In the last two weeks 1,200 High School and Elementary School students from Stockton, California, 5,000 patrons of a Clinton, Tennessee Waffle House, and thousands who ate a Norfolk, Virgina Soul Food Restaurant all have something in common – all are being urged to get Immune Globulin (Ig) shots to prevent the infection and further spread of hepatitis A after being exposed to a hepatitis A infected foodservice worker.
It seems that 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 foodservice workers, especially those that serve the very young and the elderly.
The Centers for Disease Control (CDC) estimates that 83,000 cases of hepatitis A occur in the United States every year, and that many of these cases are related to foodborne transmission. In 1999, over 10,000 people were hospitalized due to hepatitis A infections and 83 people died. In 2003, 650 people became sickened, 4 died and nearly 10,000 people got Ig shots after eating at a Pennsylvania restaurant. Not only do customers get sick, but businesses lose customers or some simply go out of business.
Although the CDC has not yet called for mandatory vaccination of foodservice workers, it has repeatedly pointed out that the consumption of worker-contaminated food is a major cause of food borne illness in the United States.
Hepatitis A continues to be one of the most frequently reported, vaccine-preventable diseases in the United States, despite the 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 preventative shots have not been used is because of the high turnover rate of foodservice employees. The argument is that why should I vaccinate my employee only to have them leave in a few months to another restaurant? That argument disappears, and eating out becomes a whole lot less of a gamble, if all foodservice workers faced the same requirement.
According to the CDC, the costs associated with hepatitis A are substantial. Between 11% and 22% 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 less than 18 years of age. In 1989, the estimated annual direct and indirect costs of hepatitis A in the United States were more than $200 million, equivalent to more than $300 million in 1997 dollars.