Persistence of hep A cases is worrisome
September 26, 2006
Citizen-Times
Over the past several years, Buncombe County has had several high-profile hepatitis A scares associated with local restaurants.
That makes it an economic as well as a health issue.
Hepatitis A scares do nothing to enhance the area’s appeal as a tourist destination and also discourage locals from eating out. The impact on restaurants can be devastating, as demonstrated a few weeks ago with the closing of Trevi Pasta Seafood & Pizza in Biltmore Forest following the discovery that one of the restaurant’s food service workers had the disease.
The question is: Why do there seem to be a larger number of such scares in our region and what can be done to reduce them?
Buncombe County Health Center Medical Director Dr. Susan Mims said the answer to what can be done is fairly straightforward: vaccinations and diligent hand washing.
Vaccinations are recommended for all children 18 years of age and younger are free from the health department, she said.
A study by researchers at the Terry Sanford Institute of Public Policy at Duke University concluded that vaccination of all food handlers is not a cost-effective way to prevent hepatitis A.
Still, Asheville Buncombe Technical Community College requires all its culinary arts students to get the immunization and that may be an example restaurants should follow. The vaccinations are not cheap, but given the negative consequences should an employee contract the disease, it may well be an expense worth considering, for economic if not public health reasons.
Eight cases here in ’06
Eight cases have been diagnosed in Buncombe County this year, Mims said. Two occurred in food service workers, one employed at Trevi’s and another at Larry’s Earth Bar, a coffee bar inside the Earth Fare store on Hendersonville Road. It is not yet clear whether some of the cases are linked. That’s the subject of an ongoing local, state and Centers for Disease Control and Prevention investigation, Mims said.
In 2003, green onions imported from Mexico caused 16 patrons of another local restaurant and one of the restaurant’s food service workers to contract the disease. The green onions that caused the 2003 outbreak were linked to cases in three other parts of the country, where the onions had also been imported, by identifying the specific strain of the virus, Mims said.
In 1990, 269 cases of hepatitis A were diagnosed in the county, at least some associated with food from a concession and convenience store at the Dreamland Drive-In Theater on Tunnel Road, which is no longer in business. As a result of that outbreak, Buncombe County had the highest number of hepatitis A cases in the state between 1987 and 1997, according to a CDC report, which averages the number of cases over the 10-year period.
A recent decline
More recently, aside from the 16 cases resulting from the imported onions in 2003, there were only two cases in 2004 and one in 2005, Mims said.
As to the number of high-profile scares associated with restaurants, Mims theorizes that it may be because there is a large service industry in our area and by happenstance, if there is an outbreak of hepatitis A, it’s likely some of the victims will be food service workers. It’s important to note, she said, that while the shots offered by the health department are an important precaution, there is not a single confirmed case here of hepatitis A being spread to a restaurant patron by a food service worker. Even if a food service worker has the disease, diligent hand washing is highly effective in preventing that person from spreading it.
It’s also important to point out that in the 2003 outbreak and the recent scares, the restaurants did nothing wrong.
That doesn’t prevent them from paying the price of lost business when a food service worker is found to have hepatitis A. Hepatitis A immunization is a two-part series of shots, given six months apart. Each shot costs $82. Given the high turnover in the food service industry, it’s understandable that restaurant owners might be reluctant to require employees to have the vaccine, which is extremely safe.
An ounce of prevention...
Still, this may be a case where it’s hard to beat the wisdom of that old cliché: An ounce of prevention is worth a pound of cure. That would not eliminate the risk of a scare associated with contaminated food, like the green onions. But that’s where hepatitis A vaccines can make a big difference in the number of people who come down with the disease.
And, as Mims said, the more people get vaccinated, the smaller the risk of spreading the disease.
Parents, especially, should take advantage of the free vaccines offered by the health department for children 18 years of age and younger.
