for acquiring infectious diseases in correctional settings and found that effective preventive measures included information dissemination and education. Inmate peer-based health education has been effective in primary prevention of HIV (Hammett, 2006). The addition of hepatitis education to existing peer-based inmate educational programs is feasible and will probably incur minimal additional cost. Boutwell et al. (2005) called education of prisoners about hepatitis C as part of a larger program of prevention, testing, and treatment a “cornerstone of the public health response to the hepatitis C epidemic in the United States” and recommended research into program implementation.

Drug-Treatment Facilities and Needle-Exchange Programs

Drug-treatment and needle-exchange programs reach a substantial proportion of active injectors who have HCV infection or are at risk of acquiring it. Because the programs have regular, long-term contact with many IDUs, there are multiple opportunities to disseminate information about hepatitis B and hepatitis C, including the benefits of hepatitis B vaccination, how to avoid reinfection with HCV, and the importance of followup care for those chronically infected.

Although education programs developed for needle exchange, drug treatment, and corrections facilities will reach substantial proportions of those at risk, important segments of IDU populations will not be reached by them. Women and young people who inject drugs are less likely than others to attend needle-exchange and drug-treatment programs (Bluthenthal et al., 2000; Miller et al., 2001). Novel programs are needed that will access the hidden injectors, and outreach and peer-education programs are potentially effective ways to achieve this goal.

Perinatal Facilities That Care for Pregnant Women

The risk of chronic infection after exposure to HBV is highest in early life, and most people who have chronic hepatitis B were infected at birth or during early childhood. Each year in the United States, about 24,000 HBsAg-positive women give birth and about 1,000 newborns develop chronic HBV infection (Ward, 2008). The latter occurs largely because of failure to adhere to ACIP recommendations and timely administration of the birth dose of the hepatitis B vaccine and hepatitis B immunoglobulin.

Although it is recommended that household contacts be tested because of high risk of infection, fewer than 50% are tested, and fewer than 50% of those tested and found to be HBV-negative or of unknown status are vaccinated (Euler et al., 2003a). Therefore, perinatal-care facilities and their staffs (including OB/GYNs and their clinic staffs) provide an excellent op-



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