Health 

NCCHC Calls for Better Correctional Health Care to Improve Community Health 

SAN ANTONIO, Jan. 28 /PRNewswire/ -- Inadequate health care in U.S. correctional facilities poses a serious threat to the nation's public health, announced the National Commission on Correctional Health Care (NCCHC) today at this year's National Hepatitis Coordinators' Conference, calling for improved health care delivery and access in the corrections system. 

The findings are part of a landmark report commissioned by Congress to assess the health status of prison inmates, which concluded that serious diseases affecting inmates, such as hepatitis, if left undiagnosed and untreated, can be easily transmitted to the thousands of  daily visitors, the half million correctional employees, other inmates, and members of the larger community once infected inmates are released. 

"Prisons and jails offer uniquely important opportunities for improving  disease control in the community by providing health care and disease  prevention programs to a large and concentrated population of individuals at  high risk for disease," noted Robert B. Greifinger,M.D., co-author of the report. "We are confident that if all state correctional facilities  implement certain improvements in the delivery of health care, such as  instituting vaccination programs to prevent hepatitis and other communicable diseases, it will have a profound effect on theoverall public health." 

The NCCHC recommends that correctional facilities conduct surveillance of communicable and chronic diseases and mental illness. 

Prisons and jails should follow nationally accepted clinical guidelines or preventing, diagnosing, and treating diseases among inmates. They should link with programs that support continuity of care on release to reduce costs and limit 

the transmission of disease in the community. Moreover, in order to protect prison inmates and the public from vaccine-preventable communicable diseases,  such as hepatitis A and B, the NCCHC calls for a federally funded national vaccine program in corrections facilities. 

A Closer Look at "The Health Status of Soon-to-be-Released Inmates" 

With more than 11.5 million inmates released in 1998 alone, Congress instructed the U.S. Department of Justice to determine whether existing concerns that ex-offenders may be contributing to the spread of communicable disease in the community was well founded. The resulting study, which was conducted under a cooperative agreement between  the National Institute of Justice (NIJ), the research and evaluation arm of the U.S. Department of Justice, and the NCCHC, revealed disturbing findings: 

* A significant proportion of prisons and jails do not adhere to the recommendations of the Centers for Disease Control and Prevention (CDC) with regard to screening for communicable diseases and most systems do not follow nationally accepted guidelines for chronic disease and mental illness. 

Despite the 1982 recommendations of the CDC's Advisory Committee on Immunization Practices to vaccinate all long-term inmates against hepatitis B, few state systems have implemented vaccination programs. As a result, in 1996 alone, more than 155,000 prison inmates with current or chronic hepatitis B were released into the community. 

* Many correctional agencies are not doing enough to address communicable disease, chronic disease, and mental illness. 

Despite the fact that the prevalence of AIDS is five times greater in jails and prisons than in the U.S. population, few systems have implemented comprehensive HIV prevention programs. 

On average, less than one quarter of jail inmates undergo routine laboratory testing for syphilis while incarcerated. In some jails, only 2 to 7 percent of inmates are actually tested. 

More than 90 percent of State and Federal prisons, and about half of jails, routinely screen at intake for latent TB infection and active TB disease. However, particularly in jails, many inmates are released before skin tests can be read. Most prisons and jails report they isolate inmates with suspected or confirmed TB disease in negative pressure rooms. However, some facilities do not test the rooms to ensure that the air exchange is working properly or continue to use the rooms even when the air exchange is known to be out of order. 

* Less than half of the state departments of corrections surveyed reported having surveillance data on the number of inmates with chronic diseases. 

The NCCHC estimates that the prevalence of asthma among Federal, State, and local inmates to be between 8 and 9 percent, for a total that exceeds 140,000 cases nationwide, making the prevalence rates for asthma higher among inmates than in the total U.S. population. 

The prevalence of diabetes is estimated to be about 5 percent, for a total of nearly 74,000 inmates with diabetes. 

Over 18 percent of inmates are estimated to have hypertension, or a total of over 283,000 inmates. 

* Prevalence of mental illness is significant among incarcerated persons. 

An estimated one percent of offenders booked into jails have schizophrenia or other psychotic disorders; about 8 to 15 percent have major depression 

An estimated 2 to 4 percent of inmates in State prisons have schizophrenia or other psychotic disorders, over 18 percent have major depression and between 22 and 30 percent have an anxiety disorder. 

A significant proportion of prisons and jails neither measure nor adhere to national standards for access and quality care. 

Only 24 state correctional systems reported they had protocols for diabetes, 25 for hypertension, and 26 for asthma. A content analysis revealed that many of these "guidelines" were incomplete or out-of-date. 

In addition, 40 percent of jails and 17 percent of prisons do not provide recommended mental health evaluations. 

Approximately 58 percent of jails do not provide psychiatric medications, 57 percent do not have crisis intervention services, and 28 percent of jails do not have access to inpatient hospitalization. 

About NCCHC 

The NCCHC is a not-for-profit, 501 (c)(3) organization committed to improving the quality of care in our nation's jails, prisons, and juvenile detention and confinement facilities. The Commission is supported by 36 national organizations representing the fields of health, law,and corrections. 

For more information regarding the NCCHC or the health status of prison inmates, please visit http://www.ncchc.org. 

SOURCE National Commission on Correctional Health Care 
CO: National Commission on Correctional Health Care; 
NCCHC 
 

 www.sfchronicle.com 

Bacteria resisting drug treatment 
Infection outbreak elsewhere appears among gay men in S.F. 

Ulysses Torassa, Chronicle Health Writer         Saturday,February 1, 2003 

Doctors who treat gay men in San Francisco said Friday they are seeing a rise in cases of drug-resistant skin infections in line with reports of a similar outbreak in Los Angeles. The problems appear to be caused by a common bacteria, Staphylococcus aureus, known as staph, that usually lives harmlessly on the skin but can cause infection when introduced into a cut or wound. Over time, many strains have become resistant to a wide range of antibiotics, and drug-resistant staph has been showing up recently in prisons, sports teams and even among Alaskan natives living in close quarters. Dr. Bill Owen, an internist in the Castro neighborhood, said one of his patients came in this fall with an infected boil on his face and had to be admitted to the hospital to receive high-powered intravenous antibiotics. 

"In December, we started to see increasing numbers of these, and now we're seeing two or three per week," said Owen, whose patients are mostly gay men. "Extrapolating from our numbers, my guesstimate is there are probably 200 or 300 cases among gay men" in the Bay Area, he said. In some cases, he added, the bacterial infections have been able to penetrate unbroken skin, making it more worrisome. 

Public health officials in Los Angeles reported this week that they are investigating staph outbreaks among gay men in Southern California, as well as more than 1,000 cases during the last year in the Los Angeles County jail system. In San Francisco, public health officials said they are aware of the issue but have not yet gotten a handle on case numbers. 

They expressed concern that people may become unduly alarmed. "I don't want people to think this is the equivalent of a new HIV/AIDS disease," said Dr. Mitch Katz, director of the San Francisco Department of Public Health, who has seen two recent infections in his own AIDS practice at San Francisco General Hospital. Although some cases may require strong medicine and some time to clear, "these are highly treatable infections," he said. About half of Owen's patients are HIV-positive, but about a third of those he's seen for staph infections do not have HIV, he said. 

"It could be that patients that have some compromise in their immune system are a little more susceptible to this bacteria, but people who have totally intact immune systems are coming down with this, too," Owen said. One such patient is Marc Caldwell, 38, an HIV-negative gay man who has been battling his infection, which started as a boil on his back, since last fall. Initial treatment with antibiotics seemed to clear up the infection, but it returned. He is now getting twice-daily infusions of vancomycin, considered the antibiotic of last resort. Caldwell said word of drug-resistant infections has spread quickly on the Internet and is already starting to cause a wave of fear in the gay community. 

Dr. Matthew Kuehnert, medical epidemiologist at the federal Centers for Disease Control and Prevention, said forms of staph resistant to the antibiotic methicillin are nothing new in Los Angeles, but it is unusual to find it among people who aren't living in close quarters or institutions such as hospitals or nursing homes. Although impervious to common and inexpensive antibiotics, the bacteria can usually be defeated with other drugs before doctors resort to vancomycin, he said. However, the overall trend toward antibiotic resistance is very troubling to public health officials. Last year, for the first time, two cases of staph infections that did not respond to vancomycin were reported in the United States. 

Dr. Marcus Conant, a dermatologist and one of the first doctors to treat AIDS patients, said he's had two patients develop resistant staph recently, both of whom had weakened immune systems. He said other local doctors also reported seeing more of the infections, but it remains unclear who is most susceptible and exactly how it is spreading. Staph infections are usually spread by skin-to-skin contact or from touching a recently contaminated surface. It usually shows up as a firm, red nodule that soon goes on to form a pus-filled center. 

Conant said doctors should be urged to drain the lesion and then send out samples to a lab to see what kind of bug it is, and whether it is drug resistant. As for precautions, Conant suggests showering -- not bathing in a tub -- with anti-bacterial soap, and treating all cuts and skin breaks with a topical antibiotic. Staff writer Rachel Gordon contributed to this report. 

E-mail Ulysses Torassa at 
 utorassa@sfchronicle.com

National Commission on Correctional Health Care 
1300 W. Belmont Ave. 
Chicago, IL 60657 
Phone (773) 880-1460 
Fax (773) 880-2424 
E-mail  ncchc@ncchc.org  

Here's the Center for Disease Control's address again: 

Send your letters to this contact person.  Let's put up the red flag. 

John W. Ward, M.D., Editor 
Epidemiology Program Office MS C-08 
Centers for Disease Control and Prevention 
1600 Clifton Rd. 
Atlanta, GA 30333 
Fax: (404) 639-4198 

Send E-mails to:  mmwrq@cdc.gov  
If your web browser does not support forms, you may send e-mails directly to MMWR-Questions at mmwrq@cdc.gov  
 

The national Center for Disease Control has posted an article in pdf format regarding vaccinations for Hepatitis B and C for those incarcerated at their website here 

 http://www.cdc.gov/mmwr/mmwr_rr.html 

You may need to download a free software program before you can read it located here. 

Health status of prison inmates, please visit 

  http://www.ncchc.org

SOURCE National Commission on Correctional Health Care 
 


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