The control of influenza outbreaks at correctional institutions

Abstract

Background Large outbreaks of influenza are known to occur at correctional institutions such as prisons. Prisoners are particularly vulnerable due to a combination of environmental and socio-behavioural risk factors. Such outbreaks are also challenging to control because of the unique environmental constraints in these institutions. However, no local guidance is available for the prevention and control of influenza outbreaks in correctional institutions. This paper aims to review and synthesise relevant evidence on the topic so that practical recommendations can be offered to the local public health and correctional services. Methods A literature search was performed using PubMed, Google Scholar and Google to locate all relevant articles in English that examined the control of influenza outbreaks at correctional institutions up to May 2012. Findings Eleven studies describing 16 outbreaks of influenza or influenza-like illness at correctional institutions were included in the review. The studies included ten case reports and one case-control study from four countries. The majority of outbreaks took place at prisons. The number of cases in each outbreak ranged from three to over 500. Attack rates were highly variable between outbreaks, while case-fatality ratios were generally low. Control strategies used included social distancing measures, transmission-based precautions, active surveillance and testing, treatment, chemoprophylaxis and vaccination. Nine studies discussed the risk factors for spread and the challenges encountered in the control of the outbreaks. These included agent, host, socio-behavioural, environmental, staff and infrastructural factors. The limited expertise and capacity of correctional institutions in responding to influenza outbreaks should be acknowledged. Close communication and collaboration with public health agencies is called for. To better prepare these institutions to respond to pandemic influenza, a detailed, multidisciplinary response plan should be set up by the various government agencies involved. Conclusions Correctional institutions require the appropriate guidance and support from public health for the successful control of influenza outbreaks. These institutions should be recognised as serving a vital role in the community, and prisoners deserve the same standards of health care that are available to other members of society.