September 20, 2020

CDC Assesses Role of Food Handlers in Hepatitis A Transmission

In the latest issue of the Center for Disease Control and PRevention’s Morbidity and Mortality Weekly Report, Notes From the Field addresses the role of food handlers restaurants in Hepatitis A transmission. Hepatitis A transmission is occurring in unprecedented numbers across the United States, given that there is an effective vaccine against the virus.

CDC Assesses Role of Food Handlers in Hepatitis A Transmission

As of May 2020, 33 states have reported hepatitis A outbreaks that have sickened more than 32,000 people, caused 19,800 hospitalizations, and 320 deaths since 2016. Hepatitis A infections among food handlers have raised public alarm. Many food safety experts are calling for vaccinating all food handlers. Health departments issue warnings to restaurant patrons every month about food handlers diagnosed with hepatitis A, warning patrons to get vaccinated.

But the risk for transmission from a hepatitis A positive food handlers to consumers isn’t well understood. So researchers developed a novel, structured survey among 30 state health departments reporting person-to-person hepatitis A outbreaks from July 1, 2016 to September 13, 2019. Twenty-nine states responded.

Among 22,825 hepatitis A outbreak cases reported in those states, 871, or 3.8%, were among food handlers. A majority of those food handlers reported one or more risk factors, such as drug use unstable housing or homelessness, or incarceration during the 15 to 50 days before symptoms began.

As the risk for secondary infection from hepatitis A-infected food handlers is low, so the authors concluded that preemptively vaccinating all food handlers would be ineffective at mitigating the current risk for person-to-person outbreaks. Instead, public health departments should assess the risk on a case-by-case basis and prioritizer vaccination efforts to situations where secondary transmission. risk is high.

Instead, they say that health departments should implement vaccination strategies targeting populations at highest risk. Those populations include drug users, people experiencing homelessness, MSM, and people who were recently incarcerated.

Hofmeister MG, Foster MA, Montgomery MP, Gupta N. Notes from the Field: Assessing the Role of Food Handlers in Hepatitis A Virus Transmission — Multiple States, 2016–2019. MMWR Morb Mortal Wkly Rep 2020;69:636–637. DOI: http://dx.doi.org/10.15585/mmwr.mm6920a4

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