Hepatitis C Outbreak Identification and Response in a High-Security Unit Within a California County Jail

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Hepatitis C virus (HCV) transmission persists in correctional facilities, driven by unregulated tattooing and injection drug use.
• Current screening guidelines may miss cases as risk behaviors are often underreported.
• In-custody HCV transmission poses a significant risk for outbreaks within facilities.

Purpose of the Study:

• To describe a multiwave HCV outbreak in a California county jail.
• To identify demographics, clinical characteristics, and risk factors associated with in-custody HCV transmission.
• To evaluate factors necessitating testing beyond routine admission screening.

Main Methods:

• A case study approach was used to investigate an HCV outbreak over 12 months in a high-security jail unit.
• Data collection included routine screening, symptomatic testing, self-requested screening, and response testing.
• Viral sequencing was performed on available samples to assess genetic linkage.

Main Results:

• Twelve HCV cases were detected, with recent tattooing (75%) and shared ink (50%) being primary risk factors.
• Twenty-five percent reported sharing sharps or injecting drug use.
• Three of five sequenced samples were genetically linked, indicating transmission within the facility.

Conclusions:

• Unregulated tattooing is a significant driver of HCV transmission in correctional settings.
• Outbreak response and testing beyond initial screening are vital for controlling in-custody HCV.
• Findings can inform policies to prevent future HCV outbreaks in jails.