As I contemplate the April HEPP Report articles, I have come to the conclusion that we could not have chosen two more controversial and current issues in health care today - the treatment of HCV infection in prisoners and the administration of smallpox vaccine to health care professionals.

In the past, much of the controversy regarding HCV treatment was due to poor sustained response rates to therapy that is not only expensive, but also fraught with significant side effects. Although potential side effects are still worrisome, combination therapy with pegylated interferon and weight-based ribavirin now provides improved sustained response rates, making therapy more attractive to both the patient and the provider. Approximately one third of those infected with HCV in the U.S. cycle through the correctional system. We have a remarkable opportunity to improve the health of the nation by screening, testing, counseling, and when possible, providing treatment to the incarcerated.

In corrections, and elsewhere in health care, the very real issue is, how can we pay for this effective, but expensive treatment? The answer is local, state, and federal funding, which there is less of in recent months due to downward trends in the economy and the war in Iraq. We must continue to educate our administrators and legislators to ensure that when funds become available, they can be requested and allocated for effective HCV treatment.

In this month's lead article, Dr. Scott Allen convincingly advocates for a systematic approach to managing hepatitis C in corrections. Such an approach will vary among the varying correctional jurisdictions and will be based on current and future resources. Despite the current inability to treat every prisoner who has HCV infection, we should screen and test those who may be affected and provide appropriate counseling regarding transmission to others, the importance of avoiding alcohol, and the potential for future treatment options.

In this month’s spotlight, Dr. Joe Bick outlines the threat faced by correctional facilities that employ individuals who have received the smallpox vaccination, and reviews CDC guidelines for preventing transmission while the inoculation site heals.

After reading this month's issue, you should be familiar with the issues surrounding the approach correctional institutions are taking with HCV-infected inmates, as well as CDC guidelines for smallpox vaccination and the precautions that should be taken to minimize transmission of the vaccina virus while the inoculation site heals.