Score: -5
(2/0/7)
San Diego County Grand Jury
• 2012-2013
An Unrecognized Health Hazard in Our Community a Proposal to Immunize the Sentenced Adults in the County Detention
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 4 findings
F01
DSB’s current policy and practice fails to meet accepted national immunization standards, including those of the CDC and Federal Bureau of Prisons guidelines for inmates. DBS does not follow the most basic and widely accepted public health standards for women in developed countries. Fact: After counseling, inmates’ participation in immunization programs increases. Fact: Inmates are generally less educated than the public and score below the public in basic reading literacy. Fact: Inmates are members of the national health disparities. They experience greater social and/or economic obstacles to health and are adversely affected. Fact: Inmates who participate in health-related programs while incarcerated have lower recidivism rates and are more likely to maintain health-conscious behaviors.
No recommendations for this finding
F02
DSB failure to provide effective counseling about the benefits of specific immunizations ensures that the inmates will underutilize the immunization program. Fact: San Diego Regional Immunization Registry (SDIR), part of the California Immunization Registry (CAIR): • Meets the requirements for Meaningful Use • Is a web-based, immunization tracking system • Allows health care providers and other authorized users to access an individual’s State record of immunizations • Allows health care providers to determine the need for other immunizations. Fact: The Jails Information Management System (JIMS) is limited to information from jails in San Diego County. It does not comply with the Federal Government’s regulations for Meaningful Use.
No recommendations for this finding
F3
DSB’s failure to track immunizations using the CAIR-SDIR system increases the cost of tracking and causes delays in evaluating inmate immunization status and implementing an effective immunization program. Fact: Due to the often-rapid turnover of adults in detention, inmates may not complete the series of immunizations before discharge. Fact: DSB’s current health assessment is for inmates who remain in custody beyond one year. Fact: The 1988/89 San Diego County Grand Jury Report recommended study and consideration of transferring administration of the medical care in the detention facilities from the Sheriff’s Department to the San Diego County Health Department. Fact: SDPHD provided vaccine to DSB during the H1N1 influenza outbreak. Fact: Maximum capacity for inmates, aged 19 to 75, housed by DSB in seven facilities, is over 5,000.
Related Recommendations (1)
R3
Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination • Administer a one-time dose of Tdap to adults younger than age 65 years who have not received Tdap previously or for whom vaccine status is unknown to replace one of the 10-year Td boosters. • Tdap is specifically recommended for the following persons: − pregnant women more than 20 weeks’ gestation, − adults, regardless of age, who are close contacts of infants younger than age 12 months (e.g., parents, grandparents, or child care providers), and − health-care personnel. • Tdap can be administered regardless of interval since the most recent tetanus or diphtheria containing vaccine. • Pregnant women not vaccinated during pregnancy should receive Tdap immediately postpartum. • Adults 65 years and older may receive Tdap. • Adults with unknown or incomplete history of completing a 3-dose primary vaccination series with Td-containing vaccines should begin or complete a primary vaccination series. Tdap should be substituted for a single dose of Td in the vaccination series with Tdap preferred as the first dose. • For unvaccinated adults, administer the first 2 doses at least 4 weeks apart and the third dose 6–12 months after the second. • If incompletely vaccinated (i.e., less than 3 doses), administer remaining doses. Refer to the ACIP statement for recommendations for administering Td/Tdap as prophylaxis in wound management (See footnote 1).
F4
Developing a robust immunization program for DSB will be very complicated. It will require training and input from multiple sources and disciplines to identify workable logistics.
Related Recommendations (1)
R4
Varicella vaccination • All adults without evidence of immunity to varicella (as defined below) should receive 2 doses of single-antigen varicella vaccine or a second dose if they have received only 1 dose. • Special consideration for vaccination should be given to those who − have close contact with persons at high risk for severe disease (e.g., health-care personnel and family contacts of persons with immunocompromising conditions) or − are at high risk for exposure or transmission (e.g., teachers; child care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers). • Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. The second dose should be administered 4–8 weeks after the first dose. • Evidence of immunity to varicella in adults includes any of the following: − documentation of 2 doses of varicella vaccine at least 4 weeks apart; − U.S.-born before 1980 (although for health-care personnel and pregnant women, birth before 1980 should not be considered evidence of immunity); 15 − history of varicella based on diagnosis or verification of varicella by a health-care provider (for a patient reporting a history of or having an atypical case, a mild case, or both, healthcare providers should seek either an epidemiologic link to a typical varicella case or to a
Additional Recommendations 20
These recommendations are not explicitly linked to specific findings.
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R5Human papillomavirus (HPV) vaccination • Two vaccines are licensed for use in females, bivalent HPV vaccine (HPV2) and quadrivalent HPV vaccine (HPV4), and one HPV vaccine for use in males (HPV4). • For females, either HPV4 or HPV2 is recommended in a 3-dose series for routine vaccination at 11 or 12 years of age, and for those 13 through 26 years of age, if not previously vaccinated. • For males, HPV4 is recommended in a 3-dose series for routine vaccination at 11 or 12 years of age, and for those 13 through 21 years of age, if not previously vaccinated. Males 22 through 26 years of age may be vaccinated. • HPV vaccines are not live vaccines and can be administered to persons who are immunocompromised as a result of infection (including HIV infection), disease, or medications. Vaccine is recommended for immunocompromised persons through age 26 years who did not get any or all doses when they were younger. The immune response and vaccine efficacy might be less than that in immunocompetent persons. • Men who have sex with men (MSM) might especially benefit from vaccination to prevent condyloma and anal cancer. HPV4 is recommended for MSM through age 26 years who did not get any or all doses when they were younger. • Ideally, vaccine should be administered before potential exposure to HPV through sexual activity; however, persons who are sexually active should still be vaccinated consistent with age-based recommendations. HPV vaccine can be administered to persons with a history of genital warts, abnormal Papanicolaou test, or positive HPV DNA test. • A complete series for either HPV4 or HPV2 consists of 3 doses. The second dose should be administered 1–2 months after the first dose; the third dose should be administered 6 months after the first dose (at least 24 weeks after the first dose). • Although HPV vaccination is not specifically recommended for health-care personnel (HCP) based on their occupation, HCP should receive the HPV vaccine if they are in the recommended age group.
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R6Zoster vaccination • A single dose of zoster vaccine is recommended for adults 60 years of age and older • regardless of whether they report a prior episode of herpes zoster. Although the vaccine is • licensed by the Food and Drug Administration (FDA) for use among and can be administered to • persons 50 years and older, ACIP recommends that vaccination begins at 60 years of age. • Persons with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy or severe immunodeficiency. • Although zoster vaccination is not specifically recommended for health-care personnel (HCP), HCP should receive the vaccine if they are in the recommended age group.
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R7Measles, mumps, rubella (MMR) vaccination • Adults born before 1957 generally are considered immune to measles and mumps. All adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless they have a medical contraindication to the vaccine, laboratory evidence of immunity to each of the three diseases, or documentation of provider-diagnosed measles or mumps disease. For rubella, documentation of provider-diagnosed disease is not considered acceptable evidence of immunity. Measles component: • A routine second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who • are students in postsecondary educational institutions; − work in a health-care facility; or plan to travel internationally. • Persons who received inactivated (killed) measles vaccine or measles vaccine of unknown type from 1963 to 1967 should be revaccinated with 2 doses of MMR vaccine. Mumps component: • A routine second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who • are students in postsecondary educational institutions; − work in a health-care facility; or • plan to travel internationally. • Persons vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (e.g., persons who are working in a health-care facility) should be considered for revaccination with 2 doses of MMR vaccine. 16 • persons working with HAV-infected primates or with HAV in a research laboratory setting; persons with chronic liver disease and persons who receive clotting factor concentrates; persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A; and unvaccinated persons who anticipate close personal contact (e.g., household or regular babysitting) with an international adoptee during the first 60 days after arrival in the United States from a country with high or intermediate endemicity. (See footnote 1 for more information on travel recommendations). The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally 2 or more weeks before the arrival of the adoptee. • Single-antigen vaccine formulations should be administered in a 2-dose schedule at either 0 and 6–12 months (Havrix), or 0 and 6–18 months (Vaqta). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule may be used, administered on days 0, 7, and 21–30 followed by a booster dose at month 12. Rubella component: • For women of childbearing age, regardless of birth year, rubella immunity should be determined. If there is no evidence of immunity, women who are not pregnant should be vaccinated. Pregnant women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility. • Health-care personnel born before 1957: • For unvaccinated health-care personnel born before 1957 who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease, health-care facilities should consider routinely vaccinating personnel with 2 doses of MMR vaccine at the appropriate interval for measles and mumps or 1 dose of MMR vaccine for rubella.
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R8Pneumococcal polysaccharide (PPSV) vaccination • Vaccinate all persons with the following indications: − age 65 years and older without a history of PPSV vaccination; − adults younger than 65 years with chronic lung disease (including chronic obstructive pulmonary disease, emphysema, and asthma); chronic cardiovascular diseases; diabetes mellitus; chronic liver disease (including cirrhosis); alcoholism; cochlear implants; cerebrospinal fluid leaks; immunocompromising conditions; and functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]); − residents of nursing homes or long-term care facilities; and adults who smoke cigarettes. • Persons with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis. • When cancer chemotherapy or other immunosuppressive therapy is being considered, the interval between vaccination and initiation of immunosuppressive therapy should be at least 2 weeks. Vaccination during chemotherapy or radiation therapy should be avoided. • Routine use of PPSV is not recommended for American Indians/Alaska Natives or other persons younger than 65 years of age unless they have underlying medical conditions that are PPSV indications. However, public health authorities may consider recommending PPSV for American Indians/Alaska Natives who are living in areas where the risk for invasive pneumococcal disease is increased.
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R9Revaccination with PPSV • One-time revaccination 5 years after the first dose is recommended for persons 19 through 64 years of age with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); and for persons with immunocompromising conditions. • Persons who received PPSV before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose. • No further doses are needed for persons vaccinated with PPSV at or after age 65 years.
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R10Meningococcal vaccination • Administer 2 doses of meningococcal conjugate vaccine quadrivalent (MCV4) at least 2 months apart to adults with functional asplenia or persistent complement component deficiencies. • HIV-infected persons who are vaccinated should also receive 2 doses. • Administer a single dose of meningococcal vaccine to microbiologists routinely exposed to isolates of Neisseria meningitidis, military recruits, and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic. • First-year college students up through age 21 years who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday. 17 • MCV4 is preferred for adults with any of the preceding indications who are 55 years old and younger; meningococcal polysaccharide vaccine (MPSV4) is preferred for adults 56 years and older. • Revaccination with MCV4 every 5 years is recommended for adults previously vaccinated with MCV4 or MPSV4 who remain at increased risk for infection (e.g., adults with anatomic or functional asplenia or persistent complement component deficiencies).
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R11Hepatitis A vaccination • Vaccinate any person seeking protection from hepatitis A virus (HAV) infection and persons with any of the following indications: − men who have sex with men and persons who use injection drugs; • laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease); − history of herpes zoster based on diagnosis or verification of herpes zoster by a health-care provider; or − laboratory evidence of immunity or laboratory confirmation of disease.
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R12Hepatitis B vaccination
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R13Selected conditions for which Haemophilus influenzae type b (Hib) vaccine may be used • 1 dose of Hib vaccine should be considered for persons who have sickle cell disease, leukemia, or HIV infection, or who have anatomic or functional asplenia if they have not previously received Hib vaccine.
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R14Immunocompromising conditions • Inactivated vaccines generally are acceptable (e.g., pneumococcal, meningococcal, and influenza [inactivated influenza vaccine]), and live vaccines generally are avoided in persons with immune deficiencies or immunocompromising conditions. Information on specific conditions is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm. 18
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13-27Page 11Develop a robust catch-up immunization program for the County jails
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13-28Page 11Develop a counseling program to educate and promote the benefits of
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13-29Page 11In partnership with SDPHD, seek funding from the recently released
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13-30Page 11With training from SDPHD, begin use of CAIR-SDIR to enter and
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13-32Page 11Begin the catch-up immunization of sentenced inmates within their
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13-33Page 12In compliance with CDC recommendations, immunize pregnant
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13-34Page 12Provide Tdap vaccine to all inmates except those identified as being
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13-35Page 12In compliance with CDC recommendations, vaccinate with MMR all
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13-36Page 12In compliance with the recent CDC recommendations, screen all
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13-37Page 12Screen all inmates for HIV.
Agency Responses 7
Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.
No Responses Found 1
Government entities assigned to respond to this report. No response documents have been linked in our database.
County of San Diego
Agency