Article Text

Managing outbreaks of highly contagious diseases in prisons: a systematic review
  1. Gabrielle Beaudry1,
  2. Shaoling Zhong2,
  3. Daniel Whiting1,
  4. Babak Javid3,
  5. John Frater4,
  6. Seena Fazel1
  1. 1Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
  2. 2Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
  3. 3Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA
  4. 4Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
  1. Correspondence to Professor Seena Fazel; seena.fazel{at}


Background There are reports of outbreaks of COVID-19 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 28 July 2020. We included quantitative primary research that reported an outbreak of a given contagious disease in a correctional facility and examined the effects of interventions. We excluded studies that did not provide detail on interventions. We synthesised common themes using the Synthesis Without Meta-analysis (SWiM) guideline, identified gaps in the literature and critically appraised the effectiveness of various containment approaches.

Results We identified 28 relevant studies. Investigations were all based in high-income countries and documented outbreaks of tuberculosis, influenza (types A and B), varicella, measles, mumps, adenovirus and COVID-19. Several themes were common to these reports, including the public health implications of infectious disease outbreaks in prison, and the role of interagency collaboration, health communication, screening for contagious diseases, restriction, isolation and quarantine, contact tracing, immunisation programmes, epidemiological surveillance and prison-specific guidelines in addressing any outbreaks.

Discussion 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.

PROSPERO registration number CRD42020178827

  • systematic review
  • public health
  • avian influenza
  • prevention strategies
  • infections
  • diseases
  • disorders
  • injuries
  • COVID-19
  • prisons

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  • GB and SZ are joint first authors.

  • Handling editor Stephanie M Topp

  • Twitter @gab_beaudry, @zsl426, @Dr_dannywhiting, @javid_lab, @seenafazel

  • Contributors GB, SZ and SF designed the study. GB and SZ conducted the data search, extraction and drafted tables. GB, SZ, DW and SF drafted the paper and all authors critically revised it.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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