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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


BMJ 2001;323:1209 ( 24 November )




Prevalence of antibodies to hepatitis B,

hepatitis C, and HIV and risk factors in

entrants to Irish prisons: a national

cross sectional survey


Jean Long, lecturer in international health and development,

a Shane Allwright, senior lecturer in epidemiology, a

Joseph Barry, senior lecturer in public health, a Sheilagh

Reaper Reynolds, education officer, b Lelia Thornton,

specialist in public health medicine, c Fiona Bradley, lecturer

in general practice, a John V Parry, deputy director. d


a Department of Community Health and General Practice, Trinity College

Centre for Health Sciences, Adelaide and Meath Hospital incorporating the

National Children's Hospital, Tallaght, Dublin 24, Republic of Ireland,

b Drugs/AIDS service, Northern Area Health Board, Phibsboro, Dublin 7, Republic of Ireland, c Department of Public Health, Eastern Regional

Health Authority, Dr Steevens' Hospital, Dublin 8, Republic of Ireland, d Sexually Transmitted and Bloodborne Virus Laboratory, PHLS Central

Public Health Laboratory, London NW9 5HT


Correspondence to: S Allwright

Objectives: To determine the prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in entrants to Irish prisons and to examine risk factors for infection.

Design: Cross sectional, anonymous survey, with self completed risk factor questionnaire and oral fluid specimen for antibody testing.

Setting: Five of seven committal prisons in the Republic of Ireland.

Participants: 607 of the 718 consecutive prison entrants from 6 April to 1 May 1999.

Main outcome measures: Prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in prison entrants, and self reported risk factor status.

Results: Prevalence of antibodies to hepatitis B core antigen was 37/596 (6%; 95% confidence interval 4% to 9%), to hepatitis C virus was 130/596 (22%; 19% to 25%), and to HIV was 12/596 (2%; 1% to 4%). A third of the respondents had never previously been in prison; these had the lowest prevalence of antibodies to hepatitis B core antigen (4/197, 2%), to hepatitis C (6/197, 3%), and to HIV (0/197). In total 29% of respondents (173/593) reported ever injecting drugs, but only 7% (14/197) of those entering prison for the first time reported doing so compared with 40% (157/394) of those previously in prison. Use of injected drugs was the most important predictor of antibodies to hepatitis B core antigen and hepatitis C virus.

Conclusions: Use of injected drugs and infection with hepatitis C virus are endemic in Irish prisons. A third of prison entrants were committed to prison for the first time. Only a small number of first time entrants were infected with one or more of the viruses. These findings confirm the need for increased infection control and harm reduction measures in Irish prisons.

    What is already known on this topic

    High rates of using injected drugs, initiation of use of injected drugs, and sharing injecting equipment occur in Irish prisons  Injecting drug users have high rates of infection with hepatitis B and C viruses, and hepatitis C is endemic in injecting drug users and in Irish prisoners

    What this study adds

The prevalence of antibodies to hepatitis B core antigen, to hepatitis C, and to HIV in prison entrants who had previously been imprisoned was similar to that found in the recent national survey of Irish prisoners, but the prevalence of these antibodies was much lower in the third of prison entrants who had never previously been in prison

Tattooing in prison is an independent risk factor for hepatitis C infection in prisoners who have never used injected drugs

© BMJ 2001

Rapid Responses:

Read all Rapid Responses

Prisons and infectious diseases - time for a robust response Oscar Simooya, et al., 26 Nov 2001

Tattooing and hepatitis C infection Tweg Abraham, 27 Nov 2001

Failure to control for duration of injecting causes results to be misleading Bobby Smyth, 11 Dec 2001,18 Dec 2001