There are now 16 dead with 292 sickened with hepatitis A in San Diego — mostly in the ignored homeless population. And, the numbers of people with this preventable disease is spiking. Colorado has 57 ill with 1 death; Michigan has 319 ill with 14 deaths; and New York has 46 ill. Other states and cities are dealing with outbreaks. Los Angeles has at least 10 sick. Lately, we have also seen the virus spread to food service workers, potentially exposing hundreds of unsuspecting consumers to the debilitating and sometimes deadly infection.

This is all preventable.

In 2006, health officials recommended routine hepatitis A vaccination for all children ages 12 to 23 months. They also recommended hepatitis A vaccinations 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 people:

• 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 vaccine may also help protect household contacts of those persons infected with hepatitis A. Although generally not a legal requirement at this time, vaccination of food handlers would be expected to substantially diminish the incidence of hepatitis A outbreaks.

Although outbreaks continue to occur in the United States, no one should ever get infected if other preventive measures are taken. For example, food handlers must always wash their hands with soap and water after using the bathroom, changing a diaper, and certainly before preparing food. Food handlers should always wear gloves when handling or preparing ready-to-eat foods, although gloves are not a substitute for good hand washing. Ill food handlers should be excluded from work.

Hepatitis A is a communicable — or contagious — 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 HAV-infected food handler. Food handlers are generally not ill when they are at peak infectivity — which is when the highest levels of the virus are present in the stool of an infected individual — because that occurs two weeks before illness begins.

Fresh produce contaminated during cultivation, harvesting, processing and distribution has also been a source of hepatitis A. In 1997, frozen strawberries were the source of a hepatitis A outbreak in five states. Six years later, in 2003, fresh green onions were identified as the source of a hepatitis A outbreak traced to consumption of food at a Pennsylvania restaurant.

Other produce, including blueberries and lettuce, has been associated with hepatitis A outbreaks in the U.S., as well as other developed countries.

HAV is relatively stable and can survive for several hours on fingertips and hands. It can live up to two months on dry surfaces. The virus can be inactivated by heating to 185 degrees F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (household bleach) in tap water. Freezing does not kill the virus.

Also, it must be noted that HAV can still be spread via cooked food because the food can become contaminated after cooking.

So, for goodness sake, vaccinate against hepatitis A.

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