Hep A Prevention

[Hep Talk]

Food for Thought
Hepatitis A prevention efforts spark controversy
by Larry Buhl

The hepatitis C virus gets a lot of attention, and rightly so, because it can and does kill. But several high profile outbreak scares from infected restaurant workers has put the less deadly hepatitis A virus (HAV) on the map as a serious public health concern.

The hepatitis A virus causes acute liver infection and it’s spread when a person ingests fecal material from an infected person and causes symptoms that include, fever, chills, nausea, dark-colored urine, and jaundice, a yellowing of the skin or eyes. It is a big issue in food service, where servers, cooks and food prep workers with the virus could spread it rapidly through every piece of food they touch.

Hepatitis A sickens as many as 17,000 people a year and kills nearly 100 according to 2010 estimates from the Centers for Disease Control and Prevention (CDC). That’s only a fraction of the 48 million people in the U.S. who suffer from food poisoning each year. But unlike E. coli and all other foodborne illnesses, hepatitis A can be prevented with a vaccine.

Though vaccinations for hep A are routine now for infants, there is a generational gap. A new CDC report shows that, in 2010, slightly more than ten percent of people between the ages of nineteen and forty-nine got a hepatitis A shot. Those are the ages of people most likely to work in restaurants.

For years the CDC said that food handlers didn’t need hepatitis A vaccinations because outbreaks are rare, especially since the introduction of a safe and effective vaccine in 1996. But recent HAV scares are causing some food industry watchers and medical specialists to urge the CDC to make vaccinations compulsory for all food handlers.

In April alone nearly 2,000 people received immunoglobulin shots to prevent hep A infections after restaurant workers in New York and South Carolina tested positive for the virus. Last fall nearly 2,000 people in New York City were vaccinated after an infected food handler caused an outbreak of HAV.

Many in the medical community argue that mandatory vaccines for food workers would be worth the investment. Critics say it would violate the rights of employees to mandate a vaccine, and would come at a cost to the restaurant.

Bill Marler, a food safety lawyer, argues for mandatory vaccination in a recent edition of Food Safety News, saying that hepatitis A continues to be one of the most frequently reported, vaccine-preventable diseases in the U.S:

“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.”

The cost of vaccinating workers is disputed, however. The restaurant industry says the cost of universal hepatitis A vaccinations to the companies could be up to $200 per worker.

Until the CDC calls for mandatory vaccinations, it will be up to states and local communities to make their own regulations. Some are going ahead with mandatory vaccination laws. After St. Louis County, Missouri, faced three large hepatitis A outbreaks tied to food handlers in the 1990s, county officials required all restaurant workers to be vaccinated. Since then, the number of cases dropped from 110 a year to near zero.

An alternative regulation to mandatory vaccinations for restaurant workers, mandatory glove-wearing, is being tried. In January, a new California law prohibiting food workers from handling ready-to-eat foods with their bare hands went into effect. The outcry from restaurant owners, waiters, chefs and bartenders was immediate. Critics argued that single-use gloves are not environmentally friendly, that they can interfere with food preparation and that they won’t necessarily limit cross-contamination. Microorganisms may still be transmitted through gloves if food workers don’t wash their hands before putting on the gloves. And cooks wearing gloves still have to watch out for cross-contamination if they’re working with both uncooked and cooked foods—that’s a big issue in transmitting the more common foodborne bugs.

The “no bare hands” regulation has been so unpopular that the California state legislature is in the process of repealing it and telling restaurants to go back to the previous “minimal food contact” law and requiring thorough hand washing after every rest room break. As always, those guidelines are impossible to enforce.

Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His young adult novel, The Genius of Little Things, debuted last year.