SDCMS "News You Can Use" (2012.09.10) <> Hepatitis Exposure From San Diego Food Handler

Special SDCMS "News You Can Use"
— September 10, 2012

Hepatitis A Case Reported in a Food Handler at College Area McDonald’s: Risk to Public is Low • Be Aware of Signs and Symptoms

WHAT HAPPENED, WHERE, AND WHEN?

People who consumed food purchased from the McDonald’s Restaurant in Walmart at 3412 College Avenue in San Diego between 10am and 11pm on August 25, 26, 27, and 30, 2012, may have been exposed to hepatitis A due to an infected food handler who worked at this McDonald’s location while communicable.

HOW IS HEPATITIS A SPREAD? WHAT ARE THE SYMPTOMS?

Hepatitis A is usually spread when a person ingests fecal matter — even microscopic amounts — from contact with objects, food, or drinks contaminated by an infected person. People are at increased risk of getting hepatitis A when they have been in close and continuous contact with an infected individual, particularly in a household. Careful handwashing is the key to preventing the spread of hepatitis A.

The early signs and symptoms of hepatitis A appear two to seven weeks after exposure and commonly include mild fever, loss of appetite, nausea, vomiting, diarrhea, dark urine, light color stools, pain in the upper right abdomen, and yellowness to the eyes or skin (jaundice). Some individuals, especially children, may not develop jaundice or any symptoms at all. However, even mildly ill people can still be highly infectious and should consult a physician.

WHAT ARE THE RISKS OF INFECTION / TRANSMISSION?

The risk of hepatitis A transmission to restaurant patrons is low. Affected patrons have been advised to monitor their health for seven weeks from the date they consumed food from this specific restaurant location on the dates specified above. If symptoms of hepatitis A develop, patrons should contact their healthcare provider and not work in occupations such as food handling, healthcare, or child care while symptomatic. Many patrons may also be immune to hepatitis A due to prior vaccination or having hepatitis A in the past. Nonetheless, some restaurant patrons may elect to receive post-exposure prophylaxis (PEP) for potential exposure at the restaurant.

IF POST-EXPOSURE PROPHYLAXIS (PEP) IS CONSIDERED, WHAT FACTORS SHOULD BE ASSESSED?

• PEP for hepatitis A is only effective if administered within two weeks of the suspected exposure date;
• Patient’s susceptibility to hepatitis A (e.g., those who have previously been immunized with hepatitis A vaccine or who had the disease may be considered immune);
• Patient’s health status (e.g., certain immune disorders may increase risk of hepatitis A complications);
• Patient’s occupation (e.g., public risk reduction for food handlers, healthcare workers, and child care workers);
• Patient’s general risk (e.g., men who have sex with men, drug users, and others are at increased risk);
• Patient’s specific risk (e.g., multiple meals at involved restaurant during the mentioned dates/times may increase risk).

If PEP is indicated, hepatitis A vaccine is recommended for healthy adults aged 1-40 years; a second dose should be given according to the licensed schedule to complete the series, approximately six months after the first dose. The CDC recommends immune globulin (IG) for children aged <12 months, immunocompromised persons, persons with chronic liver disease, and persons who are allergic to the vaccine or a vaccine component. The CDC suggests IG for persons aged >40 years; however, vaccine may be used if IG cannot be obtained. The California Department of Public Health (CDPH) suggests hepatitis A vaccine and/or IG be considered for persons 41–59 years old. Hepatitis A vaccine confers long-term immunity, and the decision to give either or both may be based on vaccine availability and clinical judgment. CDPH prefers IG for persons 60 and over, but hepatitis A vaccine may also be considered in this group.

FURTHER INFORMATION:

• Click here for the County of San Diego Sept. 7 news release.
• Anyone who was exposed to the virus but is not covered by a medical insurance plan, and wants to be evaluated for hepatitis A immunization, may go to the HHSA Central Region Public Health Center at 5202 University Avenue in San Diego, where vaccinations will be given for minimal or no cost.
• Please promptly report via Confidential Morbidity Report (CMR) (under “Disease Reporting Requirements for Healthcare Providers”) or phone any suspected or confirmed case of hepatitis A to the Epidemiology Program at (619) 692-8499.
• CDC website for health professionals on hepatitis A, including vaccination, immune globulin, and post-exposure prophylaxis.
• CDPH quicksheet on hepatitis A.
• For more information about hepatitis A, call the HHSA Epidemiology Program at (619) 692-8499.