Hepatitis A Case Evades U.S. Investigators

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Hepatitis A Case Evades U.S. Investigators

NEW YORK (Reuters Health) Jun 19 - A single case of hepatitis A in

Massachusetts highlights the guessing game that public health officials must

play when deciding whether or not to dole out prophylactic medications to

the public to avoid an outbreak.

New findings, published in the June 20th issue of the Morbidity and

Mortality Weekly Report, detail what happened when a restaurant food handler

with hepatitis A was considered an unlikely carrier of the virus only to be

implicated later in an outbreak of 46 cases.

Ordinarily when public health officials suspect that an outbreak of

hepatitis A is imminent they issue a public notification and offer

prophylaxis medication to people who believe they may have been infected.

The current case involved a restaurant worker who, after testing positive

for hepatitis A, notified his employer, who promptly called the local public

health department, lead investigator Dr. Dara Spatz Friedman, from the

Centers for Disease Control and Prevention in Atlanta, told Reuters Health.

A team of specialists was dispatched to investigate and conduct interviews

with the employees of the restaurant, including the individual with

hepatitis.

Since the worker in question reported routine hand washing and glove wearing

while preparing food, as well as a general lack of gastrointestinal

symptoms, officials on the case considered hepatitis A contamination of food

prepared by this worker unlikely. They did not issue a public health

notification.

Of note, according to Dr. Friedman, the individual with hepatitis A had a

colostomy. Still, the colostomy was under several layers of clothing and the

worker reported adequate hygiene practices, so the risk of food

contamination was considered small.

About 3 to 4 weeks later a total of 46 new cases of hepatitis A were

reported to local health officials. Further investigation revealed that at

least 21 of the cases had frequented the restaurant of the infected worker.

Interviews with people who contracted hepatitis A from the original carrier

revealed two individuals who also worked at a different restaurant. The risk

of transmission at this restaurant was considered high and a public

notification was issued.

As a result, 1600 people in the community received postexposure prophylaxis

with immune globulin and no new cases of hepatitis were reported.

Dr. Friedman says that the original investigation may have been hampered by

the fact that the public health officials on the case were not made

immediately aware of the worker's colostomy, but stressed that such a fact

does not necessarily implicate this as the route of transmission.

MMWR 2003;52:565-567