Hepatitis A and Food Service Workers

hepatitis AHepatitis A is a highly contagious disease that attacks the liver. The hepatitis A virus (HAV) is reviously known by other names including infectious jaundice, viral hepatitis and infectious hepatitis). There are a number of different hepatitis viruses but only the HAV, and possibly the hepatitis E virus, can cause foodborne disease.

Foodborne hepatitis A outbreaks are relatively uncommon in the United States; however, when they occur, intensive public health efforts are required for their control.

To prevent the spread of hepatitis A from an infected food worker to co-workers and/or restaurant patrons, food workers should never touch ready-to-eat foods with bare hands, and should carefully wash their hands after using the bathroom, even if the food worker does not feel sick. Food workers should never work while they are sick with stomach (gastrointestinal) illnesses.

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Which foods can be contaminated with hepatitis A?

The HAV can only be present in foods as the result of faecal contamination. Although this means that any food handled under poor hygienic practices could potentially be contaminated, it is bivalve molluscan shellfish, such as oysters, cockles and mussels, which are the most common source of foodborne viruses. These shellfish concentrate any virus particles in their tissues during filter feeding in contaminated water.

In recent years, fresh produce, such as salads, fresh fruits and vegetables, has increasingly been implicated in foodborne outbreaks of hepatitis A. These products are likely to be consumed raw or lightly cooked, and can become contaminated with faecal matter at almost any point during growing, harvesting, transport and packing.

Who gets hepatitis A?

Anyone can get hepatitis A, but certain persons are at increased risk of infection, including:

  • Children and adults living in areas with increased rates of hepatitis (i.e., certain Western states in the U.S.)
  • Persons traveling to countries where hepatitis A is common (i.e., Central and South America, Africa, the Middle East, Asia and the Western Pacific)
  • Men who have sex with men
  • Injecting and non-injecting drug users
  • Sexual contacts of infected persons
  • Household contacts of infected persons

How is the virus spread?

Hepatitis A virus is usually spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. This type of transmission is called the “fecal-oral” route. For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.

Most infections in the United States result from contact with a household member or sex partner who has hepatitis A.Hepatitis A virus may also be spread by consuming food or drink that has been handled by an infected person. Waterborne outbreaks are infrequent and are usually associated with sewage-contaminated or inadequately treated water. Casual contact, as in the office, factory or school setting, does not spread the virus.

What are the symptoms of hepatitis A?

The symptoms of hepatitis A may include an abrupt onset of fever, malaise, loss of appetite, nausea, stomach pain, dark-colored urine and jaundice (a yellowing of the skin and whites of the eyes). The disease is rarely fatal and most people recover in a few weeks without any complications. Adults have signs and symptoms of illness more often than children. Infants and young children tend to have very mild symptoms and are less likely to develop jaundice than are older children and adults. Not everyone who is infected will have all of the symptoms.

How soon do symptoms appear?

The symptoms commonly appear within 28 days of exposure, with a range of 15-50 days.

For how long is an infected person able to spread the virus?

The contagious period begins one to two weeks before symptoms appear, and is minimal about one week after the onset of jaundice. Food workers should be excluded from work for at least two weeks after the onset of clinical symptoms of hepatitis A. If jaundiced, food workers should not return to work for at least one week after onset of jaundice.

Does past infection with hepatitis A make a person immune?

Once an individual recovers from hepatitis A, he or she cannot be re-infected. He or she is immune for life and does not continue to carry the virus.

What is the treatment for hepatitis A?

There are no special medicines or antibiotics that can be used to treat a person once the symptoms appear.

How can hepatitis A be prevented?

To prevent person-to-person spread, careful hand washing after using the bathroom, changing diapers and before preparing or eating food, is the single most important means of prevention.

Immune globulin shots are effective in preventing the spread of hepatitis A if given within 14 days of exposure. Immune globulin may be recommended for co-workers of infected food workers. Under certain circumstances, particularly when recommended food safety procedures are not followed by food workers, public health officials may recommend that restaurant patrons receive immune globulin.

For long-term protection, hepatitis A vaccine is the best method of prevention.

Who should obtain the hepatitis A vaccine?

Hepatitis A vaccine is recommended for the following persons:

  • Travelers to areas with increased rates of hepatitis A
  • Men who have sex with men
  • Injecting and non-injecting drug users
  • Persons with clotting-factor disorders (e.g., hemophilia)
  • Persons with chronic liver disease (including persons with chronic hepatitis B or chronic hepatitis C virus infection)
  • All children aged 12-23 months; children not fully vaccinated by age two

The hepatitis A vaccine may also be used in certain outbreak situations where ongoing transmission is occurring. Although studies of certain occupational groups (for example, food service workers, health care workers, child care workers, sewerage workers) have not shown an increased risk, such people may consider vaccination if they wish to further reduce their risk or are in communities where ongoing outbreaks are occurring.

Why isn’t hepatitis A vaccine required for food service workers?

While food service employers can offer hepatitis A vaccine to their employees if they wish, most public health authorities prefer not to make it mandatory for the following reasons:

  • There is no evidence that food service workers are at any greater risk of acquiring hepatitis A than are people in other occupations.
  • Only 2-3 percent of all hepatitis A cases are acquired through restaurant food.
  • Employee turnover in some segments of the food service industry is high, making it impractical to vaccinate staff.
  • Emphasis on careful hand washing, use of disposable gloves and not working when ill are measures that can greatly minimize the risk of spreading hepatitis A and a number of other infections.
  • Hepatitis A vaccine would be strongly recommended for food service workers in a county or region where a community-wide outbreak has been recognized.

What about the vaccine?

Currently, there are two hepatitis A vaccines on the market. Both vaccines are safe and highly effective. Two doses given at least six months apart, are recommended. Approximately 99-100 percent of persons vaccinated with hepatitis A vaccine will develop long-lasting immunity.

Where can I obtain more information?

Hepatitis A (NIH MedlinePlus)
Trusted health information on causes, symptoms, treatment, and prevention.

Hepatitis A (CDC)
General information, including frequently asked questions and patient education resources.