Background: The Belize Central Prison (BCP) has an average of 250 staff members and inmate population of 1200 housed in eighteen locations. Healthcare is provided by one medical officer assisted by inmates with basic medic skills. Belize recorded its first case of COVID-19 in March 2020 and BCP detected its first case in September 2020. The prison did not have a surveillance system; it was vital to implement the COVID-19 surveillance system to monitor cases and validate effectiveness of preventive measures. The objective of this report is to analyze surveillance system data and its ability to characterize the COVID-19 cases in the BCP for September 2020 to September 2022.

Methods: The BCP adopted the national COVID-19 guidelines. Each housing location was assigned a trained inmate performing daily screening of COVID-19 symptoms. Data collected was reviewed at the medic center and the medical officer approved candidates for testing via rapid antigen tests and/or PCR. Results were recorded in a Microsoft excel database and in the Ministry of Health electronic system.
A descriptive study of COVID-19 cases detected at the BCP were characterized using figures, graphs and tables. Attack rates, proportions, and frequencies were calculated.

Results: During the reporting period, a total of 2,796 inmates tested with 417 (14.9%) testing positive. 393 (94.2%) were males and 24 (5.8%) females; cases peaked at epi-week 43 in 2020 and 2021. The attack rate was 15.9%, median age 31 years (range 15-66). Two (2/18) of the housing units accounted for 23% of all cases. There were no hospitalization or deaths and 88% of inmates and 100% of prison staff were vaccinated.

Conclusions: Despite the limited resources, the prison’s COVID-19 surveillance system provided information to guide the action plan by the management of Kolbe Foundation, thus mitigating COVID-19 effects.