Article Last Updated: Monday, July 12, 2004 – 11:32:04 AM EST
By JULIE MEHEGAN, Sun Statehouse Bureau
BOSTON There are simple ways to prevent transmission of the liver disease hepatitis A, say public health officials, who are urging people to practice good hygiene to avoid infection.
The state Department of Public Health has been working overtime to inform Massachusetts residents about hepatitis A after several cases in which restaurant employees unknowingly infected with the virus reported to work, placing patrons at risk.
In Arlington and Boston in recent weeks, hundreds of diners have waited hours in long lines for a shot of immune globulin, meant to prevent transmission of hepatitis A after contact with an infected person.
The incidents, at separate restaurants, have prompted curiosity and concern about an illness that can result in serious liver damage.
“To me, the most important thing that people should take away from all this is you should wash your hands after you go to the bathroom,” said Bela Matyas, M.D., medical director of the epidemiology program at the state Department of Public Health.

“If everybody washed their hands properly after they go to the bathroom, there would be no hepatitis A, no (immune globulin) clinics,” Matyas said. “We wouldn’t have any of this.”
Adding to the public concern about hepatitis A are statistics that show a spike in the number of cases reported in Massachusetts over the past year, and confusion about the differences between the three main strains of the virus hepatitis A, B, and C.
According to Matyas, hepatitis is a generic name for an infection of the liver, but hepatitis A, B, and C are three distinct diseases.
They can carry the same symptoms fever, fatigue, jaundice, dark urine, loss of appetite or nausea and they are all contagious.
But the three strains are caused by different viruses, are transmitted differently, and they cause a different impact on the body over the long term.
The hepatitis A virus, which can be foodborne and which has prompted the recent scrutiny, is usually found in the feces of infected people. It is most often spread when those infected do not wash their hands after using the bathroom or changing a diaper, then touch their own mouths, prepare food for others, or touch other people with their infected hands. It can also be spread by contaminated food.
Because the disease is most contagious during the two weeks before symptoms appear, it can easily be spread before a person is even aware that he or she is infected.
Occasionally, when someone who happens to be a food worker is diagnosed with the virus and has reported to work in the previous two weeks, those diners are at risk of exposure. That was the case at the restaurants in Arlington and Boston.
But Matyas said food workers or restaurant patrons are at no greater risk of contracting hepatitis A than anyone else. Speedier diagnosis and the ability to respond by immunizing large numbers of people have drawn attention to the possibility, he said.
“In fact, these are not outbreaks in restaurants, these are single cases where we are preventing outbreaks because we are having these clinics,” Matyas said.
Unlike hepatitis A, the hepatitis B and C viruses are typically spread through the blood or other bodily fluids and can result in cirrhosis, liver cancer or death. Hepatitis B and C are often transmitted between people who use intravenous drugs, share needles, have sexual contact with an infected person, or from a mother to her baby.
After the recent series of hepatitis A cases among food workers, public health officials in many communities have stepped up their efforts to encourage restaurants to practice good hygiene and adhere to state food-handling laws, although one local health official said the message has always been important.
“We’ve always really pushed the importance of hand-washing,” said Tom Carbone, director of public health in Tewksbury. “It all goes back to what our parents taught us. It doesn’t totally prevent disease transmission, whether it be hepatitis or salmonella or staphylococcus, but it certainly cuts down on the chances of exposure.”
There were 62 reported cases of hepatitis A in Massachusetts from January to May 2003, with 285 cases reported during the same period this year. But Matyas said there is no reason to believe more food workers than usual carry hepatitis A because the most recent cases have largely been isolated within high-risk communities, where conditions may be more unsanitary.
“There is definitely a higher level of hepatitis A than normal in certain populations like homeless or shelter-bound individuals, recent prison inmates, intravenous-drug users,” Matyas said. “Once you have a bug get into a population like that, it can cause a lot of illness.”
Julie Mehegan’s e-mail address is jmehegan@lowellsun.com.