CorrectCare

The Experience in Puerto Rico

by Carlos E. Rodríguez-Díaz, MPHE, CCHP

In a similar scenario, from mid-July to August 2009, the Puerto Rican Correctional System—the component of the PR Department of Corrections that encompasses nearly 31 facilities housing an average of 11,500 inmates age 18 and older—had 49 cases reported of suspicious influenza A among inmates. Of those, only two were confirmed cases of influenza A H1N1. Correctional Health Services Corp. (a not-for-profit organization responsible for health care in the PRCS), the PR Department of Health and the PR DOC solved all of these cases with no complications.

Our success with these inmates was mostly due to early preparation. By July of 2009, CHSC had approved guidelines for the surveillance, diagnosis and report of potential cases of influenza A H1N1 based on recommendations of the PR DOH, the Centers for Disease Control and Prevention and the World Health Organization. CHSC also developed a preparedness and contingency plan for pandemic influenza coordinated with governmental agencies in Puerto Rico. When the first cases of H1N1 were identified in Puerto Rico, the PRCS became a sentinel provider and accounted with a full supply of oseltamivir (Tamiflu, pills and suspensions) and zanamivir (Relenza) inhalators.

The PRCS approach to H1N1 was based on risk reduction, rapid detection of cases, management and isolation of cases and collaborations. Visits to the PRCS were regulated, and vulnerable health care facilities—such as emergency rooms and intake centers—were identified to reinforce the protective measures and capacity of health professionals and correctional officers to address the emergent needs. Identification of the most appropriate facilities in the PRCS to provide care to the suspected cases was a major component in curbing this public health threat as it enabled us to assign physicians and nurses specifically to these inmates. In addition, correctional officers and other health care providers helped to identify at-risk individuals (inmates with chronic diseases, elders, pregnant women and professionals working in the facilities) and to monitor the inmates’ general health status. Diverse professionals including physicians, nurses, epidemiologists, health educators and correctional officers, among others, participated in these activities.

— About the author: Carlos E. Rodríguez-Díaz, MPHE, CCHP, is a public health consultant, Correctional Health Services Corp., Guaynabo, PR. He prepared this summary with the help of colleagues in the CHSC Clinical Services Division.

[This article first appeared in the Summer 2009 issue of CorrectCare.]