With nearly a quarter of the world’s prison population, the United States is home to an ailing prison health care system and its large aging subpopulation. Our nation’s experience with tuberculosis, HIV and the ongoing hepatitis C epidemic has taught us that correctional settings are reservoirs of infectious diseases. Prisons push people into the paths of epidemics. Yet for those 2.4 million people under judicial custody, public guidelines and preparedness are lacking to curtail their burden of infectious diseases.