How Significant Is The Hepatitis A Threat?

By Laurel Maloy, contributing writer, Food Online

Much can be learned about Hepatitis A as a result of outbreaks occurring across the world. Three of those outbreaks were reported in an unprecedented three-month period in Europe just last year.

The Centers for Disease Control and Prevention (CDC) recently published its final update on a multistate outbreak of Hepatitis A. Between March 31, 2013 – when the first illnesses was reported – and August 12, 2013 – the date of the last occurrence of this particular outbreak – a total of 165 people were ultimately infected as the result of pomegranate seeds imported from Turkey.

The age of those infected ranged from under 1 to 84 years, with 55 percent of those affected female. The majority of the cases happening from direct exposure occurred in California, Colorado, and Arizona. Those states reported 80, 29, and 24 cases, respectively. Eight of the cases were from secondary exposure to another infected person, not direct infection from the tainted product.

Also in 2013, Europe had three Hepatitis A outbreaks, with two of them traced back to frozen strawberries or other fruits grown in Egypt and Morocco. The conundrum researchers faced was none of the three outbreaks were actually related to each other. All three viruses differed genetically, having different sub-genotypes.

However, two of the three are thought to have originated from the same place, Eastern Europe. These three outbreaks sickened 400 people in 15 European Union countries and Switzerland. Concurrently, a viral Hepatitis A outbreak attributed to Italy was responsible for more than 1,300 cases in 11 European Member States. Peculiarly, the very same strain of the virus infected 21 residents of Ireland who had no link or travel history to Italy at all.

Hepatitis A, due to its exceptionally long incubation period, is one of the most difficult foodborne pathogens to trace back. As a result, it is exceptionally difficult to contain. The average incubation time from the day of exposure is 28 days, but the time can range from 15 to 50 days. Granted, since 1995, when the Hepatitis A vaccination became available, cases in the U.S. have declined dramatically.

The largest infection rates stem from developing countries where the inhabitants are often exposed at a very young age. These countries don’t experience the high rate of infection due to their natural immunity, but they export the pathogen in the food supply to developed countries that do not have the same elevated level of immunity. Also problematic is in 70 percent of children under the age of six, the infection is often asymptomatic and is rarely accompanied by jaundice, perpetuating its spread.

In the U.S., the majority of outbreaks occur on a smaller scale and are commonly attributed to a single worker at a single business. These outbreaks are numerous, but almost always only reported on locally meaning the majority of Americans go about their business unaware. However, as the U.S. depends more and more on a growing global food chain to supply an ever-increasing population, the risk for Hepatitis A grows exponentially. Evidenced by last year’s European numbers, a severe outbreak in the U.S. could easily span the lower 48 states and Mexico, potentially infecting thousands.

Prevention is always the best course of action. The Hepatitis A vaccination is recommended for all children at one year of age, though it is not governed by law. Just as we’ve seen increased incidents of measles and chicken pox, the anti-vaccination movement can greatly affect the spread of communicable diseases. In the workplace, vaccination is the best line of defense and is available for anyone wanting to acquire immunity. Encouraging employee vaccination is an effective way to stem the spread.

Additionally, unlike undeveloped or developing countries, the water supply in the U.S. is often chlorinated which aides in killing the pathogen. Irrigation water, however, is not routinely chlorinated, leaving the door open for fecal contamination and the subsequent spread of Hepatitis A. In this instance, proper safety measures must be exercised during processing.

The CDC recommends hand washing after using the bathroom and changing diapers prior to handling food products. The agency also suggests cleaning environmental surfaces with a freshly prepared 1 to 100 part dilution of household bleach.

San Francisco’s Communicable Disease Control and Prevention program reports it sees frequent cases. The agency further points out Hepatitis A is very common in Africa, Asia, Eastern Europe, Latin America, and the Middle East. Any travelers, even those executives staying in luxury hotels and eating at fine restaurants, are at risk. The following people, according to the CDC, the U.S. National Library of Medicine and the National Institutes of Health (NIH) are most at risk of contracting Hepatitis A:

• children in day care
• anyone living in the same household with an infected person
• sex partners in heterosexual, bisexual, or (most commonly)male homosexual liaisons
• persons traveling to countries where the pathogen is common
• people eating raw or undercooked shellfish
• people sharing needles for legal or illegal drug injections

The possibilities for infection appear innocuous, but are numerous. It’s important to learn from past history in order to prevent that which can be prevented. What are you doing in your facility to protect your workers, your brand, and the consumer?