Managing Outbreaks of Highly Contagious Diseases in Prisons: A Systematic Review

Background: There are reports of outbreaks of coronavirus disease 2019 (Covid-2019) in prisons in many countries. Responses to date have been highly variable and it is not clear whether public health guidance has been informed by the best available evidence. We conducted a systematic review to synthesise the evidence on outbreaks of highly contagious diseases in prison. Methods: We searched seven electronic databases for peer-reviewed articles and official reports published between 1 January 2000 and 26 March 2020. We excluded studies that did not provide detail on interventions. We synthesized common themes using SWiM guidelines, identified gaps in the literature and critically appraised the effectiveness of various containment approaches. Findings: We identified 27 relevant studies. Investigations were all based in high-income countries and documented outbreaks of tuberculosis, influenza (types A and B), varicella, measles, mumps, and adenovirus. Several themes were common to these reports, including the public health implications of infectious disease outbreaks in prison, and the role of multi-agency collaboration, health communication, screening for contagious diseases, restriction, isolation and quarantine, contact tracing, immunisation programmes, surveillance, and prison-specific guidelines in addressing any outbreaks. Interpretation: Prisons are high-risk settings for the transmission of contagious diseases and there are considerable challenges in managing outbreaks in them. A public health approach to managing Covid-19 in prisons is required.