June 14, 2024

CDC Recommendations for Correctional Staff

Access current CDC guidelines and recommendations for testing, vaccination, and treatment of HIV, viral hepatitis, and tuberculosis (TB)/latent TB infection (LTBI) for people who work in correctional or detention settings. Links to full-text recommendations for each disease area are listed at the end of the page.

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Testing, Vaccination, and Treatment for HIV, Viral Hepatitis, and Tuberculosis/Latent TB Infection (TB/LTBI)

CDC provides a summary of recommended actions upon hire and in response to an occupational exposure for people who work in correctional or detention settings. The following prevention recommendations for staff should be implemented within the context of a facility's Occupational Health program. If testing, vaccination, or post-exposure prophylaxis for occupational exposures are unavailable through an Occupational Health program, staff should be instructed to seek these services from their personal healthcare provider or local public health department.

Access summary recommendations for persons who are incarcerated or detained:

Keep Reading: CDC Recommendations for Correctional and Detention Settings

Recommended actions for staff

Testing

HIV: Staff with an occupationalAexposure to HIVB

HBV: Staff with an occupationalA exposure to HBVC

HCV: Staff with an occupationalA exposure to HCVD

Test with NAT for HCV RNA at 3 weeks postexposureD

TB and LTBI:

Upon hire:

All staff should be screened for TB diseaseE
Perform a blood test (interferon-gamma release assay [IGRA] for TB infection) for all healthcare staff without documented history of a previously positive test result; a tuberculin skin test (TST) is an acceptable alternativeF

Periodic screening:

Annual testing of staff is not recommended unless there is a known exposure or ongoing transmissionF
Healthcare staff members who have untreated LTBI should be screened for symptoms of TB disease annuallyF

If exposed:

Any staff member with an exposure to a person with infectious TB should receive a TB symptom screen as soon as exposure is known. If no documented history of a prior positive TB test result, staff should be tested immediately and again 8–10 weeks after the last known exposure, preferably using the same test at time of hire

Vaccination

HAV:

As post-exposure prophylaxis following an occupational exposure to HAVG
Consider during an outbreak for persons at high risk for infection
Consider in facilities where hygiene is difficult to maintain

HBV:

All previously unvaccinated persons whose work duties may involve exposure to blood or other potentially infectious body fluids
As post-exposure prophylaxis following an occupational exposure to HBVC

Treatment

HIV: Antiretrovirals as post-exposure prophylaxis for staff with an occupational exposure to HIVA. Start post-exposure prophylaxis treatment as soon as possible after occupational exposure to HIV and continue treatment for a 4-week duration

HBV: Advise staff to seek consultation from their personal healthcare provider if they have a positive test result.

HCV: Advise staff to seek consultation from their personal healthcare provider if they have a positive test result.

TB and LTBI:

Positive test result for TB infection:

Staff should be evaluated to diagnose TB disease or LTBI.

TB disease:

Staff should be excluded from work until determined to be non-infectious.

Once TB disease has been excluded, treatment for LTBI is recommended for most persons.

Short-course rifamycin-based regimens are the preferred treatment for LTBIH.

Additional considerations for HIV, Hepatitis B, and Hepatitis C

Given the higher prevalence of these diseases among people incarcerated and the potential for occupational exposure, facilities with an Occupational Health program could consider including HIV, HBV, and HCV screening for all staff and HBV vaccination for staff who are identified as unvaccinated and susceptible to HBV infection upon hiring. All facilities could consider including education on screening and vaccination for these diseases for their staff and advise staff to follow up with their primary care provider to ensure they are up to date with CDC recommendations. CDC recommendations include:

HIV:

Screening: everyone between the ages of 13 and 64 should get tested for HIV at least once as part of routine health care

HBV:

Screening: all adults aged 18 years or older should be screened for HBV at least once in their lifetime
- During initial screening, test for HBsAg, anti-HBs, and total anti-HBc
Vaccination: HBV vaccine is recommended for all adults age 19 through 59 years and adults age 60 years or older with risk factors for hepatitis B infection

HCV:

Screening: all adults aged 18 years or older should be screened for HCV at least once in their lifetime
- Complete HCV testing includes HCV antibody with reflex to NAT for HCV RNA when HCV antibody is reactive

Public health reporting

If a staff member is diagnosed with HIV, viral hepatitis, or TB, the case should be reported to the appropriate public health jurisdiction or authority, especially in those states where reporting is required by law. Note that HIV, TB, and viral hepatitis are all nationally notifiable conditions; TB infection or LTBI is also reportable in some states. States voluntarily report notifiable disease cases to CDC (without personal identifying information) to facilitate nationwide aggregation and monitoring of disease trends.