– Opinion –
Advisory Board on Immunization
1600 Clifton Road, NE, Mailstop H24-8
Atlanta, Georgia 30329-4027
Re: letter to CDC Immunization Enforcement Committee – It’s Time to Deal with Hepatitis A and Food Service Workers
Dear ACIP Secretariat,
The Advisory Committee on Immunization (ACIP) provides advice and guidance to CDC directors regarding the use of vaccines and related agents to control vaccine-preventable diseases in the US public. Recommendations made by the ACIP are reviewed by the CDC Director and, if adopted, are published as official her CDC/HHS recommendations in the Morbidity and Mortality Weekly Report (MMWR).
Currently, about 5% of all hepatitis A outbreaks are associated with infected food handlers.
Here’s what the CDC continues to say about vaccinating food handlers:
If infected food handlers could spread the disease during an outbreak, why doesn’t the CDC recommend vaccination for all food handlers?
CDC does not recommend vaccination for all food handlers. This is because doing so will not prevent or stop ongoing outbreaks that primarily affect individuals who report using or injecting drugs and those experiencing homelessness. A food handler’s occupation does not increase her risk of hepatitis A. During an ongoing outbreak, transmission from food handlers to restaurant patrons is extremely rare. This is because standard food handler hygiene practices help prevent the spread of the virus. Individuals who live in households with infected people or participate in the aforementioned risk behaviors are at increased risk of hepatitis A infection.
CDC is missing the point.Admittedly, food service workers not so much risk to get Hepatitis A due to their occupation, but they spreading risk to the customer. Food service positions are generally underpaid and can certainly be filled by immigrants from countries where hepatitis A may be endemic, or by people who have recently experienced homelessness.
Over the past several years, the United States has seen a continuing outbreak of hepatitis A. As of February 2, 2023, there are a total of 44,779 cases and a hospitalization rate of 61% (approximately 27,342 hospitalizations). The death toll is 421. Since the outbreak began in 2016, 37 states have reported cases to CDC.
Although the CDC generally recommends that the best way to prevent hepatitis A is through vaccination, the CDC does not explicitly state that food service workers should be vaccinated. . A food service worker is not traditionally designated as being at risk for hepatitis A infection, but he is not without risk.
24% of hepatitis A cases are asymptomatic. This means that food handlers who carry the virus can unknowingly pass the disease on to consumers. Historically, when outbreaks occur, local health departments begin administering vaccines for free or at reduced rates. These vaccinations are funded by taxpayer funds.
In St. Louis County, Missouri, a mandatory vaccination policy for all food service workers has been shown to be effective in reducing communicable diseases and economic burden.
From 1996 to 2003, Clark County, Nevada had 1,523 confirmed hepatitis A cases, higher than the national average. A mandatory immunization policy was implemented. The county lifted mandatory vaccine regulations in 2012 and is part of her ongoing hepatitis A outbreak.
A dose of the vaccine costs $30 to $120, but hospital bills are in the thousands, according to the CDC, with a 95% efficacy rate for the first dose and a 99% success rate for the second dose. You get effectiveness. In addition, the vaccine remains effective for 15-20 years.
During an outbreak, if a food service worker is found to be hepatitis A positive, the local health department will initiate a post-exposure treatment regimen that must be administered within two weeks to be effective. Economic burdens also affect the health sector in terms of personnel and other limited resources. In some cases, interventions implemented by local health departments may not be effective.
While there have been many examples of point-source outbreaks of hepatitis A in the country within the last few years, a particularly severe outbreak occurred in early fall 2021 in Roanoke, Virginia. The health department was notified of the outbreak on 21 September 2021 after the first case was reported by a local hospital. The Roanoke Department of Health, along with the Virginia Department of Health, investigated this outbreak.
Ultimately, three different locations of a local restaurant, Famous Anthony’s, were determined to be linked to this outbreak. The Virginia Department of Health issued a community announcement on the outbreak and potential exposure risks on September 24, 2021.
For the purpose of investigation, a case is defined as “[p](a) development of individual symptoms; and (b) jaundice or elevated serum aminotransferase levels; and (c) [who] Between August 10 and August 27, 2021, tested positive for hepatitis A (IgM anti-HAV positive) and frequented or had a new case at any of the three well-known Anthony locations. I had close contact with the patient. ”
As of November 2021, a total of 49 initial cases (40 confirmed and 9 probable) have been identified in this outbreak. Two secondary cases were also identified. Cases ranged from age 30 to he 82 (median age 63). Overall, 57% of cases were male. Thirty-one cases included hospitalization, and at least four of his patients died. The onset of illness occurred between 25 August and 15 October 2021.
Ultimately, an outbreak investigation revealed that a cook who also had hepatitis A-related risk factors contracted hepatitis A while working at several famous Anthony’s restaurants. The mother and adult son of this first case also tested positive for hepatitis A. Policy. “In this outbreak, human-to-human transmission was determined to be the most likely route of transmission. Environmental contamination was also considered a possible transmission.
Overwhelmed by the number of victims seeking legal action for their injuries, the famous Anthony filed for bankruptcy and several of its locations have closed.
The tragedy of this preventable hepatitis A outbreak cannot be overstated. Four people died. In one family, two of its members lost their lives. Most of the victims were hospitalized. Many were at risk of acute liver failure. At least one of her required both a liver and kidney transplant. Victims’ medical bills totaled him over $6,000,000, with future costs running into the millions. This is all because one of her employees did not receive her hepatitis A vaccine from her $30 to her $120.
Affordable prevention of future tragedies like the famous Anthony epidemic is both possible and necessary. Time to at least recommend vaccinations for food service workers to reduce the spread of hepatitis A. came.
On behalf of 31 hepatitis A patients and their families
1 Medical summaries of 31 victims were privately emailed to enable a clear assessment of the impact of hepatitis A on food consumers by one unimmunized food service worker. It offers.
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