Seyed Moayed Alavian
Baqiyatallah Research Center for Gastroenterology and Liver Disease, Tehran, Iran
I read with interest the article by Stief et al. published in your journal recently1. It showed us that hepatitis B virus (HBV) infection remains a significant problem in prisons, and it was related with other published studies2,3. The finding on higher prevalence of HBV infection in the male gender and in prisoners with positive history of intravenous drug use and STD demonstrated a new strategy for the control of HBV infection in prisons. Low vaccination coverage and the high number of injecting drug users (IDUs) suggest that most of them are susceptible to this infection.
Prisoners and IDUs are at constant risk of HBV infection, and the classic 6-month HBV vaccination might not provide immunization rapidly enough4,5. Compared with classic HBV vaccination regimen, an accelerated 0, 1, 4, and 8 weeks vaccination schedule can achieve early seroprotection more rapidly, provides clinically sufficient seroprotection with higher compliance in prisoners, and can be suggested in situations that rapid immunization against HBV infection is warranted4. I suggest the selection of higher-risk groups in prisons, including males with history of IDUs and STD, to start the accelerated vaccination against HBV infection early. This will be extremely useful to ensure immunity against HBV infection soon.
I would like to inform those identified by Stief et al. as having high risk of contracting HBV infection, particularly those in prisons and of old age, that being infected would be related to more duration of staying in high-risk place (prison) and more exposure with the risk factors. And finally, I would like to ask about hepatitis C virus (HCV) and HIV infections, which are more common in IDU groups6 as stated in the literature; the authors did not present this in their study.
1. Stief AC, Martins RM, Andrade SM, Pompilio MA, Fernandes SM, Murat PG, et al. Seroprevalence of hepatitis B virus infection and associated factors among prison inmates in state of Mato Grosso do Sul, Brazil. Rev Soc Bras Med Trop 2010; 43:512-515. [ Links ]
2. Mir-Nasseri MM, Mohammadkhani A, Tavakkoli H, Ansari E, Poustchi H. Incarceration is a major risk factor for blood-borne infection among intravenous drug users. Hepat Mon 2011; 11:19-22. [ Links ]
3. Azarkar Z, Sharifzadeh G. Evaluation of the Prevalence of Hepatitis B, Hepatitis C, and HIV in Inmates with Drug-Related Convictions in Birjand, Iran in 2008. Hepat Mon 2010; 10:26-30. [ Links ]
4. Asli AA, Moghadami M, Zamiri N, Tolide-Ei HR, Heydari ST, Alavian SM, et al. Vaccination against hepatitis B among prisoners in Iran: Accelerated vs. classic vaccination. Health Policy 2011; 100:297-304. [ Links ]
5. Jahani MR, Alavian SM, Shirzad H, Kabir A, Hajarizadeh B. Distribution and risk factors of hepatitis B, hepatitis C, and HIV infection in a female population with “illegal social behaviour”. Sex Transm Infect 2005; 81:185. [ Links ]
6. Ataei B, Tayeri K, Kassaeian N, Farajzadegan Z, Babak A. Hepatitis B and C among Patients Infected with Human Immunodeficiency Virus in Isfahan, Iran: Seroprevalence and Associated Factors. Hepat Mon 2010; 10:188-192. [ Links ]
Dr. Seyed Moayed Alavian
Baqiyatallah Research Center for Gastroenterology and Liver Disease
P.O. Box 14155/3651, Tehran, I.R.Iran.
Phonefax: 98 21 88945186-8, Fax: 98 21 81262072
Received in 01/06/2011
Accepted in 22/09/2011
Resposta dos autores quanto aos comentários feitos sobre o artigo Soroprevalência e fatores associados à infecção pelo vírus da hepatite B em população encarcerada no Estado do Mato Grosso do Sul, Brasil
Alcione Cavalheiro Faro StiefI;.Regina Maria Bringel MartinsII; Sônia Maria Oliveira de AndradeI; Mauricio Antonio PompilioI; Sonia Maria FernandesI; Paula Guerra MuratI; Gina Jonasson MousquerI; Sheila Araújo TelesIII; Graciele Rodrigues CamolezI; Roberta Barbosa Lopes FranciscoIV; Ana Rita Coimbra Motta-CastroI
IDepartamento de Bioquimica e Farmácia, Universidade Federal do Mato Grosso do Sul, Campo Grande, MS
IIInstituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO
IIIFaculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO
IVLaboratório Central de Saúde Pùblica, Laboratory, Campo Grande, MS
We are very pleased to present our answers to the comments made by Professor Seyed Moayed Alavian in relation to our work Seroprevalence of hepatitis B virus infection and associated factors among prison inmates in State of Mato Grosso do Sul, Brazil.
Before publication, we had the opportunity to present the paper in a seminar (Encontro Estadual de Vigilância em Saúde) in Campo Grande-MS, in November 24, 2009, promoted by the State Health Office.
Concerning the vaccination against the hepatitis B virus in the population exposed to the risk of becoming infected, the findings were sent to the State Health Office (State Program of STD/AIDS and viral hepatitis) of Mato Grosso do Sul State. The high number of susceptible individuals (58%) was enhanced so that HBV vaccination could be initiated in this population, with the objective of preventing and controlling the hepatitis B virus infection in and out of the prisons.
The history of drug use is paramount when investigating the possibility of acquiring diseases transmitted sexually and parenterally, such as HBV infection1. Drugs are prohibited in prisons; therefore, their use is considered a crime in Brazil, which causes many inmates not to report the use of injecting drugs. The present study was given continuity by selecting more samples, with a total sample size of 443 men and 243 women. The overall seroprevalence of HCV infection was 4.8% (95% CI: 3.4% to 6.8%), and the coinfection of HIV and HCV was 33.3%2. After bivariate and multivariate analyses, injecting drug use was found significantly associated with HCV2 and HIV3 infections.
1. Macalino GE, Vlahov D, Sanford-Colbt S, Patel S, Sabin K, Salas C, et al. Prevalence and incidence of HIV, hepatitis B virus, and hepatitis C virus infections among males in Rhode Island prisons. Am J Public Health 2004; 94:1218-1223.
2. Pompilio MA, Pontes ERJC, Castro ARCM, Andrade SMO, Stief ACF, Martins RMB, et al. Prevalence and epidemiology of chronic hepatitis C among prisoners of Mato Grosso do Sul State, Brazil. J Venom Anim Toxins incl Trop Dis 2011; 17: 216-222.
3. Francisco RBL. Infection with human immunodeficiency virus (HIV) in the prison population of Campo Grande, Mato Grosso do Sul: epidemiological and molecular characterization. [Dissertation]. [Campo Grande]: Universidade Federal do Mato Grosso do Sul; 2009. 102 p.
Drª Ana Rita Coimbra Motta-Castro.
Deptº de Farmácia e Bioquímica/UFMS.
Av. Filinto Muller s/n, Campus Cidade Universitária, Caixa Postal 649
74004-382 Campo Grande, MS, Brasil.
Fax: 55 67 3382-9687
Received in 11/07/2011
Accepted in 22/09/2011