Publisher’s Platform: Message to Public Health — It is time, past time, to change views on hepatitis A vaccines for food handlers

I will spare you the list of hepatitis A cases that I have been involved with since 1998 when I represented 30 people exposed in a Seattle, Washington Subway restaurant, including one child who suffered acute liver failure requiring an emergency liver transplant.

There have been dozens in the last 24 years, many with tragic consequences.  Yet, here we are once again.

The Montgomery County Office of Public Health announced today the temporary closure of Gino’s Ristorante & Pizzeria in West Norriton in relation to a Hepatitis A Virus outbreak in the county. The restaurant will be closed until further notice while the investigation continues. Authorities believe the outbreak began in late November.

Currently, 11 total cases are under investigation, with 9 confirmed cases of Hepatitis A and 2 potential cases of Hepatitis A. Of the 9 confirmed cases, 7 people were hospitalized. To date, one death is confirmed, and one additional death is under investigation.

Hepatitis A is considered preventable via good personal hygiene practices such as thorough handwashing and glove wearing. Hepatitis A is the only vaccine preventable foodborne illness. Hepatitis A vaccines are available, and nationwide are given out free by local health departments, or at a cost of less than $100.

Here is what the CDC continues to say about vaccinating food handlers:

Why does CDC not recommend all food handlers be vaccinated if an infected food handler can spread disease during outbreaks?

CDC does not recommend vaccinating all food handlers because doing so would not prevent or stop the ongoing outbreaks primarily affecting individuals who report using or injecting drugs and people experiencing homelessness. Food handlers are not at increased risk for hepatitis A because of their occupation. During ongoing outbreaks, transmission from food handlers to restaurant patrons has been extremely rare because standard sanitation practices of food handlers help prevent the spread of the virus. Individuals who live in a household with an infected person or who participate in risk behaviors previously described are at greater risk for hepatitis A infection.

CDC, you miss the point, granted food service workers are not more at risk of getting hepatitis A because of their occupation, but they are a risk for spreading it to customers. Also, food service are low paid jobs that certainly have the likelihood of being filled by people who are immigrants, where hepatitis A might be endemic, or people who have been recently homeless.

What should I do if I have eaten at a restaurant that has reportedly had a hepatitis A-infected food handler?

If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department who can help you to learn if you were recently exposed to hepatitis A virus at that restaurant, have not been vaccinated against hepatitis A, and might benefit from either hepatitis A vaccine or an injection of immune globulin. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.

I will also spare you the numerous times I pleaded with the CDC, local and state health officials, and restaurants to require hepatitis A vaccinations for food handlers.  Let’s be clear, had the food handler who exposed patrons of Gino’s Ristorante & Pizzeria been vaccinated against hepatitis A, we would not be having this discussion.

My guess is that the cost of a hepatitis A vaccine looks very appetizing at this point.

Additional Resources

• About Hepatitis A
• Hepatitis A Fact Sheet
• Hepatitis A Video
• Marler Clark Hepatitis A Video
• Hepatitis A Litigation