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Hepatitis A: Common but PreventableIt must have been a strange anniversary party. Last December, public health officialsgathered in Vienna, Virginia for the one-year anniversary of the largest Hepatitis A outbreak inU.S. history. That outbreak occurred near Pittsburgh where 600 people contracted the infectionfrom contaminated restaurant food. Three of them died.That should not have happened. Proper hygiene and effective vaccines can control thespread of this viral infection, yet it remains one of the most commonly reported, vaccine- preventable diseases in the U.S.In 2001, the Centers for Disease Control (CDC) recorded 10,609 cases of Hepatitis A.With underreporting and a large number of asymptomatic carriers, true figures for Hepatitis Amay be somewhere between 100,000 and 250,000 cases per year. Young children have thehighest incidence of infection and those infections are often asymptomatic. As a result, childrenwith undetected infections readily spread the virus among themselves, and to adults. Each year about one hundred people in the U.S. die from liver failure due to Hepatitis A.Hepatitis A is caused by a small RNA virus that infects and damages the liver. The virusis spread hand-to-mouth (the so-called “fecal-oral” route), through contaminated food and water,and sometimes through shared needles and other “risky behaviors.” Drug abuse seems to befueling an outbreak in New Hampshire this month and health officials are urging users to getvaccinated.Symptoms of infection include fever, nausea, abdominal pain, fatigue, brown urine, andyellow skin and eyes from jaundice. It’s hard to miss the symptoms in adults, but blood tests arestill done to distinguish Hepatitis A from other forms of hepatitis. (Hepatitis viruses aredesignated A through E, and G. If you’re wondering what happened to F, investigators thought1
 
they had discovered F in 1994, but it proved to be a false report. Hepatitis H will probably befound in the near future.)During the period 1987-1997, the CDC recorded about eight cases of Hepatitis A per 100,000 people in Maryland. Numbers of cases varied from county to county with Anne Arundeland Baltimore counties matching the state-wide average, and Queen Anne’s County recordingone case. Baltimore City, however, measured more than twenty cases of Hepatitis A per 100,000residents. The total reported for all of Maryland in 2004 was 52 cases.The Hepatitis A virus does not present any chronic or long-term health threats (unlikeHepatitis B and C), and once you’ve had it you’re immune to further infection. But no one wants jaundice and no one wants to spread the disease to friends, family and colleagues. So consider getting vaccinated.There are two vaccines available in the U.S. Both provide long-term immunity. Thevaccines can be given to any healthy child over the age of two. Vaccination also isrecommended for travelers and tourists going to countries where the quality of sanitation and personal hygiene may be less than what the average Westerner expects. Others potential vaccinerecipients include children living in areas with high rates of Hepatitis A, and people with chronicliver disease or clotting disorders such as hemophilia.Surprisingly, the CDC does not recommend routine vaccination for food service workers.According to a number of studies, most food-borne outbreaks of Hepatitis A have involvedinfected food handlers in restaurants and at catered events. A worker showing symptoms—andtherefore infectious—potentially could infect large numbers of customers and guests by handlingraw and uncooked foods. (This is why restaurant bathrooms have those signs that read,“Employees must wash hands.”) Most workers are not a threat to customers, but when food-2
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