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Better to Vaccinate Food Workers Ahead of Time

Making restaurants pay for vaccinating their own employees against hepatitis A before they become food service workers would be a far cheaper alternative than running huge vaccination clinics after a food service worker becomes infected and exposes the public.

The city of Lubbock, TX is the latest community holding a vaccination clinic — at a cost of $256,000 — for anyone who dined at Cheddar’s Casual Cafe between Aug. 31 and Sept. 8. A restaurant employee working in food preparation at that time later tested positive for the virus.

“From both a public health perspective and business perspective, it makes sense for restaurants to vaccinate their employees against hepatitis A before being forced to go through mass customer vaccines,” says food safety attorney Bill Marler, publisher of Food Safety News.

Marler says it would be simpler for restaurants to pay to keep their employees vaccinated rather than put hundreds and sometimes thousands through the ordeal of waiting in lines for hours to get hepatitis A vaccine or Immune globulin.

“The amount of business Cheddar’s and other restaurants lose in a situation like this can be devastating,” he added.  “Worker vaccinations are not only an investment in employee and customer health, but the health of the business as well.”

Hepatitis A is a communicable disease.  It is spread almost exclusively through ingestion of fecal matter, even in microscopic amounts, from person-to-person contact, or via contaminated food or beverages. It is the only common foodborne illness that is vaccine preventable.

Lubbock’s free clinic with vaccines and Immune globulin shots will be held  September 15-19 at the Memorial Civic Center.  Anyone who dined at Cheddar’s between August 31 and September 8 may have been exposed to the virus and should participate in the clinic, officials say.

Earlier this year, an estimated 3,000 people were exposed to hepatitis A at an Olive Garden restaurant in Fayetteville, NC.

© Food Safety News
  • John C.

    I completely agree that vaccinating the employees would be the best way to prevent the devesting effects a Hepatitis situation causes. As a retired supervisor of Food Protection of a County Health Department in Western New York, I have seen two restaurants go out of business because of Hepatitis Outbreaks. After the outbreaks some food establishment owner/operators had their employees vaccinated, however, with the huge employee turnover in the industry the preventive vaccination program has been abandoned. It’s worth noting that anyone can get the Hep.A or the newer Hep.A/B vaccine. For about $110.00 it’s cheap “insurance” and gives you life long immunity. My wife and I got ours over 10 years ago.

  • Your statement, “It [hepatitis A] is the only foodborne illness that is vaccine preventable.” is incorrect.
    The CDC says, at least, rotavirus and typhoid fever (see http://www.cdc.gov/vaccines/vpd-vac/default.htm) and cholera (see http://www.cdc.gov/cholera/prevention.html) have vaccines.
    My guess is that millions of American servicemen and women, like I, took the cholera vaccine during the Vietnam War.
    I ask that you correct the article and also note the correction in the article.

  • mrothschild

    Thank you, Harry, for the opportunity to inform parents about rotavirus and the available vaccines to prevent it. Information about rotovirus, symptoms, transmission, treatment and prevention is available at the CDC website: http://www.cdc.gov/rotavirus/about/index.html
    Also, the way you typed the link will take readers to the wrong page. Try this instead to learn about the life-saving importance of vaccines:
    http://www.cdc.gov/vaccines/vpd-vac/default.htm

  • Although you may be correct Mr. Hamil, the two you mention are very seldom found in the United States as a Foodborne contaminant. For example Cholera in the US is only 0-5 cases a year. Obviously vaccinating food workers for this would not be cost effective. So although you may be correct Mr. Marler is correct in the sense that Hep A is the only Foodborne illness that has a vaccine and is still of concern in the United States Food Industry.
    Jim Schmidt, REHS

  • Your statement, “It [hepatitis A] is the only foodborne illness that is vaccine preventable.” is incorrect.
    The CDC says, at least, rotavirus and typhoid fever (see http://www.cdc.gov/vaccines/vpd-vac/default.htm) and cholera (see http://www.cdc.gov/cholera/prevention.html) have vaccines.
    My guess is that millions of American servicemen and women, like I, took the cholera vaccine during the Vietnam War.
    I ask that you correct the article and also note the correction in the article.

  • Mary Rothschild

    Thank you, Harry, for the opportunity to inform parents about rotavirus and the available vaccines to prevent it. Information about rotovirus, symptoms, transmission, treatment and prevention is available at the CDC website: http://www.cdc.gov/rotavirus/about/index.html
    Also, the way you typed the link will take readers to the wrong page. Try this instead to learn about the life-saving importance of vaccines:
    http://www.cdc.gov/vaccines/vpd-vac/default.htm

  • Thanks, Mary, for the link to Dr. Fiore’s article as the source of FSN’s revised statement, “It is the only common foodborne illness that is vaccine preventable.” Dr. Fiore’s article provides additional data which I found useful in evaluating Bill Marler’s proposal that ALL food service workers be vaccinated.
    Near the top of the right column just below figure 2, Dr. Fiore wrote, “there were 6.5 million food and beverage serving jobs in 2000 [33], and the industry is the largest private employer in the United States [35].” The bracketed numbers are his footnotes as to his sources for this info. And thanks to John S’s comment, I learned that he paid $110 for his hepatitis A vaccination. Combine these and we have a cost of over $700,000,000 initially to vaccinate every food service workers. Obviously, the cost per vaccine would drop were it to be to every food service worker. I, also, learned that Dr. Fiore did NOT recommend such an action.
    Add to this the fact that Table 2 of the CDC estimate published on 12-15-10, “Foodborne Illness in the United States—Major Pathogens” (http://www.cdc.gov/eid/content/17/1/pdfs/09-1101p1.pdf), estimates the number of cases of domestically acquired foodborne illness due to hepatitis A as only 1566 (90% confidence interval 702-3,024) and we can see that the cost benefit ratio is quite high because the turnover in these jobs is quite high.
    As the CDC also estimated there were almost 10 times as many cases due to rotavirus (15,433 with a 90% confidence interval of 5,569-26,643) as hepatitis A, it is clear that although FSN’s revised statement, “It (hepatitis A) is the only common foodborne illness that is vaccine preventable,” came from a reputable source (an “invited article” in the CDC journal, Food Safety), unfortunately, it is still incorrect.
    Once again, I ask that FSN correct the article and also not the correction in the article.
    BTW, the CDC estimate calls vibrio cholerea a “major pathogen” and estimates the number of number of domestically acquired foodborne cases as 84. The designation of “major” may be due to the fact that CDC estimates that about 200 additional Americans will acquire the disease while traveling.

  • mrothschild

    You are welcome, Harry.

  • Harry, it is good to see you back so often after telling us that you would stop reading and commenting. You are the moth to my flame. By the way, did you get the book, “Poisoned” after renewing your subscription?
    Harry, I have to admit I enjoy your comments (well, not all), but I do not see anything here that needs to be corrected. Hepatitis A has been a problem for restaurants and their customers for decades. I have seen the inconvenience, and illnesses and deaths. Some restaurants (after an outbreak or exposure and forced vaccinations of customers – and resulting lawsuits) have instituted employee vaccines. The city of St. Louis required shots for restaurant employees. Some cities and states have spent thousands of dollars paying for investigations and vaccines caused by the risk of an ill employee. I am simply not aware that rotavirus and typhoid fever have been the cause for the same level of concern for the restaurant industry or its customers.
    So, keep the comments and your positive attitude coming. And I hope you enjoy the book.

  • Thanks, Mary, for the link to Dr. Fiore’s article as the source of FSN’s revised statement, “It is the only common foodborne illness that is vaccine preventable.” Dr. Fiore’s article provides additional data which I found useful in evaluating Bill Marler’s proposal that ALL food service workers be vaccinated.
    Near the top of the right column just below figure 2, Dr. Fiore wrote, “there were 6.5 million food and beverage serving jobs in 2000 [33], and the industry is the largest private employer in the United States [35].” The bracketed numbers are his footnotes as to his sources for this info. And thanks to John S’s comment, I learned that he paid $110 for his hepatitis A vaccination. Combine these and we have a cost of over $700,000,000 initially to vaccinate every food service workers. Obviously, the cost per vaccine would drop were it to be to every food service worker. I, also, learned that Dr. Fiore did NOT recommend such an action.
    Add to this the fact that Table 2 of the CDC estimate published on 12-15-10, “Foodborne Illness in the United States—Major Pathogens” (http://www.cdc.gov/eid/content/17/1/pdfs/09-1101p1.pdf), estimates the number of cases of domestically acquired foodborne illness due to hepatitis A as only 1566 (90% confidence interval 702-3,024) and we can see that the cost benefit ratio is quite high because the turnover in these jobs is quite high.
    As the CDC also estimated there were almost 10 times as many cases due to rotavirus (15,433 with a 90% confidence interval of 5,569-26,643) as hepatitis A, it is clear that although FSN’s revised statement, “It (hepatitis A) is the only common foodborne illness that is vaccine preventable,” came from a reputable source (an “invited article” in the CDC journal, Food Safety), unfortunately, it is still incorrect.
    Once again, I ask that FSN correct the article and also not the correction in the article.
    BTW, the CDC estimate calls vibrio cholerea a “major pathogen” and estimates the number of number of domestically acquired foodborne cases as 84. The designation of “major” may be due to the fact that CDC estimates that about 200 additional Americans will acquire the disease while traveling.

  • Mary Rothschild

    You are welcome, Harry.

  • Thanks, Bill, for reminding me why it is largely a waste of time to comment on Food Safety News. Even when I send in a clearly straightforward, irrefutable correction, FSN is unable to simply make that correction. Why did I send it in? Because I hoped that FSN would care enough about being accurate that it could simply review my cites and then correct its copy accordingly as is the practice in all good publications.
    Instead, y’all accepted what an expert—who should have known better—wrote without checking it out despite my having named 3 other pathogens for which we have vaccines.
    So, I read your long cite and then took the time to do the research to check it out, document the error and send in another correction. In other words, Bill, I did what fact checkers used to do at newspapers.
    This time, you, the publisher, wrote a comment refusing to make a correction with the remark, “I do not see anything here that needs to be corrected.” Well, I do. The CDC study from which you regularly cite numbers estimates that rotavirus causes 15,433 illnesses versus hepatitis A’s estimated 1566. Therefore, FSN’s statement that hepatitis A “is the only common foodborne illness that is vaccine preventable,” is clearly false on 2 counts.
    First, as the US has a population well over 300,000,000, 1566 illnesses per year is far from “common.”
    Second, if 1566 is “common,” then 15433 is obviously a lot more common.
    My comment that you referenced (http://www.foodsafetynews.com/2011/08/usda-funds-norovirus-research/) was made on 8-5-11. The key part is “Bill Marler and Food Safety News don’t deserve any more comments from me. I will endeavor harder to not make any more comments on Food Safety News.” That does NOT say I “would stop reading and commenting.” As this is the first article upon which I’ve commented since then, I believe it is clear that I’ve done what I said I would do.
    And, just as you promised us, NEW—not renewal—subscribers, I did get “Poisoned” a few days ago. Thanks. I look forward to reading it after I finish Ben Hewitt’s “Making Supper Safe.”

  • Thanks, Bill, for reminding me why it is largely a waste of time to comment on Food Safety News. Even when I send in a clearly straightforward, irrefutable correction, FSN is unable to simply make that correction. Why did I send it in? Because I hoped that FSN would care enough about being accurate that it could simply review my cites and then correct its copy accordingly as is the practice in all good publications.
    Instead, y’all accepted what an expert—who should have known better—wrote without checking it out despite my having named 3 other pathogens for which we have vaccines.
    So, I read your long cite and then took the time to do the research to check it out, document the error and send in another correction. In other words, Bill, I did what fact checkers used to do at newspapers.
    This time, you, the publisher, wrote a comment refusing to make a correction with the remark, “I do not see anything here that needs to be corrected.” Well, I do. The CDC study from which you regularly cite numbers estimates that rotavirus causes 15,433 illnesses versus hepatitis A’s estimated 1566. Therefore, FSN’s statement that hepatitis A “is the only common foodborne illness that is vaccine preventable,” is clearly false on 2 counts.
    First, as the US has a population well over 300,000,000, 1566 illnesses per year is far from “common.”
    Second, if 1566 is “common,” then 15433 is obviously a lot more common.
    My comment that you referenced (http://www.foodsafetynews.com/2011/08/usda-funds-norovirus-research/) was made on 8-5-11. The key part is “Bill Marler and Food Safety News don’t deserve any more comments from me. I will endeavor harder to not make any more comments on Food Safety News.” That does NOT say I “would stop reading and commenting.” As this is the first article upon which I’ve commented since then, I believe it is clear that I’ve done what I said I would do.
    And, just as you promised us, NEW—not renewal—subscribers, I did get “Poisoned” a few days ago. Thanks. I look forward to reading it after I finish Ben Hewitt’s “Making Supper Safe.”

  • Jim Schmidt

    Mr. Hamil vibrio cholerae although one may receive a vaccine, the majority of cases in the USA are not from ill food workers it is from consumers taking risks and eating raw seafood. Vaccinating a whole population because a few people want to risk their own well being is not a cost effective use of public dollars.
    Did you even read up on Rotavirus? Do you really think that is a major contributor to foodborne illness? Let’s move on to Salmonella or Typhoid, you are just speaking of one species of Salmonella what about the 1,999 others of which 200 are common in the United States? Not a very cost effective proposal I would say. Money better spent with education, sanitation upgrades, fly control, etc. Just look at the recent salmonella outbreaks and what the types they were.
    I think what you want corrected are not even reasonably things that would be considered to be a foodborne illness in the truest sense or to be worthy of a full blown public vaccine push as it would have virtually no effect on the number of foodborne illnesses reported.

  • Lora J

    I for one, am certainly enjoying the lively debate. thanks everyone.

  • Ray James

    I just want to thank the commentors as well as the author of this article. I have a much clearer understanding of vaccines in the prevention of food borne illness as a result of all of your work.

  • Vishwanath

    Harry, I have to admit I enjoy your comments (well, not all), but I do not see anything here that needs to be corrected. Hepatitis A has been a problem for restaurants and their customers for decades. I have seen the inconvenience, and illnesses and deaths. Some restaurants (after an outbreak or exposure and forced vaccinations of customers – and resulting lawsuits) have instituted employee vaccines. The city of St. Louis required shots for restaurant employees. Some cities and states have spent thousands of dollars paying for investigations and vaccines caused by the risk of an ill employee. I am simply not aware that rotavirus and typhoid fever have been the cause for the same level of concern for the restaurant industry or its customers.

  • Jim Schmidt & Vishwanath, I am confused by y’all’s responses to what I wrote.
    I did NOT suggest the need for a “full blown public vaccine push” for rotavirus, cholera or typhoid nor that “rotavirus and typhoid fever have been the cause for the same level of concern for the restaurant industry or its customers” as hepatitis A.
    I am NOT advocating vaccination for food service workers or anyone else for cholera, rotavirus, hepatitis A or typhoid.
    I’m asking for FSN to correct its clearly false “correction” of its earlier statement, “It [hepatitis A] is the only foodborne illness that is vaccine preventable.” FSN add “common” between “only” and “foodborne.” Unfortunately for FSN’s readers that, too, is clearly wrong. As I wrote in my second comment, the CDC’s newest estimate is only 1566 cases a year that are foodborne. With over 300 million American’s eating who knows how different things on average in a day, that is a VERY low chance of illness.
    In contrast, both of you appear to advocate vaccination for hepatitis A. In that case, how can you NOT advocate vaccination for rotavirus when the CDC estimates almost 10 times as many cases as with hepatitis A?
    After re-reading the FDA’s Bad Bug Book (http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/default.htm) entries on Norwalk virus (called “norovirus” in the Scallan estimates) and rotavirus and then again reviewing the Scallan estimates of foodborne illness for them, I see no justification for Scallan’s disparity in the percentage of both illnesses attributed to food (26% for norovirus and less than 1% for rotavirus). My only guess is that norvirus has been studied more widely which is ironic as rotavirus appears to be more easily identified and is a more severe illness.
    The closer I look the clearer it is to me that, like the Mead estimates before them, the Scallan estimates appear increasingly dubious. Why aren’t they being questioned more carefully? My guess is that doing so would be a major career mistake for any researcher in the field.

  • Jim Schmidt & Vishwanath, I am confused by y’all’s responses to what I wrote.
    I did NOT suggest the need for a “full blown public vaccine push” for rotavirus, cholera or typhoid nor that “rotavirus and typhoid fever have been the cause for the same level of concern for the restaurant industry or its customers” as hepatitis A.
    I am NOT advocating vaccination for food service workers or anyone else for cholera, rotavirus, hepatitis A or typhoid.
    I’m asking for FSN to correct its clearly false “correction” of its earlier statement, “It [hepatitis A] is the only foodborne illness that is vaccine preventable.” FSN add “common” between “only” and “foodborne.” Unfortunately for FSN’s readers that, too, is clearly wrong. As I wrote in my second comment, the CDC’s newest estimate is only 1566 cases a year that are foodborne. With over 300 million American’s eating who knows how different things on average in a day, that is a VERY low chance of illness.
    In contrast, both of you appear to advocate vaccination for hepatitis A. In that case, how can you NOT advocate vaccination for rotavirus when the CDC estimates almost 10 times as many cases as with hepatitis A?
    After re-reading the FDA’s Bad Bug Book (http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/default.htm) entries on Norwalk virus (called “norovirus” in the Scallan estimates) and rotavirus and then again reviewing the Scallan estimates of foodborne illness for them, I see no justification for Scallan’s disparity in the percentage of both illnesses attributed to food (26% for norovirus and less than 1% for rotavirus). My only guess is that norvirus has been studied more widely which is ironic as rotavirus appears to be more easily identified and is a more severe illness.
    The closer I look the clearer it is to me that, like the Mead estimates before them, the Scallan estimates appear increasingly dubious. Why aren’t they being questioned more carefully? My guess is that doing so would be a major career mistake for any researcher in the field.

  • Cheddar’s vaccination program? Everything I read on Hep A is there are no treatments. The shot is for prevention; not post exposure. Further, exposure to any virus/bacteria means your body is already building the natural immunity–and for many the disease would not even develop.
    So, the idea of an ineffective mass vaccination sounds ridiculous for those who may have eaten something that may have contained Hep A that may not have the natural immunity to prevent developing Hep A (and if they did it usually resolves in a few weeks with the bonus of lifetime immunity). Those with weakened immune systems that would be most likely to develop Hep A are also at the higher risk for adverse reactions to the vaccine.
    Like Harry said, there are only 1500 cases a year (and nearly all recover)and this is with nearly a zero Hep A vaccinated population.

  • mrothschild

    From the Centers for Disease Control and Prevention:
    Persons who recently have been exposed to HAV and who previously have not received hepatitis A vaccine should be administered a single dose of single-antigen vaccine or IG (0.02 mL/kg) as soon as possible.
    When administered within 2 weeks of last exposure, IG is 80%–90% effective in preventing clinical hepatitis A.

  • Mary Rothschild

    From the Centers for Disease Control and Prevention:
    Persons who recently have been exposed to HAV and who previously have not received hepatitis A vaccine should be administered a single dose of single-antigen vaccine or IG (0.02 mL/kg) as soon as possible.
    When administered within 2 weeks of last exposure, IG is 80%–90% effective in preventing clinical hepatitis A.