You may have seen or heard a lot about the spread of hepatitis A in Hawaii recently. It was reported on August 3, 2016 that 135 hepatitis A infections occurred in the last few months and as a result, the Hawaii Department of Health has launched an investigation into the source of these infections. As a restaurant worker, it is important to know the facts about hepatitis A and how to protect yourself from infection.
What is hepatitis A?
It is a liver disease caused by the hepatitis A virus, resulting in inflammation of the liver and minor to severe illness. Hepatitis A is the most common form, but hepatitis B and C viruses also cause liver disease. Unlike the other two forms, hepatitis A generally does not cause chronic (long-lasting) liver disease, but in some cases acute liver failure may develop, which can be fatal.
How is it spread?
The virus is present in stool and spreads through ingestion of food or water that has been contaminated by the feces of an infected individual. The food industry can be especially susceptible to the spread of hepatitis A if workers do not employ careful hygiene practices before handling food. The virus can also be spread through close physical interaction with someone who is infected. However, casual contact does not spread the virus.
What are the symptoms?
The time between exposure to the virus and the onset of symptoms is 14 to 28 days. Symptoms will range in severity based on the individual. The most common symptoms include:
- Fever
- Diarrhea
- Jaundice (yellowing of the skin)
- Loss of appetite
- Abdominal pain
- Malaise (general discomfort)
- Nausea
- Dark urine
There is no specific treatment for hepatitis, and recovery times vary. Hospitalization is only necessary in cases showing signs of acute liver failure. Infected persons should avoid certain medications including acetaminophen, paracetamol, and nausea/vomiting medication.
If you have recently been exposed to hepatitis A, you should contact your doctor immediately. By knowing what the virus is and how to prevent or treat it, you can help stop its spread.
How do I prevent infection?
Adequate sanitation is important for preventing infection. Frequently washing your hands with soap and warm water, then drying thoroughly (with paper or air so the drying towel is not reused) will help decrease the likelihood of contracting the virus as well as the risk of spreading it.
A vaccine is also available and given in two separate doses over a six-month period. The hepatitis A vaccine is very effective and provides long-term immunity. Talk with your physician to see whether he or she recommends that you receive the vaccine. Common reactions to the vaccine include fever injection site pain and redness, rash and headache.
Is the vaccine medically necessary for me?
According to the Advisory Committee on Immunization Practices for the CDC and the World Health Organization, these are some recommendations to take into account when considering the hepatitis A vaccine:
- A routine immunization is recommended for children at age 1 year.
- A routine immunization is not recommended for all adults, but should be given to high risk individuals. Examples of high risk exposure include:
- Household contact with an individual infected with hepatitis (also includes sexual contact, IV drug sharing).
- Daycare employee taking care of infected children with diapers.
- Workplace contact of a food handler with the infection.
- For individuals who think they may have been exposed to hepatitis A, they can discuss the infection with their doctor to see if a preventive shot is needed with the vaccine or Immunoglobulin. Preventive injection must be given within 2 weeks of exposure to be effective.
Please note: Hepatitis transmission to restaurant and workplace patrons is very low unless you ate in an institutional cafeteria. The preventive shot is not recommended once cases begin to appear because the 2 week period has been exceeded. It is also important to note that once you are exposed to the virus, you will then have long-term immunity. In Hawaii, it is estimated that up to 50% of the population is already protected being infected because of prior exposure or vaccination. Pregnant women transmitting the disease to their baby have not been reported. The most common foods contaminated with the virus are shellfish and vegetables. If you want to know if you are considered high risk or if the vaccine is medically necessary for you, talk to your doctor.
Dr. John E. Aoki, M.D. CHCQM, FABQAURP
Chief Medical Officer
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