Viral Hepatitis B and C in Prisons in the European Union Countries: A Multi-Stage Systematic Review and Meta-Analysis

Author: Babak Moazen

Theme: Epidemiology & Public Health Research Year: 2022

Background: Behavioral and structural factors create situations in which people living in prisons are
more likely to acquire and transmit viral hepatitis B (HBV) and C (HCV). The present study aimed to
estimate the prevalence of HBV and HCV in prisons in the European Union (EU) countries.
Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) criteria, we systematically searched 4 databases of peer-reviewed publications (MEDLINE
(PubMed), ISI Web of Science, EBSCO, and ScienceDirect) and 53 databases containing gray literature
to collect data published from January 2008 to August 2018. Meta-analyses using random effect
models were applied to estimate pooled prevalence of HBV and HCV in the EU countries.
Results: A total of 23,969 documents (17,297 papers and 6,672 gray documents) were identified and
reviewed, of which 48 were included in the meta-analysis. According to the meta-analysis, the overall
prevalence of HCV was 12.36% (95% Confidence Interval (CI): 11.81%-12.91%), while the prevalence
was 20.36% (16.86%-23.85%) among male, and 15.26% (7.66%-22.86%) female prisoners. The overall
HBV prevalence was 2.59% (2.27%-2.92%), 4.44% (2.75%-6.13%) among male, and 2.52% (1.04%-
3.99%) female prisoners.
Conclusion: Compared with the latest estimates of the European Centre for Disease Prevention and
Control (ECDC), our findings reveals that HBV and HCV are 432 and 1405 times more prevalent than
among the general population of the EU, respectively. The excessively high prevalence of viral
hepatitis is a serious cause for public health concern in the EU. Urgent and concrete actions are
required to mitigate the burden of HBV and HCV in prisons and ensure appropriate access to
prevention and care for people exiting detention facilities in this region. The EU prison health policy
makers are recommended to initiate and expand acceptable, accessible, and high-quality services to
control HBV and HCV transmission in prisons.
Disclosure of interest: The authors declare no competing interest.

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