European Journal of Epidemiology

, Volume 16, Issue 11, pp 1043–1049 | Cite as

Prevalence and incidence of bloodborne viral infections among Danish prisoners

  • P.B. Christensen
  • H.B. Krarup
  • H.G.M. Niesters
  • H. Norder
  • J. Georgsen


In order to determine the prevalence and incidence of bloodborne viral infections among prisoners, we conducted a prospective study in a Danish medium security prison for males. The prisoners were offered an interview and blood test for hepatitis and human immunodeficiency virus HIV at inclusion as well as at release from prison or end of study. Of 403 prisoners available 325 (79%) participated in the initial survey and for 142 (44%) a follow-up test was available. 43% (140/325) of the participants were injecting drug users (IDUs) of whom 64% were positive for hepatitis B (HBV) and 87% for hepatitis C (HCV) markers. No cases of HIV or human T lymphotropic virus (HTLV) were found. 32% of all prisoners could transmit HBV and/or HCV by blood contact. 70% of IDUs had shared injecting equipment, and 60% had injected inside prison. Only 2% of IDUs were vaccinated against HBV. Duration of injecting drug use, numbers of imprisonments, and injecting in prison were independently and positively associated with the presence of HBV antibodies among IDUs by logistic regression analysis. The HBV incidence was 16/100 PY (95% CI: 2–56/100 PY) and the HCV incidence 25/100 PY (1–140) among injecting drug users (IDUs). We conclude that IDUs in prison have an incidence of hepatitis B and C 100 times higher than reported in the general Danish population. They should be vaccinated against hepatitis B and new initiatives to stop sharing of injecting equipment in and outside prison is urgently needed.

Hepatitis B Hepatitis C Incidence Injecting drug use Prison Risk behaviour 


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  1. 1.
    Levine OS, Vlahov D, Nelson KE. Epidemiology of hepatitis B virus infections among injecting drug users: Seroprevalence, risk factors, and viral interactions. Epidemiol Rev 1994; 16: 418–436.Google Scholar
  2. 2.
    Sulkowski MS, Thomas DL. Viral hepatitis among injection drug users. Viral Hep Rev 1998; 4(4): 229–244.Google Scholar
  3. 3.
    Fuglsang T, Fouchard J, Ege P. Prevalence of HIV, hepatitis B, and C among drug users in the City of Copenhagen (in Danish). Ugeskr Laeger 2000; 162(27): 3860–3864.Google Scholar
  4. 4.
    Christensen PB. Bloodborne viral infections in Funen. Ph.D. thesis, University of Southern Denmark, Odense, 2000.Google Scholar
  5. 5.
    Butler TG, Dolan KA, Ferson MJ, McGuinness LM, Brown PR, Robertson PW. Hepatitis B and C in New South Wales prisons: Prevalence and risk factors. Med J Aust 1997; 166(3): 127–130.Google Scholar
  6. 6.
    Malliori M, Sypsa V, Psichogiou M, et al. A survey of bloodborne viruses and associated risk behaviours in Greek prisons. Addiction 1998; 93(2): 243–251.Google Scholar
  7. 7.
    Krarup HB, Drewes AM, Madsen PH. A quantitative HCV-PCR test for routine diagnostics. Scand J Clin Lab Invest 1998; 58(5): 415–422.Google Scholar
  8. 8.
    Niesters HG, Honkoop P, Haagsma EB, de-Man RA, Schalm SW, Osterhaus AD. Identification of more than one mutation in the hepatitis B virus polymerase gene arising during prolonged lamivudine treatment. J Infect Dis 1998; 177(5): 1382–1385.Google Scholar
  9. 9.
    Norder H, Hammas B, Magnius LO. Typing of hepatitis B virus genomes by a simplified polymerase chain reaction. J Med Virol 1990; 31(3): 215–221.Google Scholar
  10. 10.
    Dean AG, Dean JA, Columbier D, et al. Epi Info Version 6.04: A wordprocessing, database, and statistics program for epidemiology on microcomputers. Atlanta, Georgia, USA, 1997.Google Scholar
  11. 11.
    SPSS (Statistical Program for the Social Sciences) version 7.5. Chicago, IL: SPSS inc, 1997.Google Scholar
  12. 12.
    Kleinman S, Busch MP, Korelitz JJ, Schreiber GB. The incidence/window period model and its use to assess the risk of transfusion-transmitted human immunodeficiency virus and hepatitis C virus infection. Transfus Med Rev 1997; 11(3): 155–172.Google Scholar
  13. 13.
    Kelley PW, Redfield RR, Ward DL, Burke DS, Miller RN. Prevalence and incidence of HTLV-III infection in a prison. JAMA 1986; 256(16): 2198–2199.Google Scholar
  14. 14.
    Decker MD, Vaughn WK, Brodie JS, Hutcheson RH Jr, Schaffner W. The incidence of hepatitis B in Tennessee prisons. J Infect Dis 1985; 152: 214–217.Google Scholar
  15. 15.
    Brewer TF, Vlahov D, Taylor E, Hall D, Munoz A, Polk BF. Transmission of HIV-1 within a statewide prison system. AIDS 1988; 2(5): 363–367.Google Scholar
  16. 16.
    Hull HF, Lyons LH, Mann JM, Hadler SC, Steece R, Skeels MR. Incidence of hepatitis B in the Penitentiary of New Mexico. Am J Public Health 1985; 74: 1213–1214.Google Scholar
  17. 17.
    Kokkevi A, Richardson C, Palermou B, Leventakou V. Reliability of drug dependents' self-reports. Drug Alcohol Depend 1997; 45(1–2): 55–61.Google Scholar
  18. 18.
    Darke S, Hall W, Heather N, Ward J, Wodak A. The reliability and validity of a scale to measure HIV risk-taking behaviour among intravenous drug users. AIDS 1991; 5(2): 181–185.Google Scholar
  19. 19.
    Christensen PB, Tittlestad I, Homburg KM, Antonsen S, Georgsen J, Kristensen T. Hepatitis B core antibodies in Danish blood donors-surrogate marker of risk behavior? Vox Sang, 1998, 74(S1), Abstract 1087.Google Scholar
  20. 20.
    Christensen PB. Epidemiology of hepatitis C (in Danish). Ugeskr Laeger 1998; 160(24): 3529–3532.Google Scholar
  21. 21.
    Graversen L, Smith E. Hepatitis B 1998. Epi-news 1999; 23. Copenhagen, Statens Serum Institut.Google Scholar
  22. 22.
    Glismann S, Graversen L. Hepatitis C 1997–1998. Epi-news 1999; 8. Copenhagen, Statens Serum Institut.Google Scholar
  23. 23.
    Crofts N, Stewart T, Hearne P, Ping XY, Breshkin AM, Locarnini SA. Spread of bloodborne viruses among Australian prison entrants. BMJ 1995; 310: 285–288.Google Scholar
  24. 24.
    Keppler K, Nolte F, Stöver H. Transmission of infecious diseases in prison. Results of a study in the prison for women in Vechta, Lower-Saxony, Germany. Sucht 1998; 42(2): 98–117.Google Scholar
  25. 25.
    Smith E. HIV/AIDS-surveillance in Denmark (in Danish). Ugeskr Laeger 2000; 161(31): 4436–4439.Google Scholar
  26. 26.
    Department of Healths registry of drugusers in treatment 1996 (in Danish). Nye tal fra Sundhedsstyrelsen. 4, 1–12. 1997. Copenhagen, Sundhedsstyrelsen.Google Scholar
  27. 27.
    Taylor A, Goldberg D, Emslie J, et al. Outbreak of HIV infection in a Scottish prison. BMJ 1995; 310: 289–292.Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • P.B. Christensen
    • 1
  • H.B. Krarup
    • 2
  • H.G.M. Niesters
    • 3
  • H. Norder
    • 4
  • J. Georgsen
    • 1
  1. 1.Department of Clinical ImmunologyOdense University HospitalDenmark
  2. 2.Department of Clinical ChemistryAalborg HospitalDenmark
  3. 3.Department of VirologyUniversity Hospital Rotterdam Sophia/DijkzigtRotterdamThe Netherlands
  4. 4.Department of VirologySmittskyddsinstitutetStockholmSweden

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