Hepatitis A is a highly contagious virus that infects the liver. In 2016, nationwide outbreaks of hepatitis A were identified. Since these initial outbreaks, and up through Aug. 16 of this year, there have been 24,280 cases reported across 29 states resulting in 14,525 hospitalizations and 236 deaths.
Hepatitis A is usually transmitted from person-to-person through consumption of food or water containing undetected traces of fecal matter from someone who is infected. Hepatitis A can also be spread through close personal contact with an infected person.
In the United States, this disease has traditionally been a concern in homeless and drug using populations, and in those who travel to countries where hepatitis A is prevalent. However, hepatitis A has become a growing concern in the food industry. Moreover, young children or anyone with a compromised immune system is at higher risk for contracting the disease.
Contamination of food can occur at any point in the food chain from the growing of produce to handling cooked food. Anyone who is infected with the hepatitis A virus and handles food can pass the virus onto food, and subsequently to another person. Additionally, food workers can pass the virus by handling utensils or by touching food preparation or contact surfaces.
Although hepatitis A can be killed by cooking food to 185 degrees Fahrenheit for one minute, the virus is not destroyed by freezing foods, and cooked foods can easily become contaminated by food handlers infected with the virus.
In the food codes for both Idaho and Washington, food handlers who are jaundiced or have been diagnosed as having hepatitis A must report the illness to the person in charge at the establishment, who must then report it to the health department or other appropriate regulatory authority.
However, food handlers often do not report illnesses because of the fear of missing work and wages. Just last month, a restaurant in Lynnwood, Wash., was shut down by the Snohomish Health District after a confirmed case of hepatitis A in a food worker. Anyone who had eaten at the restaurant, over a period of two weeks, is now at risk of being infected. Multiple outbreaks have occurred in Washington over the past two decades because of infected food workers.
Processed or fresh food is not immune to becoming contaminated with hepatitis A. Two major brands of frozen berry blends were recalled this past June. In February, chocolate and caramel candies were recalled because of potential contamination with hepatitis A. A multi-state outbreak of hepatitis A occurred in 2017, affecting consumers in nine different states. This outbreak resulted in 143 illnesses and 46 hospitalizations. Epidemiologic and traceback evidence indicated that frozen strawberries imported from Egypt were the likely culprit.
On the bright side, hepatitis A is the only foodborne illness for which there is a vaccine. The first hepatitis A vaccine in became available in 1995, and babies are now regularly vaccinated against hepatitis A. The wide availability of this vaccine has resulted in a 95-percent decrease in hepatitis cases in the United States.
Additionally, unvaccinated people who have been exposed to hepatitis A can receive the vaccine prophylactically within two weeks of exposure to prevent the disease from manifesting. The CDC has a list of high-risk populations who should get the vaccine, but anyone who wishes to be immune to the virus can be vaccinated.
Spokane Regional Health District has confirmed 11 cases of hepatitis A, resulting in nine hospitalizations in Spokane County since April 2019. Although this outbreak has been confined to the homeless population, SRHD is partnering with local businesses and organizations to provide free hepatitis A vaccinations. For more information on SRHD’s vaccination clinics, visit srhd.org/hepatitis-vaccination-locations.
For more information on hepatitis A, visit the CDC’s hepatitis A website at cdc.gov/hepatitis/hav/index.htm.
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Dr. Stephanie Smith is an Assistant Professor and Statewide Consumer Food Safety Specialist for Washington State University Extension.