Hepatitis A is a communicable disease that often spreads from person to person. Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water. Food-related outbreaks are usually associated with contamination of food during preparation by a hepatitis A – infected food handler. The food handler is generally not ill because the peak time of infectivity – that is, when the most virus is present in the stool of an infected individual – occurs two weeks before illness begins. Hepatitis A symptoms may not occur for several weeks after exposure and may include abdominal discomfort, fever, malaise, muscle aches, and a yellowing of the skin called jaundice. In rare cases, hepatitis A causes liver failure and death.
In 2017 San Diego saw at least 577 illness with 20 deaths and 396 hospitalizations some of those illnesses have spread to local restaurants workers. We also saw clusters of hepatitis A illnesses spreading to other parts of California as well as Utah, Kentucky, New York and Hawaii, and there are likely other less reported hepatitis A illnesses. The largest outbreak that has also spread to restaurant workers is in South East Michigan where the total number is 658 illnesses with 22 deaths.
In 2006, the CDC recommended routine hepatitis A vaccination for all children ages 12-23 months, that hepatitis A vaccination be integrated into the routine childhood vaccination schedule, and that children not vaccinated by two years of age be vaccinated subsequently. The vaccine is also recommended for the following persons: Travelers to areas with increased rates of hepatitis A, Men who have sex with men, Injecting and non-injecting drug users, Persons with clotting factor disorders, Persons with chronic liver disease, Persons with occupational risk of infection, Children living in regions of the U.S. with increased rates of hepatitis A, and Household members and other close personal contacts.
The CDC has not yet recommended hepatitis A vaccinations for food service workers. However, to Oakland County Michigan Health Department’s credit, in the last weeks it has hosted vaccination clinics for restaurant workers. In fact, the department recognized restaurant workers as a priority target for the limited supply of the hepatitis A vaccine because they handle other people’s food and could unknowingly infect customers with the hepatitis A virus.
Other health departments – especially in areas with active hepatitis A outbreaks – should take Oakland County’s lead. In addition, restaurants, in those areas or generally, are putting themselves and their customers at risk if they do not offer hepatitis A vaccines to their employees.
One hepatitis A positive food service worker can infect customers and cause thousands of customers to seek preventive vaccines. Illness and vaccines can cost us all thousands if not millions of dollars, and can cost restaurants its viability either by a downturn in customers or an increase if lawsuits.
All of this is preventable by a vaccine.