Prisons Unprepared for Flu Pandemic

As the fear of an impending avian flu pandemic is compelling hospitals, businesses and cities to develop preparedness plans, one of the most potentially dangerous breeding grounds of disease is woefully ill-prepared for a crisis, according to a new study presented September 15 by researchers at Saint Louis University.

"There's a real failure to recognize how important the health status of inmates is to the public health of all of us," said Rachel Schwartz, PhD, a researcher at the Institute for Biosecurity at Saint Louis University School of Public Health. "Nearly 85 percent of those in jails and prisons will be released within a year. So even if we as a society don't think protecting them from disease is a priority, prisoners released into the general population pose a real threat to society."

The research was being presented at the Correctional Medicine Institute's 2006 Conference in Baltimore. There are more than two million prisoners in the United States, making up what Schwartz calls "a highly vulnerable population."

"There's a much higher level of disease among prisoners—people with HIV, drug-resistant tuberculosis, hepatitis C and other diseases," she said, adding that 80 percent of inmates come to prison with some sort of illness. And once they're incarcerated, they're more likely to get other diseases. It makes correctional facilities into ticking time bombs. Many people crowded together, often suffering from diseases that weaken their immune systems, form a potential breeding ground and reservoir for diseases."

Schwartz and fellow researchers studied research and protocols from the Centers for Disease Control, the World Health Organization and other governments to identify what plans were in place for prisons should an infectious disease break out.

Many of the correctional facilities that Schwartz and colleagues studied have acknowledged they don't have an adequate plan to deal with a pandemic or similar health crisis. Schwartz said government leaders are reluctant to provide prisoners with medical care, such as flu vaccines.

"The thinking is that there won't be enough for the general public, and that they should get the shots first," she said. "We tend to think of all inmates as being violent offenders, but the average length of incarceration is only 48 hours. Many are not convicted criminals, but rather people merely accused of crimes and awaiting trial. We know that illness among prisoners will eventually spread and cause illness in society, so we must address this now."

The solution, said Schwartz, is to spend more energy and money on preparedness. She and fellow researchers developed a plan to educate the judicial and prison systems on ways to prevent the spread of disease, from meticulous hand-washing to appropriate use of quarantine and isolation in prison and jail settings. The pandemic plans are designed to provide useful information for many kinds of crisis situations.

"Ideally, they will help authorities prepare and respond to anything from a bird flu breakout to a biological attack," Schwartz said. The information is also critical for existing illnesses within prisons, like HIV, not just emerging infections."

The Saint Louis University Institute for Biosecurity was established in 2000 to provide public health and emergency response professionals with the education needed for preparedness, response, recovery and mitigation of emerging public health threats. Faculty and staff at the Institute conduct research that contributes to the development of national policies to address these threats.