The onset of symptoms from hepatitis A virus infection may include diarrhea, fever, malaise, anorexia, nausea, abdominal pain, dark urine and jaundice.

For adults, it can be even more severe, leading to acute liver failure or the need for a liver transplant.

USF College of Public Health alumna Dr. Jill Roberts, assistant professor in the Department of Global Health, says that the majority of cases involving hepatitis A infection are foodborne, therefore, increasing vaccination among food handlers is key for prevention.

In her latest paper, “Prevention of Hepatitis A through Food Handler Immunization,” published in the May issue of Food Protection Trends, she outlines recent cases of hepatitis A virus transmission from food handlers and why vaccination is the answer to addressing the issue.

“The disease is eradicable,” Roberts said. “It only exists in humans and you have a vaccine available.”

The vaccine, Roberts said, is one of the most effective out there.

“Many vaccines have problems such as reported side effects or less than ideal efficacy,” she said. “This one is so good, so easy, and so inexpensive. It takes two doses and you’ve got a life time of coverage. It’s time to have this conversation and push the [food] industry to start thinking about this.”

Hepatitis A is primarily spread by the fecal-oral route, according to Roberts, and less frequently can be spread sexually.

According to Roberts, food products can become contaminated at any step in the continuum of food production from farm to fork.

From frozen imported Turkish pomegranate seeds sickening 165 people in 10 states in 2013 to an exposure of more than 90 patrons of a beach resort sushi restaurant in Hawaii leading to class action lawsuits in 2016, Roberts said it’s time to start addressing this at the food handling level.

Some of the strongest push back from the food industry, Roberts said, has been the cost involved.

However, she said that since mandatory vaccination for hepatitis A has been added to the CDC’s childhood vaccination schedule in 2003, the young people entering the food service industry are already vaccinated.

Roberts said every new employee who will handle food should be vaccinated, but she said much of that relies on the efforts of the food industry.

She said from a cost-benefit standpoint, it makes sense for the food industry to want to protect from potential hepatitis A related infections and lawsuits from patrons.

“Hospitals and daycares require mandatory vaccinations for their employees,” Roberts said. “As the lawsuits get more and more costly, profit is going to drive it [mandatory vaccination].”

Roberts said one’s risk of getting infected by hepatitis A while dining or consuming food depends on a few factors, the first being vaccination status.

“If you’re vaccinated, you’re at almost no risk whatsoever. If you’re not vaccinated, but you’ve had the disease before you’re not at risk,” she said. “If you’ve not had either prior infection or the vaccine, you’re at high risk.

Roberts said she intends to continue to monitor outbreaks of hepatitis A virus infection to see which ones are linked to food and which ones are not.

“Are there more or less situations happening in restaurants? Are restaurant managers doing anything? Are they starting to drive this vaccination? Does this increase interest  in the idea of vaccinating in food service?” Roberts said.

Roberts said anti-vaccine commentary is a danger to preventing the spread of global diseases such as this.

She said she hopes her latest paper highlights the importance of vaccination, especially among food handlers.

“To be able to bring together food and vaccines was obvious,” she said “You have a disease that has a highly safe and efficacious vaccine that only exists in humans, so theoretically we could wipe hepatitis A off the planet. Hopefully people will start to think about it.”

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Roberts, Jill. (2017). Prevention of Hepatitis A through Food Handler Immunization. Food Protection Trends, 37, 3, pp. 218-222.

 

Story by Anna Mayor, USF College of Public Health