Friday, April 25, 2008

Hepatitis Update - San Diego Chipotle's

The number of cases of hepatitis A infection linked to a Chipotle's Mexican Grill outlet in La Mesa (San Diego) has risen to 12, according to the Union Tribune.

The county's Department of Environmental Health is still investigating the source of the outbreak. None of the restaurant's 25 employees have tested positive for the virus so far.

Bill Marler (food safety attorney and blogger) has long advocated that all food handlers should receive hepatitis A vaccine. Now, only St. Louis County in Missouri and Clark County, Nevada mandate this.

The CDC Advisory Committee on Immunization Practices (ACIP) has this to say about hepatitis A and food handlers:
"Foodborne hepatitis A outbreaks are recognized relatively infrequently in the United States. Outbreaks typically are associated with contamination of food during preparation by an HAV-infected food handler; a single infected food handler can transmit HAV to dozens or even hundreds of persons (34,36,37,78--81). However, the majority of food handlers with hepatitis A do not transmit HAV. Food handlers are not at increased risk for hepatitis A because of their occupation. However, among the approximately 40,000 adults with hepatitis A reported during 1992--2000 for whom an occupation was known, 8% were identified as food handlers, reflecting the large number of persons employed in the food service industry (34). Evaluating HAV-infected food handlers is a common and labor-intensive task for public health departments. In a 1992 common-source outbreak involving 43 persons, the estimated total medical and disease control cost was approximately $800,000 (82)."
Nevertheless, ACIP does not recommend routine vaccination of food handlers, on the grounds that this is not an occupation that presents increased risk of becoming infected with the virus. They don't appear to consider the potential benefits or cost-savings to the general public that food handler vaccination would bring.

Current CDC recommendations for hepatitis A vaccination include:
  • all children under one year of age;
  • adults who live in a community with a high rate of hepatitis A infection;
  • males who have sex with other men;
  • users of street drugs;
  • those who work in or travel to countries with a high rate of hepatitis A infection;
  • people with long-term liver disease;
  • people who receive agents to help their blood clot; and
  • people who work with hepatitis A virus-infected animals or who work with the virus in a research setting.
Roughly one-third (31% in 2006) of US residents already have long-term immunity to hepatitis A, either through prior infection or as a result of having been vaccinated. This proportion should continue to rise, if parents follow CDC recommendations and have their children immunized.

Meanwhile, the two-thirds of the public without immunity to hepatitis A are at risk of infection from the occasional asymptomatic – and symptomatic – carrier working as a food handler. Perhaps it's time for one of the major restaurant food chains to take the lead and require that its employees be tested for hepatitis A immunity and, if necessary, be vaccinated. Are you listening, Chipotle?

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