Hepatitis A is the only common vaccine-preventable foodborne disease in the United States (Fiore, 2004). It is one of five human hepatitis viruses that primarily infect the human liver and cause human illness. Unlike hepatitis B and C, hepatitis A doesn’t develop into chronic hepatitis or cirrhosis, which are both potentially fatal conditions; however, infection with the hepatitis A virus (HAV) can still lead to acute liver failure and death. Click on image to download:
Jill Blocker over at Eat, Drink and Be wrote a great summary of what to pay attention to while traveling
Spring is here and people who were bundled up in their homes all winter are finally ready to go out into the world, but as the vacation season begins, remembering food and water safety can help prevent painful vacation memories.
Hepatitis A is one of the most vaccine-preventable infections contracted by travelers. Similar to Travelers’ Diarrhea, another common traveler’s illness, Hepatitis A is spread through food and drink that has come in contact with infected people — often from traces of infected feces — who handle food.
Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus (HAV), according to the Mayo Clinic. It causes the liver to inflame, affecting its ability to function. Approximately 10 million people are infected with HAV each year. Symptoms, which often appear between two and six weeks of contraction, can include nausea, abdominal pain, fever, itching and jaundice.
The fatality rate from HAV is generally low, at approximately 0.3 percent. However, in adults older than 50 the fatality rate increased to 1.8 percent.
HAV infections are more common in developing countries, according to the Centers for Disease Control. Community-wide outbreaks are more likely to occur in developed countries.
“In most intermediate and high anti-HAV-endemic countries, many long-term residents are infected as children, at a time when they may not get symptoms,” according to the CDC. “Cases of hepatitis A in the resident population will be very low; however, travelers from low endemic settings such as the United States are at risk for HAV infection and should be protected.”
In 2006, 72 percent of travel-related HAV cases were associated with travels to Mexico and Central and South America, according to the CDC.
To protect against Hepatitis A while traveling:
• Avoid eating raw fruits and vegetables, or wash fresh produce with a vinegar-solution before consuming.
• Avoid raw or undercooked meats and foods, which could have been contaminated during harvesting or preparation.
• Beware of shellfish harvested from sewage-contaminated water.
• Avoid untreated tap water, including ice. Instead, opt for beverages made with boiled water or prepackaged with an intact seal.
• Avoid street-vendor foods, as they could be less regulated.
The best way to prevent HAV is getting a vaccine. In 2006, the HAV was added to the recommended vaccinations for children. The CDC recommends susceptible people traveling to or working in countries with have high or intermediate hepatitis A endemicity should be vaccinated or receive Immunoglobulin before departure. Immunoglobulin (IG) is an injection of plasma already containing the antibody for instant, but temporary protection of HAV.
On July 13, 2009, Rock Island County Health Department officials informed the McDonald’s corporate office that a McDonald’s franchise in Milan, Illinois had an employee infected with hepatitis A. The employee had been working at that restaurant over the past week. The next day, health officials went to the Milan McDonald’s and found that employees were washing their hands improperly and should have been wearing gloves when they had cuts, painted nails, or fake nails. The inspector provided the employees material about proper hand washing and hepatitis A.
On July 15, health officials returned for a full inspection. The inspection detailed a laundry list of violations, two of them critical, involving “hygienic practices” and “presence of insects/rodents.” It was also reported that after the first employee was confirmed positive with hepatitis A on June 9, another employee had been confirmed positive with hepatitis A on July 15. As a result, the Milan McDonald’s was ordered to close until all employees completed health histories, got vaccinated, and completed hand-washing training.
Though it was initially believed that the employee infections were not detected until July 13, evidence later surfaced suggesting otherwise. The second employee who contracted hepatitis A, Cheryl Schram, had been diagnosed on June 20 and told the restaurant a few days later, once she had been released from the hospital. Despite the highly contagious nature of her illness, she was permitted to return to work.
During the period when the infected employees had been allowed to work and handle food, it was estimated that as many as 10,000 people ate at that restaurant. This led to county health officials inoculating more than 5,000 local residents against the disease in order to contain the outbreak. Unfortunately, the damage had already been done and those infected were beginning to exhibit symptoms.
The Illinois Department of Public Health (IDPH) released a report of its investigation into the Hepatitis A outbreak on October 30, 2009. IDPH reported a final tally of 34 confirmed cases of Hepatitis-A with onsets from June 11 through August 10, 2009. IDPH concluded that food from the Milan McDonald’s was the source of the outbreak. IDPH explained:
The restaurant had inspection reports indicating issues with bare hand contact with food, employees reported no use of gloves when preparing foods not later cooked, during hand hygiene education the employees had difficulty in properly washing hands, and the index case in the community, a food handler at McDonalds, had a period of communicability and work history that match with the dates of onset of the majority of the other cases and she handed food that was not later cooked with bare hands. In addition, the case-control study showed that there was an elevated risk of hepatitis A associated with consuming food from the McDonalds in Milan, Illinois. Other possible sources in the community were ruled out.
