Inside Prisons: Europe's New Front Line in Hepatitis Fight
The launch of the European Toolkit for the Elimination of Viral Hepatitis in Prisons (EuroHePP) aims to support local efforts to eliminate viral hepatitis in prison settings in accordance with the United Nations Sustainable Development Goal on Good Health and Well-Being.
The EuroHePP provides practical guidance on preventing, evaluating, and treating hepatitis B virus (HBV) and hepatitis C virus (HCV) in prisons. Tackling viral hepatitis in these prison settings is essential to reach the UN target of eliminating hepatitis as a public health threat by 2030.
Individuals in prison experience a higher incidence of viral hepatitis than the general population, making them a key group for targeted prevention and treatment of the disease. In Europe, individuals entering prisons are also more likely to have a history of injecting drug use, a major risk factor for HBV and HCV transmission.
Sharing of injecting equipment and other risk factors, such as unsafe tattooing or body piercing practices, sharing of razors, and unprotected sex, make prisons a priority setting for targeted viral hepatitis prevention and treatment interventions.
The toolkit was developed in collaboration with European experts and practitioners.
The toolkit comprises four key sections: background, strategy development, strategy implementation, and monitoring and evaluation.
It includes links to relevant public health guidance and practical tools to understand the context and define and implement an elimination strategy in prisons. Examples from prisons in Germany, Spain, France, Italy, and Luxembourg are provided to illustrate the models of care.
Using this toolkit, the EUDA and ECDC provide practical, evidence-based information for those working in prison healthcare on how to establish interventions to prevent and control viral hepatitis in these settings.
The information is also likely to be relevant to other audiences, including policymakers, security staff, people living in prisons, peer support workers, and voluntary workers.
Further support for people working in prison healthcare will be available in the form of dedicated training sessions provided by the EUDA and ECDC in the coming months to facilitate the effective implementation of the toolkit and scaling up of services.
Addressing Inequity
The project highlights the principle of equivalence of care recognised in European and international law, which states that individuals in prison should receive the same healthcare as those in the community. As the ECDC stated: 'People deprived of their liberty must not also be deprived of their right to health.'
A dossier titled Invisible Populations in Epidemiologia & Prevenzione , the journal of the Italian Association of Epidemiology, shows that infectious diseases remain a leading cause of preventable death in prisons.
This research, led by Erica De Vita, MD, a resident in Hygiene and Preventive Medicine at the University of Pisa, Pisa, Italy, highlights how prison conditions, such as overcrowding, poor sanitation, rapid turnover, and fragile health, make inmates particularly vulnerable. These factors create a high-risk setting for the spread of infections, including hepatitis B, influenza, human papillomavirus, COVID-19, and pneumococcal disease.
The article describes the RISE-Vac project, Reaching the hard-to-reach: increasing access and vaccine uptake among prison populations in Europe , coordinated by the University of Pisa. The project ended in November 2024 after working in six countries: Italy, the UK, France, Germany, Cyprus, and Moldova.
Key outcomes included the establishment of vaccination clinics in prisons, such as in Milan, combined with awareness campaigns and health empowerment programs.
The project also studied vaccine hesitancy among inmates and staff, showing that health literacy is crucial for improving vaccine acceptance and vaccination coverage.
Public Health Impact
The scope of the new European 'toolbox' goes beyond the prison walls. Short sentences and repeated incarcerations mean that the same group of people often move between prison and the community.
Therefore, addressing health problems, such as viral hepatitis, in prison settings can also deliver health benefits to the wider community by reducing the overall disease burden and preventing future transmission of infections.
According to ECDC experts in Stockholm, Sweden, the new toolkit is well-structured, adaptable, and evidence-based. They emphasised the need for political and organisational courage to make it central to public health efforts to fight viral hepatitis in prisons.
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