Journal of Vaccines & Vaccination

Immunization program in the largest U.S. jail: Protecting the highest risk individuals against infl uenza and hepatitis

International Conference & Exhibition on Vaccines & Vaccination

22-24 Nov 2011 Philadelphia Airport Marriott, USA

Mark Malek, John Costumbrado, Garrett Cox, Armidia Miranda RN, A. Nelson El Amin and Ali Stirland

Scientific Tracks Abstracts: J Vaccines Vaccin

Abstract:

Background: In the US today, 1 in 33 Americans is incarcerated during their lifetime. US jails are local correctional institutions for persons who have short sentences or are awaiting trial. Th ey house a highly transient population, which, compared to the general population, are more likely to: be black or Hispanic, have low socio-economic status, suff er from a disproportionately high burden of infectious diseases, and engage in behaviors that put them at high risk for transmitting or acquiring communicable diseases. Although inmates are nationally recognized by the Centers for Disease Control as a high-priority population, the potential to provide vaccines in jails remains largely unrealized. Th is is the fi rst reported jail-based infl uenza and hepatitis immunization program in the US, established in the Los Angeles County Jail, the largest of its kind in the world (n=20,000). Methods: Using vaccine provided by State and local Immunization Programs (at no cost to the jail), in 2007 we designed and implemented two separate infl uenza and hepatitis vaccination campaigns which are ongoing. All inmates are off ered fl u vaccine upon entry into the jail. Inmates housed in dormitories for homosexual and transgendered persons (the K6-G Unit) are off ered hepatitis A and B vaccination. Due to their short stay in K6-G (median: 10-20 days), these inmates receive a combined hepatitis A and B vaccine using the US FDA approved accelerated schedule (doses on day 0, 7 and 21, followed by a booster dose at 12 months). In addition, inmates in some long stay units of the jail are off ered hepatitis B vaccine using the conventional schedule (doses at 0, 1 and 6 months). In presenting our evaluation of the vaccination programs, we will summarize: the work plan; methods used to change the professional culture of medical providers and sworn personnel; strategies employed to establish the vaccination program and ensure its success despite the unique barriers present in the correctional setting. Findings: Between the months of November � March (infl uenza season), approximately 6,000 (range: 5,000 � 8,000) inmates are vaccinated against infl uenza; this accounts for approximately 5% of all infl uenza vaccines available for distribution by the Los Angeles County Department of Public Health. From August 2007 to December 2010, approximately 3,000 inmates in the K6-G Unit have initiated a hepatitis vaccination series. Most (75%) are males between 18-49 years of age and are Hispanic or black. Programmatic factors that increased the effi ciency of the vaccination process, improved vaccination rates and higher hepatitis vaccine series completion rates will also be presented. Conclusions: Our fi ndings indicate that an eff ective immunization program can be established in a county jail facility, and reach an extremely high risk population that is unlikely to access preventive health services outside the jail. Because jail-based populations regularly interact with the general population, from which they are temporarily displaced, taking the opportunity to off er vaccination to inmates has the potential to improve community health and reduce costs associated with medical trea tment, particularly hospitalization. Th is vaccination campaign should serve as a model for other correctional facilities, though it must be tailored to suit each locale appropriately.

Biography :

Mark Malek (M.D., University of California Los Angeles; MPH, Johns Hopkins University) is director of the Infection Control and Epidemiology and Employee Health Units for the Los Angeles County Sheriff?s Department (LASD) jail system. Dr. Malek completed a surgical internship at Stanford University, residency in Preventive Medicine at the Johns Hopkins Hospital, and served as an Epidemic Intelligence Service Of fi cer in the Respiratory and Enteric Viruses Branch, U.S. Centers for Disease Control and Prevention (Atlanta, GA) from 2004-2006. His major research contributions have been in the areas of viral disease epidemiology and prevention in the U.S. and abroad while working with the CDC, and establishment of surveillance, research and programs to prevent the spread of communicable disease transmission, including communicable disease screening and prevention interventions, within the Los Angeles County Jail (LACJ). He is currently co-investigator on an NIH-funded research grant entitled ?Seek, Test, and Treat: Addressing HIV in the Criminal Justice System? (R01: RFA- DA-10-017). In addition, he has completed research projects while working at the NIH, CDC and the LASD including a newly funded CDC study on expansion of HIV testing within the LA County Jail. Dr. Malek has published manuscripts in peer-reviewed scienti fi c journals such as Journal of Correctional Health, Corrections Health Today, Journal of Infectious Diseases, Clinical Infectious Diseases, Pediatrics, Morbidity and Mortality Weekly Report, Panamerican Journal of Public Health, Journal of Bone & Joint Surgery and Scandinavian Journal of Urology