Introduction

Despite an effective vaccine, hepatitis B virus (HBV) infection continues to impose a large burden of disease globally. Until childhood immunisation achieves high adult population coverage, people who inject drugs (PWID), including prison inmates remain at risk. PWID have a higher prevalence of HBV than the wider population, and lower rates of vaccine-conferred immunity. This study sought to identify the incidence and predictors of HBV transmission and uptake of immunisation in PWID prisoners in Australia.

Methods

Longitudinally collected, stored sera from subjects previously enrolled in a prospective study of hepatitis C in recently incarcerated PWID prisoners (n = 590) were serologically tested for HBV. Interviews recording demographic and behavioural risks were analysed. Multivariate statistical analyses were applied to identify associations of incident infection or immunisation.

Results

Upon imprisonment there were n = 373 (63%) individuals who were HBV susceptible, of whom 140 remained susceptible at the subsequent enrolment into the cohort, and had one or more follow-up visits (a total of 406.73 person years [p.y.]), and so were included in this analysis. There were 7 incident cases of HBV infection (1.7 per 100 p.y.) in this group, with transmission being associated with injecting drug use daily or more often. There were 48 individuals who were successfully immunised (11.8 per 100 p.y.) with younger age and continuous imprisonment predicting this outcome.

Conclusions

The Australian prison environment poses a high risk for HBV infection, and also provides an opportunity for immunisation for PWID. Further efforts are required to improve coverage and prevent ongoing transmissions.

中文翻译：

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澳大利亚监狱囚犯中的乙型肝炎病毒感染事件和免疫接种事件。

介绍

尽管有有效的疫苗，但乙型肝炎病毒（HBV）感染继续在全球范围内造成很大的疾病负担。在儿童免疫接种获得成人较高的覆盖率之前，包括监狱囚犯在内的注射毒品者（PWID）仍然处于危险之中。与更广泛的人群相比，PWID的HBV患病率更高，而疫苗赋予的免疫率则更低。这项研究试图确定澳大利亚PWID囚犯中HBV传播和免疫接种的发生率和预测因素。

方法

对先前入狱的最近被囚禁的PWID囚犯（n = 590）中的丙型肝炎进行前瞻性研究的受试者纵向收集并存储了血清，并对其进行了血清学检测。记录人口和行为风险的访谈进行了分析。应用多元统计分析来确定事件感染或免疫接种的关联。

结果

入狱后，n = 373（63％）个人为HBV易感者，其中140人在随后入组时仍然易感，并进行了一次或多次随访（共406.73人年[py]） ，因此也包含在此分析中。该组中有7例HBV感染病例（每100年1.7例），其传播与每天或更频繁地注射毒品有关。年龄较小且连续入狱的48人已成功免疫（每100 py为11.8人），预示了这一结果。

结论

澳大利亚的监狱环境对HBV感染构成了高风险，也为PWID的免疫接种提供了机会。需要进一步的努力来提高覆盖范围并防止持续的传输。