Publisher’s Platform: A letter to the CDC’s Committee on Immunization Practices – It is time to deal with hepatitis A and foodservice workers
Dear ACIP Secretariat,,
The Consultative Committee for Vaccination Practices (APIP) provides advice and advice to the CDC director concerning the use of vaccines and related agents for the control of vaccine preventable diseases in the United States civilian population. The recommendations made by the APIP are examined by the director of the CDC and, if adopted, are published as official recommendations of the CDC / HHS in the weekly Morbidity and Mortality (MMWR) ratio.
Currently, around 5% of all hepatitis A epidemics are linked to infected food managers.
Here is what the CDC continues to say about the vaccination of food managers:
Why does CDC not recommend that all food managers be vaccinated if an infected food manager can distribute diseases during epidemics?
The CDC does not recommend vaccination of all food managers, as this would not prevent or do not stop ongoing epidemics mainly affecting persons who report or inject drugs and people who have undergone homelessness. Food managers do not run an increased risk of hepatitis A because of their occupation. During current epidemics, the transmission of food managers to restaurant customers has been extremely rare because standard sanitation of food managers help prevent the spread of the virus. People who live in a household with an infected person or who participate in risk -described behaviors are more at risk of hepatitis A infection.
The CDC lacks the point; Admittedly, food services do not risk obtaining hepatitis A because of their profession, but they are a risk of disseminating it to customers. Food service positions are generally not very paid and certainly have the probability of being provided by people who are immigrants from countries where hepatitis A could be endemic or by people who have recently been known.
In recent years, there has been an epidemic during hepatitis A in the United States. As of February 2, 2023, there was a total of 44,779 cases with a hospitalization rate of 61% (around 27,342 hospitalizations). The number of deaths is 421. Since the epidemic began in 2016, 37 states reported cases to the CDC.
The CDC recommends to the public that the best way to prevent hepatitis A is by vaccination, but the CDC has not explicitly declared that food workers should be administered vaccination. Although food workers are not traditionally designated as having an increased risk of transmission of hepatitis A, they are not exempt from risk.
24 percent of hepatitis A cases are asymptomatic, which means that a food coat bearing the virus can transmit disease to consumers without knowing it. Historically, when an epidemic occurs, local health services are starting to administer the vaccine for free or at a reduced cost. The financing of these vaccinations is done through taxpayers’ dollars.
A compulsory vaccination policy for all food workers has proven to be effective in reducing infections and economic burden in the county of St. Louis, Missouri.
From 1996 to 2003, Clark Country, Nevada, had 1,523 confirmed cases of hepatitis A, which was greater than the national average. Due to these alarming rates, the Clark County has implemented a compulsory vaccination policy for food services. Consequently, in 2000, hepatitis A levels fell considerably and reached historic stockings in 2010. The county removed the compulsory vaccine rule in 2012 and is now part of the hepatitis A epidemic.
According to the CDC, vaccinations cost $ 30 to $ 120 to the administration, compared to thousands of dollars in hospital bills, and offer an efficiency rate of 95% after the first dose and an efficiency of 99% after the second dose. In addition, the vaccine retains its effectiveness for 15 to 20 years.
During an epidemic, if a food worker turns out to be positive of hepatitis, a local health service will initiate post-exposure treatment plans which must be administered within two weeks to be effective. The economic burden also affects the health service in terms of personnel and other limited resources. Sometimes the interventions implemented by the local health service can be ineffective.
Although there are many examples of punctual epidemics of hepatitis A which have occurred in recent years across the country, a particularly flagrant epidemic has occurred in early 2021 in Roanoke, Virginia. The health service was informed of the epidemic on September 21, 2021, after the first case was reported by a local hospital. The Roanoke Department of Health, as well as the Virginia Health Department, investigated this epidemic.
Three different locations from a local restaurant, famous Anthony, were finally determined to be associated with this epidemic. The Virginia Department of Health published a community announcement on September 24, 2021 on the epidemic and the risk of potential exposure.
For the purpose of the investigation, a case was defined as a “[p]Erson with (a) discreet beginning of symptoms and (b) jaundice or high rate of serum aminotransferans and (c) [who] Tested positive for hepatitis A (IgM anti-HAV-Postix) and frequented one of the three famous Anthony locations, or was close contact with the patient in the index case, during dates from August 10 to August 27, 2021. “
In November 2021, a total of 49 primary cases (40 confirmed and 9 probable) were identified in this epidemic. Two secondary cases were also identified. Cases varied from 30 to 82 years (median age of 63). In total, 57% of cases were men. Thirty -one case included hospitalizations and at least 4 patient patients died. The problems of illness took place between August 25 and October 15, 2021.
In the end, the investigation into the epidemic revealed that a cook, which also had risk factors associated with hepatitis A, had been infected with hepatitis for a time working in several locations of Anthony restaurants. The adult mother and son of this indexed case were also tested positive for hepatitis A. After an inspection, the epidemic inspector noted: “Due to the etiology of the transmission of hepatitis A, it is assumed that the infection food manager has not carried out appropriate handwasher nor followed the policy of use of gloves.” It was determined that the person’s spread to the person was the most likely mode of transmission in this epidemic. Environmental contamination was also considered a possible mode of transmission.
Overwhelmed by the number of victims who pursued legal actions for their injuries, the famous Anthony was filed in bankruptcy and several of his locations were closed.
The tragedy of this epidemic of preventable hepatitis cannot be overestimated. Four people died. In a family, two of its members lost their lives. Most of the victims have been hospitalized. Many risked keen liver defective. At least one person needed a liver and kidney transplant. Medical invoices for victims have totaled more than $ 6,000,000 in acute costs with millions of dollars in future expenses. And, all because an employee did not receive hepatitis A vaccine A from $ 30 to $ 120.
The affordable prevention of future tragedies like the famous Anthony epidemic is possible and necessary. The time has come to recommend at least vaccinations to food services to reduce the spread of hepatitis A.
I urge you to review this recently published article.
“Determine the burden of hepatitis of food origin propagated by food managers: suggestions for targeted vaccination?”
Studies have highlighted critical challenges, including sub-declaration, asymptomatic cases and delayed interventions. Control measures have largely relied on the administration of immunoglobulins, while vaccination has rarely been implemented and has shown poor membership of food services. Although economic analyzes have been limited and sometimes not conclusive, some evidence has suggested a potential economy of health care health care. Given the high transmissibility of HAV and the difficulty detection difficulty, targeted vaccination of food managers – in particular those in high -risk contexts or seasonal jobs – emerges as a promising method of organic risk management in food industries. These considerations could support food industries to consider vaccination as a tool to prevent food transmission.
Trucchi C, del Puente F, Piccinini C, Roveta M, Sartini M and Cristina ML (2025) Determine the burden of food hepatitis propagated by food managers: Suggestions for targeted vaccination? In front. Public Health 13: 1617004. DOI: 10.3389 / FPUBH.2025.1617004
Sincerely,
William Marler
On behalf of 31 victims and families of hepatitis A
