Communicable Diseases in Inmates: Public Health Opportunities

At midyear 1997, more than 1.7 million people, or 1 of every 155 U.S. residents, were in either jail or prison. At yearend 1997, 1 of every 117 males and 1 of every 1,852 females in this country were sentenced prisoners under State or Federal criminal jurisdiction.1 Fifteen million arrests are made annually,2 and more than 10 million individuals are released from detention each year. Approximately two-thirds of incarcerated individuals are in State and Federal facilities, and the remaining one-third are in local, generally short-term-stay jails.3 Any discussion of the public health implications of prisoners in this country must pay heed to these statistics. The incarcerated community cannot and must not be considered a small, separate population with minimal relevance to the outside community. People who are currently in the criminal justice system, those who have been in the past, and those who are destined to be in the future comprise a large segment of the overall population of this country, particularly in the urban centers. Furthermore, the view that physical separation limits the health threat of prisoners to the outside community is a dangerous misconception. The number of inmates released into the community annually4 should dispel this myth, as should the average length of stay in local jails, which is often on the order of several days to several weeks. In a worst-case view these facilities can serve as places where arrestees go, acquire and/or transmit infection, and are quickly released to further spread their infection in the outside community.5