(Reuters Health) – Among vaccinated staff and inmates of Rhode Island prisons and jails, about 1% experienced breakthrough SARS-CoV-2 infections, a new study finds.
Weekly PCR testing of 2,380 incarcerated persons and staff members who had received at least one dose of a SARS-CoV-2 vaccine revealed 27 positives between March and May 2021, for an incidence rate of 1.3% among inmates and 0.8% among staff, according to the brief report published in the New England Journal of Medicine.
“The main take-home is that, coupled with decarceration, vaccination is a mitigation strategy that works at preventing severe disease and transmission in carceral settings,” said the study’s lead author, Lauren Brinkley-Rubinstein, an associate professor of social medicine and co-founder of the COVID Prison Project at the University of North Carolina, at Chapel Hill.
The study’s findings suggest that “prisons and jails should ensure that people who are incarcerated in their facilities should have equal access to the COVID-19 vaccine,” Brinkley-Rubinstein said in an email.
To look at the impact of vaccinations on workers and prisoners, Brinkley-Rubinstein and her colleagues turned to data from Rhode Island, which is one of six states with a unified carceral system.
The Rhode Island Department of Corrections (RIDOC) maintains six facilities that include a jail-like intake facility, buildings with three levels of security (minimum, medium, and maximum), and a women’s building on the same campus.
The RIDOC offered the two-dose Pfizer-BioNTech or Moderna vaccines to all incarcerated persons and staff members. Since November 2020, the standard of care at the RIDOC facilities has included weekly universal polymerase-chain-reaction (PCR) testing for SARS-CoV-2 to all incarcerated persons and staff members.
The policy includes a 10-day isolation period for all persons with symptoms or a positive Covid-19 test, but isolation can be ended early following two consecutive negative tests.
The researchers analyzed weekly PCR results from the RIDOC system between March 9 and May 6, 2021. Among the 4,638 people tested for COVID-19 were 2,380 who had received at least one dose of a SARS-CoV-2 vaccine. The analysis focused only on the vaccinated staff and prisoners, of whom 20 prisoners and 7 staff tested positive. All the cases detected were asymptomatic.
Of the 27 vaccinated people with positive test results, five had received one dose of the vaccine, five had received their second dose within two weeks before infection, and 17 received their second dose at least two weeks before infection.
The report presented no information on the unvaccinated staff or inmates. “We did not present unvaccinated outcomes because for this analysis, we were interested primarily in the rate of breakthrough cases post-vaccine,” Brinkley-Rubinstein said.
The study is helpful, but there are some concerns, said Seth Prins, an assistant professor of epidemiology and socio-medical sciences at Columbia University’s Mailman School of Public Health in New York City.
The main issue, Prins said, is that there is no comparison group of people who were not vaccinated. “If the percentage of unvaccinated people with positive tests is much higher, then that would be consistent with what we know about how vaccines work,” he added. “But if they are not much higher, it could mean other mitigation efforts within the prison suppressed the virus.”
“My concern is that people might take the results to mean that prisons are safe and I think without the context of the substandard mitigation efforts we know are going on in jails and prisons, we can’t really conclude that,” Prins said. “I worry that people who are resistant to reform might take that message and run with it.”
“Even with vaccines, there is a much higher positivity rate among prisoners and incarcerated people (than among the general population),” Prins said. “We can’t lose sight of this if we’re going to have a surge of variants.”
“The ultimate message needs to be that we should be releasing as many prisoners as possible to protect their health and the health of their families and communities,” Prins said.
SOURCE: https://bit.ly/3wF9mVr NEJM, online July 7, 2021.
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