Ways to promote screening for hepatitis B virus and accelerated vaccination schedule in prison: Training, information, peer education.

The World Health Organization has suggested prioritizing preventive measures for communicable diseases, including the hepatitis B virus (HBV) infection. To reduce inequalities in health, we have conducted a study on the impact of HBV in prisons located in the region of Tuscany by recording the results of serum screening in clinical medical records, the objective being to increase anti-HBV vaccination in subjects susceptible to infection by means of an accelerated schedule. To further advance disease prevention, we conducted health promotion and education activities prior to a screening/vaccination program in Tuscany prisons; both staff working in the prisons and the prisoners themselves were actively involved. The study started on 11 April 2016 and ended on 10 October 2017. In this paper, we report on the interventions carried out beforehand, such as training, information, and peer education. In addition to information, in a previous study on the overall rate of inmate screening and vaccination, this article incorporates supplemental analysis to differentiate the rate of screening and vaccination among inmates previously present in this setting and those having recently arrived. For health staff, six courses were conducted on Continuing Education in Medicine. A total of 138 inmates of the main nationalities present were selected by justice, health and education staff as peer educators. Out of the 15 prisons participating in the screening and vaccination program, courses for prisoners were conducted in 10 prisons by a medical doctor and the International Organization for Migration cultural mediators, taking into account the multi-ethnic origins of the detainee population and applying a peer education approach. All prisoners received an HBV brochure in various languages. HBV screening was performed by the prisons' sanitary staffs. Out of the 1075 inmates who needed screening, 70.9% of those previously present and 93.6% of the recently arrived agreed to undergo screening for HBV. Out of the 601 prisoners who required vaccination, 85.2% of those previously present and 72% of the recently arrived received the first dose. In conclusion, training, information, and a peer education approach could explain a high rate of adherence to a screening and vaccination program.

Screening for hepatitis B virus and accelerated vaccination schedule in prison: A pilot multicenter study.

BACKGROUND AND AIM: Vaccine against hepatitis B virus (HBV) is highly effective in preventing HBV infection. The aims of this study were to (1) increase the epidemiological knowledge on the impact of HBV in Tuscany region prisons by registering the results of serum screening on a clinical medical record and (2) increase the anti-HBV vaccination using an accelerated schedule. METHODS: Our study population was composed of all detainees present in prisons and all constrained from freedom or at institutions in the Tuscany region and not vaccinated at these facilities from 1 December 2016 to 31 May 2017. RESULTS: Of 17 detention facilities in the Tuscany region, 15 were enrolled in the study. On 28 February 2017, there were 3068 detainees present in these institutions. Considering the 1075 subjects screened for HBV serum markers, 730 (67.9%) were susceptible to infection and needed to be vaccinated. Five hundred and ninety-six agreed to be vaccinated (82%); 27 (2.5%) of our subjects had an isolated anti-HBc, 20 (1.9%) were HBV infected (HBsAg+), 127 (11.8%) had previous HBV infection (anti-HBs+, anti-HBc+ and HBsAg-), and 171 had been previously vaccinated. Five hundred and fifty-five inmates (95.1%) received the first vaccine dose, and 404 (83%) underwent the third dose at day 21. CONCLUSION: This study showed that of a high percentage of subjects who underwent screening, more than half needed to be vaccinated. Moreover, our study reached very high levels of vaccination coverage, considering both the entire enrolled population and the new inmates.

High-sensitivity γ-glutamyltransferase fraction pattern in alcohol addicts and abstainers.

BACKGROUND: Four fractions of gamma-glutamyltransferase (GGT) with different molecular weight (b-, m-, s-, and f-GGT) are present in human plasma. Differential GGT fraction pattern is found in non-alcoholic liver disease (NAFLD) and chronic viral hepatitis, characterized by normal or decreased b-GGT/s-GGT (b/s) ratio, respectively. METHODS: Chromatographic fractional GGT analysis was performed on plasma obtained from 51 subjects: 27 alcoholics (mean (SD), age 45 (9) years; 23 males; 14 positive for viral infection), 24 abstinents from at least 1 month (43 (12) years; 20 males; 6 positive for viral infection). Twenty-seven blood donors matched for age and gender (44 (9) years; 23 males) were selected as controls. RESULTS: All fractions were significantly increased in alcoholics (P<0.001), s-GGT showing the largest increase, while only m-GGT and s-GGT were elevated in abstainers (P<0.01), in comparison with controls. The b/s ratio was significantly lower in both alcoholics and abstainers than in controls (median (25th-75th perc.): 0.10 (0.07-0.15), 0.16 (0.10-0.24), 0.35 (0.29-0.53), respectively, P<0.001). Viral infection did not significantly changes absolute values of individual GGT fractions in alcoholics, but the b/s ratio was significantly lower in virus positive than in virus negative subjects (0.08 (0.05-0.12), 0.14 (0.09-0.20), respectively, P<0.01). CONCLUSIONS: The fraction pattern analysis might increase the specificity of GGT as biomarker of alcohol abuse, especially concerning the differential diagnosis between alcoholism and NAFLD, a common cause of elevated GGT level in the general population.