According to the CDC, the hepatitis a virus (HAV) is transmitted via the fecal-oral route, usually from direct person-to-person contact or consumption of contaminated food or water (33). Children were a key source of HAV transmission before HepA vaccination was available and recommended routinely for children because the majority of children infected with HAV have asymptomatic or unrecognized infections and can shed the virus in their feces for months (34,35). Transmission currently occurs primarily among susceptible adults.
Common-source outbreaks and sporadic cases also occur from exposure to food or water with fecal contamination. Uncooked foods have been recognized as a source of outbreaks (36). Cooked foods also can transmit HAV if the heat level used in preparation is inadequate to inactivate the virus or if food is contaminated after cooking, which can occur during outbreaks associated with infected food handlers (36). Waterborne outbreaks of hepatitis A are infrequent in developed countries with well-maintained sanitation and water supplies (37). Depending on conditions, HAV can be stable in the environment for months (33,38). HAV also is stable when frozen (10,39–41). Heating foods at temperatures >185°F (>85°C) for 1 minute or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (i.e., household bleach) in tap water inactivates HAV (42).
HAV vaccination is not specifically recommended for persons who handle food in the absence of other risk factors. Foodborne hepatitis A outbreaks occur relatively infrequently in the United States; however, recent outbreaks of hepatitis A related to pomegranate arils (the fruit-coated seeds) imported from Turkey, frozen scallops imported from the Philippines, and frozen strawberries imported from Egypt demonstrated the risk for outbreaks related to foods imported from HAV-endemic areas (10,11,169). Contamination of food with HAV can happen at any point: growing, harvesting, processing, handling, or after cooking. Food handlers are not at increased risk for hepatitis A because of their occupation (36). Transmission of HAV from infected food handlers to susceptible consumers or restaurant patrons in the workplace is rare (36,170,171). Transmission among food handlers has not been common since the adoption of the universal childhood HepA vaccination recommendation in 2006, despite costly and resource-intensive investigations of HAV infections among food handlers. One study found that in >90% of case investigations of infected food handlers, only the food handler was infected, with no secondary cases (172). A survey of state health departments experiencing person-to-person hepatitis A outbreaks during 2016–2019 demonstrated that among almost 23,000 hepatitis A outbreak cases reported from states, <4% occurred among food handlers; secondary infections among patrons accounted for 0.2% of outbreak cases (173). The risk for secondary infection from hepatitis A–infected food handlers to food establishment patrons in these person-to-person hepatitis A outbreaks was <1% (173).
However, as a lawyer, I have seen first-hand the impacts on consumers exposed to HAV positive food service workers. Here are a few examples of cases involving ill workers and the impact on customers and restaurants:
- McDonalds in Skagit County in 1998 was implicated in a cluster of Hepatitis A illnesses linked to an exposure by a Hepatitis A positive assistant manager.
- In 1999 nearly 40 became ill after being exposed to a Hepatitis A positive working at two Subway locations in the Seattle area. Several of the patrons were hospitalized with one young boy suffering acute liver failure requiring a liver transplant.
- A Carl’s Jr. was hit in Spokane in 2000 with a Hepatitis A cluster that sickened over a dozen after being exposed to an ill worker.
- In 2001 a Massachusetts D’Angelo’s Hepatitis A ill employee was linked to several customers who became ill after being exposed to contaminated food served at the restaurant.
- A Hepatitis A positive employee at Maple Lawn Dairy in New York sickened at least six customers in 2004, including one patron who suffered acute liver failure and died.
- In 2009, public health officials in the Quad-City region of Illinois identified at least 32 confirmed cases of hepatitis A among residents of Rock Island, Henry, Mercer, Warren, and Woodford Counties. People became ill after eating food purchased from the Milan McDonald’s restaurant and then developing a Hepatitis A infection.
- In 2017 Bartaco in New York at least 5 people sickened with Hepatitis A many of who were hospitalized with hundreds of thousands in medical bills and wage loss.
- In 2017 a McDonald’s in Waterloo, New York was linked to the death of one woman who was exposed to a hepatitis A ill worker.
- In 2019 the New Jersey Department of Health announced that 23 people contacted hepatitis A after being exposed to an ill worker at the Mendham Golf & Tennis Club.
- And in 2021 52 were sickened, with over 30 hospitalized, including 2 with liver transplants and 4 deaths linked to an HAV ill worker at Famous Anthony’s restaurants in Roanoke, Virginia.
Real people, not statistics. See more at https://marlerclark.com/food-litigation/hepatitis-a-outbreak-litigation
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