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Síndrome metabólico; Epidemiología; Prisiones Metabolic syndrome; Epidemiology; Prisons Síndrome metabòlica; Epidemiologia; Presons Objetivo Investigar la prevalencia de la morbilidad metabólica (MM) en población penitenciaria. Diseño Estudio observacional, transversal y multicéntrico. Emplazamiento Los 9 centros penitenciarios de Cataluña. Participantes Reclusos que no están en «régimen abierto» y, por consiguiente, dependen sanitariamente de los equipos de atención primaria penitenciaria (EAPP). Intervenciones Se consideraron internos con MM los que presentaban al menos un componente del síndrome metabólico: obesidad, hipertensión arterial, diabetes tipo 2 y/o dislipidemia. Se estudiaron variables antropométricas, antecedentes clínicos y parámetros analíticos asociados a la MM. Fuente de información: Sistema de Información de los Servicios de Atención Primaria de Cataluña (SISAP). Mediciones principales Cálculo de prevalencia de la MM, total y por categorías. Para estudiar variables asociadas se realizó un análisis de regresión logística multivariante, calculándose la odds ratio ajustada (ORA) con intervalo de confianza del 95%. Resultados Un total de 4.338 internos estudiados: el 93,9% hombres, edad media 38,4 años, 51,7% de la Unión Europea y 6,7% (8,2% de los analizados) infectados por VIH. Presentaron más MM los de más edad y las personas infectadas por VIH y menos los europeos de países no miembros de la Unión Europea, los del Magreb y los del África subsahariana. Conclusiones La prevalencia de MM es alta en presos, aun siendo una población joven, especialmente en reclusos de mayor edad y en infectados por VIH. La prevalencia varía mucho según el origen geográfico. Es conveniente que la MM sea detectada precozmente para evitar complicaciones. La prevención, la detección y el manejo terapéutico deben ser actividades prioritarias de la atención primaria penitenciaria. Objective To investigate the prevalence of metabolic morbidity (MM) amongst prison inmates. Design Multicentric, cross-sectional observational study. Setting All (nine) prisons in Catalonia. Participants Convicted inmates that are not in an «open regime», whose healthcare relies on the Prison Primary Care Teams. Interventions MM was defined as the presence of at least one component of the metabolic syndrome, i.e., obesity, arterial hypertension, type 2 diabetes, and/or dyslipidemia. The variables collected included anthropometric measurements, medical history and laboratory values related to MM. The source of information was the Catalan Primary Healthcare Services Information System (SISAP). Main measurements The prevalence of MM, overall and by several participant subcategories, was calculated. To investigate the risk factors associated to a higher prevalence of MM, a multivariable logistic regression analysis was carried out and expressed as adjusted odds ratios and 95% confidence intervals. Results 4338 inmates were studied, of whom 93.9% were male. Mean age was 38.4 years, 51.7% were born in European Union countries, and 6.7% were infected by HIV. The variables associated with a significantly increased risk of presenting MM were older age and HIV infection, whereas certain geographical origins (i.e., non-UE European countries, Maghreb and Sub-Saharan Africa) were associated with lower risk of MM. Conclusions In spite of being an overall young population, prison inmates present high rates of MM. Older age, HIV infection and geographic origin appear as the most strongly associated factors with MM in the prison population. MM should be detected early in order to prevent complications. Prevention, screening and treatment of MM ought to be considered a priority in the clinical routine of prison healthcare professionals.

IntroductionTo analyse the effectiveness of a dose of adenovirus vector ChAdOx1 vaccine (AVChOx1) in an outbreak of SARS-CoV-2 detected in a prison.MethodsObservational study carried out at Brians-1 Prison, Barcelona. After detecting a case of infection, rt-PCR was administered to all prisoners (some of whom had been vaccinated 21-23 days previously with a dose of AVChOx1) and to staff. Infection rates in vaccinated and unvaccinated populations were calculated, as was vaccine effectiveness.ResultsOne hundred and eighty-four asymptomatic prisoners (50.3% vaccinated) and 33 staff were screened. Forty-eight (25.9%) infections by the SCV-B.1.17 variant were recorded in prisoners and none in staff. Infection rates were higher in younger prisoners, immigrants, and those admitted ≥7 days previously. In all, 22.6% of vaccinated subjects were infected vs. 29.3% of unvaccinated. Vaccine effectiveness was 23%. Only 6.2 cases would have been prevented by vaccinating the unvaccinated individuals. At seven days, the rt-PCR was negative in 46.2% of vaccinated subjects vs. 13.6% of unvaccinated (p = 0.02).DiscussionIn a prison outbreak, a dose of AVChAdOx1 administered 21-23 days earlier did not significantly prevent the occurrence of infections, but did reduce the duration of rt-PCR positivity. Maintaining post-vaccination preventive measures is essential.

Background Prisoners and other high-risk patients who show a sustained virological response (SVR) after treatment for hepatitis C virus (HCV) can become reinfected. We aimed to calculate the rate of HCV reinfection in a large cohort of inmates with SVR and to determine factors that predict reinfection. Methods We included all inmates treated for hepatitis C in Catalonia (Spain) from January 2002 to December 2016 who achieved SVR and in whom viral load was subsequently determined. The incidence rate was calculated per 100 person-years (100 py) of follow up. Risk factors associated with reinfection were evaluated by bivariate log-rank test and multivariate Cox regression. Hazard ratio (HR) and their 95% confidence intervals (CI) were calculated. Results 602 patients were included, with a mean age of 37.9 years: 95% were men, 74.1% had a history of intravenous drug use (IDU) and 28.7% were HIV-infected. Patients were followed for a total of 2154.9 years (average 3.58 ± 3.1 years). 63 (10.5%) had HCV reinfection. 41 (65.1%) presented different genotype/subgenotype, 8 the initial genotype/subgenotype, and in 14 (22.2%) the genotype could not be determined. Of the 21 reinfected patients who were interviewed, 20 (95.2%) reported IDU after antiviral treatment, and 7 (33.3%) during treatment. The overall incidence of reinfection was 2.9 cases per 100 py. All reinfections occurred in patients with IDU history. At multivariate level, HIV infection was associated with reinfection (HR = 3.03; CI:1.82-5.04). Conclusion In HIV-infected inmates with IDU history, the rate of reinfection of HCV post-SVR is very high. Prisons play a key role in the detection and treatment of infection and reinfection by HCV and in the post-treatment monitoring in these patients, which should be combined with counseling and the optimization of the harm reduction programs. Effective control of these vulnerable groups favours the elimination of the HCV infection.

An outbreak of SARS-CoV2 infection in a Barcelona prison was studied. One hundred and forty-eight inmates and 36 prison staff were evaluated by rt-PCR, and 24.1% (40 prisoners, two health workers and four non-health workers) tested positive. In all, 94.8% of cases were asymptomatic. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. There were no deaths. Generalised screening and the isolation and evaluation of the people infected were key measures. Symptom-based surveillance must be supplemented by rapid contact-based monitoring in order to avoid asymptomatic spread among prisoners and the community at large.