At-A-Glance: CDC Recommendations for Correctional and Detention Settings

1.Screening should be offered as opt-out screening. Facilities should initiate screening unless prevalence of undiagnosed HIV infection in their facility population has been documented to be <0.1%. In the absence of existing data for HIV prevalence, facilities should initiate voluntary HIV screening. Such screening is no longer warranted in facilities able to establish that the diagnostic yield is <1 per 1,000 persons screened.

2.Test for HBsAg, total anti-HBs, and total anti-HBc. For a chart outlining interpretations and recommended actions based on HBV serology findings, see Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice from the American College of Physicians and the Centers for Disease Control and Prevention.

3.Anti-HCV followed by HCV RNA if positive.

4.Persons should be screening for symptoms of pulmonary TB by being asked if they have had a prolonged cough (i.e., >3 weeks), hemoptysis (i.e., bloody sputum), or chest pain.

5.A facility has minimal TB risk if a) no cases of infectious TB have occurred in the facility in the last year, b) the facility does not house substantial numbers of persons with risk factors for TB (e.g., HIV infection, injection drug use), c) the facility does not house substantial numbers of persons who have arrived in the U.S. within the previous 5 years from areas of the world with high rates of TB, or d) employees in the facility are not otherwise at risk for TB. All other facilities should be categorized as a nonminimal TB risk facility.

6.Gonorrhea, chlamydia, and trichomonas screening should be offered as opt-out screening.

7.Opt-out syphilis screening should be conducted on the basis of local area and institutional prevalence of early (primary, secondary, and early latent) infectious syphilis. Correctional facilities should stay apprised of syphilis prevalence as it changes over time see http://www.cy118119.com/ std/treatment-guidelines/correctional.htm.

8.Unless documentation is available showing completion of the vaccine series.

9.For a full list of risk factors for HAV infection, see full HAV guidance document http://www.cy118119.com/mmwr/volumes/69/rr/rr6905a1.htm

10.Persons at risk for severe outcomes from hepatitis A infection include those with chronic liver disease or HIV infection.

11,Pre-exposure vaccination in populations at risk for hepatitis A infection is an effective outbreak control strategy. Because correctional facilities house individuals from high-risk populations (e.g., persons experiencing homelessness and persons who use drugs), vaccination in correctional settings can help to control community outbreaks of hepatitis A. Vaccination can also help control transmission inside facilities.

12.Unless documentation is available showing completion of the vaccine series, or the individual tests negative for HBsAg, total anti-HBs, and total anti-HBc.

13.See Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices | MMWR (cdc.gov)

14.All persons diagnosed with chronic HBV or HCV infection should be evaluated to determine the presence and extent of liver disease and candidacy for antiviral therapy.

15.Persons who have pulmonary TB symptoms or an abnormal chest radiograph should be evaluated to rule out TB disease; if TB disease is excluded as a diagnosis, LTBI treatment should be considered if the TST or QFT-G result is positive.

5.A facility has minimal TB risk if a) no cases of infectious TB have occurred in the facility in the last year, b) the facility does not house substantial numbers of persons with risk factors for TB (e.g., HIV infection, injection drug use), c) the facility does not house substantial numbers of persons who have arrived in the U.S. within the previous 5 years from areas of the world with high rates of TB, or d) employees in the facility are not otherwise at risk for TB. All other facilities should be categorized as a nonminimal TB risk facility.

8.Unless documentation is available showing completion of the vaccine series.

9.For a full list of risk factors for HAV infection, see full HAV guidance document http://www.cy118119.com/mmwr/volumes/69/rr/rr6905a1.htm

10.Persons at risk for severe outcomes from hepatitis A infection include those with chronic liver disease or HIV infection.

11.Pre-exposure vaccination in populations at risk for hepatitis A infection is an effective outbreak control strategy. Because correctional facilities house individuals from high-risk populations (e.g., persons experiencing homelessness and persons who use drugs), vaccination in correctional settings can help to control community outbreaks of hepatitis A. Vaccination can also help control transmission inside facilities.

12.Unless documentation is available showing completion of the vaccine series, or the individual tests negative for HBsAg, total anti-HBs, and total anti-HBc.

13.See Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices | MMWR (cdc.gov)

14.All persons diagnosed with chronic HBV or HCV infection should be evaluated to determine the presence and extent of liver disease and candidacy for antiviral therapy.

15.Persons who have pulmonary TB symptoms or an abnormal chest radiograph should be evaluated to rule out TB disease; if TB disease is excluded as a diagnosis, LTBI treatment should be considered if the TST or QFT-G result is positive.

16.Although risk behaviors including drug use and sexual activity are prohibited in correctional and detention environments, they may still occur. Clinicians should note that individuals may be hesitant to report these behaviors due to fear of reprisal.

17.For a full list of persons at risk for chronic HCV infection, see full guidance, http://www.cy118119.com/hepatitis/hcv/guidelinesc.htm

18.Complete vaccine series while in custody if the individual has not been released prior to the minimum time required between doses.

19.See Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020 for guidance on administering vaccine and/or immune globulin as postexposure prophylaxis for HAV infection.

20.See Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices for guidance on testing and administering vaccine and/or immune globulin as postexposure prophylaxis for HBV infection. Recommendations depend upon vaccination status.

8.Unless documentation is available showing completion of the vaccine series.

9.For a full list of risk factors for HAV infection, see full HAV guidance document http://www.cy118119.com/mmwr/volumes/69/rr/rr6905a1.htm

10.Persons at risk for severe outcomes from hepatitis A infection include those with chronic liver disease or HIV infection.

12.Unless documentation is available showing completion of the vaccine series, or the individual tests negative for HBsAg, total anti-HBs, and total anti-HBc.

18.Complete vaccine series while in custody if the individual has not been released prior to the minimum time required between doses.

19.See Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020 for guidance on administering vaccine and/or immune globulin as postexposure prophylaxis for HAV infection.

20.See Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices for guidance on testing and administering vaccine and/or immune globulin as postexposure prophylaxis for HBV infection. Recommendations depend upon vaccination status.

21.Pregnant women at increased risk for chlamydia (e.g., those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI) and gonorrhea (e.g., those with other STIs during pregnancy or those with a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI or is exchanging sex for money or drugs) should be screened at first prenatal visit. All persons diagnosed with chlamydia or gonorrhea should be rescreened 3 months after treatment (e.g., new sexual partner, unprotected sex, STI history). See CDC’s Pregnancy Screening Recommendations and Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement | JAMA | JAMA Network for additional information.

22.Pregnant persons who are being treated for drug-resistant TB should receive counseling about the risk to the fetus.