Assessment of the Risk of Zoonotic Infections in Prisons in French Guiana

The French Guiana Correctional Facility The French Guiana Correctional Facility (CPG) comprises a pretrial detention center characterized by a high turnover of inmates, a detention center, as well as a women's wing, a juvenile wing, and a day-release wing. The prison's theoretical capacity is 616 inmates, but chronic overcrowding is a serious problem, with the number of inmates reaching 1,050 in 2023-170% of its capacity. In 2023, the CPG recorded 1,750 inmates, including 121 women (11.5%)-more than the national average (around 4%). In total, 65% of the inmates were first-time offenders; the average age was 34, and more than half were French nationals. Approximately one-third of the inmates were serving sentences of less than 3 months.

Health care for inmates is part of a health care system that addresses all health issues, whether physical or psychiatric. The reform of the prison healthcare system entrusted the public hospital system with the responsibility for all such care. This care is governed by a methodological guide.

The CPG's Outpatient Consultation and Care Unit (UCSA) is responsible for addressing somatic issues, while the Incarceration Psychiatry Functional Unit (UFPI) handles psychological and psychiatric care. All incarcerated patients receive a routine initial medical examination (VME) within 48 hours of admission to custody, which includes a physical and psychological evaluation. One of the objectives of the VME is to detect any contagious or progressive conditions and to implement appropriate health measures. The inmate is evaluated both physically and psychologically. A clinical examination is performed. Following the consultation, specific treatment is recommended. An STI screening and a frontal chest X-ray are routinely offered, though they are not mandatory. The screening includes serology for syphilis, HIV, hepatitis B, hepatitis C, and HTLV, as well as urinary PCR tests for chlamydia and gonorrhea. The care pathway for detainees is well-structured, and they may also receive medical or paramedical consultations throughout their detention, with the wait time for a consultation depending on the level of urgency. In case of an emergency, the detainee may be transferred to the emergency medical department at the Cayenne Hospital. A routine annual checkup is offered.

The inmate population at the CPG is a vulnerable group facing a multitude of risk factors. Half of the prison population is French citizens originally from French Guiana. Furthermore, French Guiana is one of the French regions most affected by poverty; according to the national institute for statistics, 50% of the population lived below the poverty line in 2017. Compounding the issue of precarious living conditions are difficulties in accessing rights and healthcare. Nearly 30% of patients were undocumented prior to incarceration and were not entitled to outpatient care. Little data is available regarding educational attainment, but in 2020, 80.9% of inmates were referred by the prison administration to undergo an illiteracy assessment conducted by teachers. Precarious living conditions, low socioeconomic status, low educational attainment, and difficulties accessing healthcare and rights are recognized factors contributing to poor health. In addition to these pre-incarceration vulnerabilities, there are difficult conditions of detention, such as overcrowding exacerbated by prison overcrowding.

In terms of health and infectious disease risks, there is a high prevalence of people living with HIV (PLHIV), at 3.8% in 2021, representing approximately 3% of PLHIV under care in French Guiana in 2021. Following an analysis of tuberculosis-related risk, it was found that nearly 10% of people who reported having active tuberculosis between 2008 and 2020 in French Guiana had been incarcerated at least once.

Zoonotic risk In 2010, the prison administration commissioned an agency to assess the health risks associated with the presence of tens of thousands of swallows at the CPG. In fact, since the early 2000s, a colony of swallows has chosen the CPG as its roosting site. Their presence at the prison varies in size depending on the season. These swallows migrate to Argentina or southern Brazil starting in October to nest there and return to French Guiana to spend the southern hemisphere winter between April and May. A census conducted by the French Guiana Bird Study and Protection Group in July 2009 recorded 52,367 birds, more than 98% of which were Chalybea swallows. From October to April, when the bulk of the colony migrates south, some so-called "sedentary" swallows nevertheless remain in the vicinity of and within the prison grounds. Over the past ten years, this colony of "sedentary" birds has grown to its current size of approximately 15,000 to 25,000 birds. Numerous measures have been taken to scare the swallows away or relocate them, and the CPG has enlisted the help of experts to implement these measures.

These measures-which are by no means exhaustive-included installing protective nets, using gunshots to scare them away, setting up electric wires and ultrasonic devices, deploying inflatable scarecrows (shaped like falcons), using gas cannons and repellents, and constructing a structure adjacent to the CPG in an attempt to relocate them.

Overall, these various measures have been unsuccessful, but there appear to be fewer swallows each year (approximately 25,000 during the 2020 season). The agency report highlighted the zoonotic risk and conducted a theoretical assessment of these risks (in addition to an assessment of noise and odor nuisances). Four zoonoses were identified and considered to pose a risk of transmission within the prison: Chlamydia psittaci infections, toxoplasmosis, histoplasmosis, and Q fever.

Few studies on the health of incarcerated individuals have been conducted at the correctional facility; one study was reportedly carried out in the early 2000s by the Pasteur Institute of French Guiana, but the results were never published, and as a result, little information is available. It appears that rodents were captured, but no cases of Q fever were detected. No swallows or bats were captured. The presence of these animals has been confirmed, as they are potential reservoirs and/or intermediate hosts of zoonoses. The zoonotic risk is real but currently poorly understood. To date, although little data is available regarding zoonotic risks, given the high risk in the general population, these risks must be taken into account among the prison population in French Guiana.

Zoonoses are a major public health issue in French Guiana. They encompass a wide range of infections: bacterial (Q fever, leptospirosis), viral (rabies), parasitic (Chagas disease, toxoplasmosis, leishmaniasis), and fungal (histoplasmosis). These infections are responsible for a large number of hospitalizations and deaths, both during epidemics (such as leptospirosis) and in routine clinical practice (Q fever accounts for 30% of hospitalizations for pneumonia in the territory).

Although it is supposed to be isolated from the outside world, the CPG does not appear to be spared from these zoonotic diseases. There appear to be factors facilitating the transmission of zoonotic diseases-such as vectors and animal reservoirs-combined with overcrowding, and a lack of air conditioning. An endemic-epidemic circulation of Q fever within the CPG has recently been described. The incidence rate of acute, symptomatic Q fever even exceeded that of the general population in 2020. Other zoonotic diseases may be circulating within the CPG, as noted in the health risk assessment report by the agency (2010). The presence of rodents and swallows at the CPG could facilitate the spread of psittacosis (Chlamydia psittaci infection), Q fever, or histoplasmosis, although this hypothesis has not yet been verified.

Five zoonoses of interest were selected for this study :

• Q fever
• Leptospirosis
• Chagas disease
• Histoplasmosis
• Toxoplamosis

Study hypothesis We hypothesize that there is a risk of zoonotic disease transmission at the French Guiana Penitentiary Center (CPG). This study aims to assess the actual zoonotic risk among the CPG prison population in a systematic, comprehensive, and multidisciplinary manner. Five zoonoses of interest were selected based on their transmission cycle (presence of potential reservoirs or vectors within the prison) and their epidemiological characteristics.

Expected benefits

This study will make it possible to:

• Objectively assess the risk of zoonotic diseases within the French Guiana correctional facility
• Implement preventive, informational, or reassurance measures based on the results obtained.
• Increase knowledge about zoonotic diseases in correctional settings.
• Raise awareness among correctional staff and relevant authorities regarding the importance of health in correctional facilities.
• Contribute to improving the health and living conditions of inmates.
• Strengthen cooperation between health and justice stakeholders to foster an integrated approach to the prevention and management of infectious diseases in correctional facilities.