In the past few days, restaurants from a Papa John’s in North Carolina to the La Fontana suburban New York restaurant to a Moose Jaw bar, are issuing hepatitis A warnings due to an ill worker putting customers at risk. Hardly a month passes without a warning from a health department somewhere that an infected food handler is the source of yet another potential hepatitis A outbreak. Absent vaccinations of food handlers, combined with an effective and rigorous hand-washing policy, there will continue to be more hepatitis A outbreaks. It is time for health departments across the country to require vaccinations of food-service workers, especially those who serve the very young and the elderly. Hepatitis A is a communicable disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Hepatitis A is the only foodborne illness that is vaccine-preventable. According to the U.S. Centers for Disease Control and Prevention (CDC), since the inception of the vaccine, rates of infection have declined 92 percent. CDC estimate that 83,000 cases of hepatitis A occur in the United States every year, and that many of these cases are related to food-borne transmission. In 1999, more than 10,000 people were hospitalized due to hepatitis A infections, and 83 people died. In 2003, 650 people became sickened, four died, and nearly 10,000 people got IG (immunoglobulin) shots after eating at a Pennsylvania restaurant. Not only do customers get sick, but also businesses lose customers or some simply go out of business. Although CDC has not yet called for mandatory vaccination of food-service workers, it has repeatedly pointed out that the consumption of worker-contaminated food is a major cause of foodborne illness in the U.S. Hepatitis A continues to be one of the most frequently reported, vaccine-preventable diseases in the U.S., despite FDA approval of hepatitis A vaccine in 1995. Widespread vaccination of appropriate susceptible populations would substantially lower disease incidence and potentially eliminate indigenous transmission of hepatitis A infections. Vaccinations cost about $50. The major economic reason that these preventive shots have not been used is because of the high turnover rate of food-service employees. Eating out becomes a whole lot less of a gamble if all food-service workers faced the same requirement. According to CDC, the costs associated with hepatitis A are substantial. Between 11 percent and 22 percent of persons who have hepatitis A are hospitalized. Adults who become ill lose an average of 27 days of work. Health departments incur substantial costs in providing post-exposure prophylaxis to an average of 11 contacts per case. Average costs (direct and indirect) of hepatitis A range from $1,817 to $2,459 per case for adults and from $433 to $1,492 per case for children younger than 18. In 1989, the estimated annual direct and indirect costs of hepatitis A in the U.S. were more than $200 million, equivalent to more than $300 million in 1997 dollars.  A new CDC report shows that, in 2010, slightly more than 10 percent of people between the ages of 19 and 49 got a hepatitis A shot. Vaccinating an employee make sense.  It is moral to protect customers from an illness that can cause serious illness and death. Vaccines also protect the business from the multi-million-dollar fallout that can come if people become ill or if thousands are forced to stand in line to be vaccinated to prevent a more serious problem.

  • Matthew Rollosson

    The CDC’s Advisory Committee on Immunization Practices (ACIP)
    can only recommend immunizations for a population. All immunization laws are
    state laws; there are no federal immunization laws. So, even if the ACIP
    recommended hepatitis A immunization for food handlers, the legislatures of
    each state would have to enact laws mandating the vaccine for that population.

    The ACIP recommended routine hepatitis A immunization for
    all children at one year of age in 2006.
    http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.htm

    Currently, around a quarter of states require hepatitis A
    vaccination for childcare or kindergarten admission.

    The ACIP recommend influenza vaccine for health care
    workers, but few states require influenza immunization for health care workers.

    I suspect that an ACIP recommendation would result in few
    states legislating hepatitis A immunization requirements for restaurant
    workers.

    Matthew Rollosson, RN, MPH&TM

  • D in Maryland

    Even if food handlers are vaccinated, I would eat out more often if food handlers wore gloves. Many of the food borne illness I’ve read about are spread from human poop. Gross!!! Washing hands won’t get poop out from underneath fingernails as that would have to be scrubbed out. Even after scrubbing, there are probably microscopic particles, and that’s all it takes to make someone sick. It is worse for people who do not have a choice about eating food prepared by others such as child care facilities, nursing homes, special events, and people traveling. When my family travels, we pack food from home in a cooler, but inevitably at some point, we take our chances at a restaurant along the highway.

  • Barb3000

    A lot of the workers in restaurants in the kitchens are illegal aliens hired by the management at lower wages. These people come from third world countries that don’t teach their populations about hand washing after you use the bathroom, if you have a working bathroom or soap that is. I don’t recall reading about so many cases of hepatitis in the US before all of these people were hired, there looks like a close connection. Another thing too is the refugees being brought to the US from the African countries many don’t know what toothpaste is let alone hand washing after bathroom use. many of these people were living in refugee camps where there is always a shortage of soap and water.

  • Russell La Claire

    I would love to see this come about. However, as Matthew says, each state can/will decide for themselves. And, with the silly discussions concerning vaccination running through the veins of the country, I would be shocked it you could get a third of them to go along.

  • Doc B

    The comment about illegal aliens is a cheap shot. I have worked in service industries most of my life. When asked why we employ so many minorities, I always have the same answer. I hire the folks that will do a good job for what I can afford to pay them.
    These folks work very hard and most of them are very willing to follow the directions I supply. If I am not willing to take the time to train my folks correctly, that is my fault not theirs.
    By the way I am always very careful to check immigration status as this also is my responsibility.

    • Matthew Rollosson

      Thanks doc.

      It occurred to me that people who come from endemic countries are more likely to be immune to hepatitis A and, therefore, less likely to transmit hepatitis A virus than a person born in the U.S.

      “Only 13% of children <2 years of age were immune, compared with 80% of children 12 to 17 years of age (P = .002).”
      http://pediatrics.aappublications.org/content/126/5/e1039.long

  • Malcolm Kane

    There are serious issues of civil liberties here. Vaccination of ‘food workers’ is actually vaccination of human beings and should be subject to control by appropriate medical authorities in each Country. Screening of food workers for transmissible infections is a different matter
    Malcolm Kane