Appendix D: Prevalence of Infectious Diseases in Correctional Facilities
Tuberculosis in correctional facilities is a significant problem. This is due to the high prevalence of TB in the incarcerated population and the specifics of the correctional facility environment where there is extensive face-to-face contact with persons with active TB infections, transport of infectious persons in patrol vehicles, and prolonged assignment to these institutions. Thus, the recommendation of the Task Group is that COs should participate in a TB surveillance program (periodic – at least annually and post-exposure).5,6 Also, COs with positive TB tests and/or active TB should be treated as per current protocols. Those with active TB should be restricted until cleared as no longer being infectious.
Of the TB cases reported annually in the U.S., 4-6% occur among the incarcerated at the time of diagnosis.5 Between 1993 and 2014, 4.0% (n = 12,830) of TB cases reported in the U.S. for persons ≥15 years were residents of correctional facilities.5,6 In 2014, a total of 8,961 TB cases in persons ≥15 years old were reported in the U.S.6 Of these cases 376 (4.2% of all TB cases) were reported in residents of correctional facilities. The incidence of TB is approximately 0.003% in the general population, and 0.02% in the incarcerated population – an approximate 10 times increased incidence.
HIV also has a high prevalence in prisons. In 2012, 1.57 million were incarcerated in federal prisons and 731,208 in local jails with 20,093 (0.25%) of inmates in federal jails and 3,913 (0.54%) in local jails carrying a diagnosis of HIV positivity.7 It was estimated that 933,941 (0.29%) persons were living with chronic HIV infection in the U.S. in 2013.4 A 2010 study estimated that 1.5% of the total U.S. custody population in federal and state prisons was infected with HIV.11
The prevalence rate for hepatitis B (HBV) in the U.S. was 0.4% in 20098; 1.0-3.7% of inmates had serological markers of chronic HBV infection.11
The prevalence rate for hepatitis C (HCV) in the U.S. was reported as 2% in 2016.9 As recently as 2015, the prevalence of HCV infection in U.S. correctional institutions has been reported as 10.1 to 29.7%.10
A 2010 study estimated that 1.5% of the total U.S. custody population in federal and state prisons was infected with HIV; 12.0 to 35.0% had chronic HCV infection; and 1.0 to 3.7% had serological markers of chronic HBV infection.11 Therefore, based on these estimates, the prevalence of HIV was about four times higher among prison inmates than in the general population. Similarly, the prevalence of chronic HBV infection was 2 to 6 times higher, and that of chronic HCV infection was up to 10 times higher among prison inmates vs. the general population.