Managing outbreaks of highly contagious diseases in prisons: a systematic review

23rd November 2020

Researchers in the Department of Psychiatry at the University of Oxford have conducted a systematic review on managing outbreaks of highly contagious diseases in prisons. 28 studies of investigations were examined in high-income countries with documented outbreaks of various contagious diseases such as tuberculosis, influenza and COVID-19.
 

Findings:

The researchers found a number of challenges to managing outbreaks in prisons including: 

• Contract tracing is more complicated in prisons due to concerns regarding stigma, confidentiality, fears of further restrictions and medical isolation.
• Effective isolation and quarantine measures difficult due to overcrowding, poor ventilation, sanitation and hygiene.
• Transmission could occur at multiple points, including between prisoners and staff, and quickly due to proximity of prisoners. This has a knock-on impact on the wider community as turnover in prisons is high.    
• People in prison have higher rates of physical and mental health comorbidities than in the community.
• As well as concerns regarding transmissions, there are also concerns regarding how an outbreak would be managed.
• Higher prevalence of underlying health conditions within prisoners than in the community.
   

Recommendations:

Researchers argued that the need to take ‘a public health approach to managing COVID-19 in prisons is important now and for any future infectious disease outbreaks.’ On publication of the research, Professor Seena Fazel stated ‘Our research suggests that people in prison should be among the first groups to receive any COVID-19 vaccine to protect against infection and to prevent further spread of the disease’.

 Other key recommendations to health and prison authorities include: 

• Sharing clear and up to date information about health risks, prevention and control measures with people in prisons and prison staff
• Assessing the benefits of prolonged infection control strategies against the potential negative consequence of measures such as its impact on the mental health of the prison population
• Ensuring that people in prison are released to suitable housing, to ensure that transmission risks are reduced
   

‘Managing outbreaks of highly contagious diseases in prisons: a systematic review’ can be read in full on the British Medical Journal here.

A short news article on the research can be read on the University of Oxford website here.