Introduction
After the introduction of clean drinking water, vaccination is probably the public health intervention that avoids the most premature deaths.[1] Vaccination, in general terms, is highly efficacious and cost effective and can eliminate and even eradicate some communicable diseases. In general, vaccines are administered according to age criteria (systematic vaccination schedules) or to individual criteria in risk groups (e.g., people with some chronic diseases). These strategies have gradually achieved higher vaccination coverages and in many vaccine-preventable diseases, herd immunity, which can reduce or even halt the transmission of certain diseases. Specific vaccination strategies include the search for and immunization of identified closed communities or difficult-to-treat population groups that may harbor pockets of susceptible subjects. In these cases, targeted interventions can improve coverages considerably with respect to the immunization policies of traditional healthcare services. The prison environment, with a defined population confined within a limited space, provides a paradigm for this type of intervention.
In addition to being an accessible population, the benefits of vaccination programs for prisoners are immense, as the risk of acquiring both vaccine-preventable and non-vaccine-preventable diseases is extremely high among prisoners compared with the general population. The determinants that increase the risk of these diseases include the large number of incarcerated persons, prison overcrowding, rotational dynamics in the prison population, the social heterogeneity of prisoners and the high prevalence of transmissible diseases in prisoners belonging to lifestyle risk groups, among others.
Although there are some guidelines and recommendations, both local ones and those of various international agencies, on the health aspects of prisons, the sections on the prevention of communicable diseases and vaccination are generally limited and do not adequately reflect their importance. Furthermore, most recommendations and approaches are not easily applicable to the reality of prison life.[2] There are few reports on this subject and operational research into vaccination programs and factors related to vaccination coverage in prisons is limited.[3] One potential explanation for this may be related to the fact that prisons were designed and structured essentially to ensure public safety. This 'limited' concept, which persists today, may work against the idea that a prison can be a place that provides a real opportunity and space for inmates to access healthcare and an important point in the overall, integrated strategy of reducing the incidence rates of vaccine-preventable diseases, both within and outside prisons. Access of prisoners to vaccination has a direct impact not only on the target population but also in the community, by preventing possible infections and the complications of transmittable diseases.
From the vaccinology point of view, prison inmates should be considered a health priority for the following reasons:
Expert Rev Vaccines. 2013;12(5):469-471. © 2013 Expert Reviews Ltd.
