Prisons: an important link in the elimination of Hepatitis B

Abstract

88 Current estimates give figures of approximately 240 million people with chronic hepatitis B virus infection (HBV). The distribution of the disease is very heterogeneous, with a more marked prevalence (high prevalence = ≥8% of the population) in countries in Africa and South East Asia1. HBV infection is responsible for most cases of cirrhosis and liver cancer worldwide, which have a considerable impact on healthcare resources. In Spain, despite the prevention campaigns implemented through health education and screening of pregnant women and high risk groups, and the establishment of universal vaccination in the nineties2, current prevalence is estimated curren prevalence is estimated to be at around 0.2-1.7%, making Spain a country with low endemicity (<2% of the population with infection)3. This prevalence has increased in recent years, probably as a result of migratory movements of persons who have not been vaccinated against hepatitis B or who come from countries with high levels of endemicity. Improved notification of cases may also be another factor4. A recent study on adults who went to the Emergency Department of a university hospital in Catalonia with symptoms compatible with acute hepatitis showed that HBV infection was the main aetiological cause5. One third of cases were immigrants from countries with no vaccination programmes, and sexual transmission was found to be the main associated risk factor. The fact that chronic hepatitis B is an asymptomatic infection up to the advanced stages of liver disease, implies that many persons are unaware of being infected. There are also cases of patients who know that they are infected and do not receive adequate monitoring. The WHO estimates that less than 5% of the individuals infected with HBV in low-income countries are aware of the diagnosis6. Therefore, screening and linkage to care programs for patients with hepatitis B, especially in certain high risk groups, would help to prevent the disease from progressing, which in turn would have a highly positive impact on public health. The possibility of preventing further progression of liver disease and the resulting complications led to the WHO approving the 2016 Global Health Sector Strategy to eliminate hepatitis B and C by 20307. The program includes a wide range of strategies, many of which are focused on prisons. As Vergara M8, comments in her study, prisons represent an opportunity for screening, treatment and monitoring of a number of pathologies, and for discovering more about their natural history, since they include groups where the prevalence of diseases associated with certain risk factors is greater than in the community. This scenario is well known in the case of hepatitis C, where several strategies of microelimination in prisons have been put into effect in a number of Spanish prisons with excellent results and highly valued experience9. There is a large amount of data to support the benefits of such programs in terms of diagnosis of new cases and treatment adherence10. These strategies have allowed the detection, treatment and linkage to care of many patients with hepatitis C, with the positive impact that this implies to eliminate infection. Editorial