About Hepatitis A Food Poisoning
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Hepatitis A is the only common vaccine-preventable foodborne disease in the United States (Fiore, 2004). It is one of five human hepatitis viruses that primarily infect the human liver and cause human illness. Unlike hepatitis B and C, hepatitis A doesn’t develop into chronic hepatitis or cirrhosis which are both potentially fatal conditions (Mayo Clinic, 2006); however, hepatitis A infection can still lead to acute liver failure and death.
Hepatitis A is relatively uncommon in nations with developed sanitation systems such as the United States. Nevertheless, it continues to occur here, and approximately one-third of the United States population has been previously infected with hepatitis A (Fiore, 2004).
Viral hepatitis is a major public health concern in the United States, and a source of significant morbidity and mortality. Each year, approximately 30 - 50,000 cases of hepatitis A occur in the United States. Direct and indirect costs of these illnesses exceed $300 million, including wage loss and medical expenses. Adults who become ill miss an average of 27 work days per illness. Eleven to 12 percent of persons infected are hospitalized, and 100 people die as a result of acute liver failure annually in the United States due to hepatitis A (CDC, 2007). The unfortunate aspect of these statistics is that with 21st Century medicine, hepatitis A is totally preventable and cases—especially outbreaks relegated to food consumption—need not occur.
The hepatitis A virus or “HAV” is relatively stable and will survive for up to a month at ambient temperatures in the environment, but can be inactivated by heating to 185°F (85°C) or higher, or exposure to formalin or chlorine.
How is Hepatitis A transmitted?
Hepatitis A is a communicable (or contagious) disease that spreads from person to person. It is transmitted by the “fecal – oral route,” generally from person-to-person, or via contaminated food or water. Outbreaks associated with food have been increasingly implicated as a significant source of hepatitis A infection. Such “outbreaks are usually associated with contamination of food during preparation by an HAV-infected food handler.” (CDC, 2007; Francis & Maynard, 1983).
Food contaminated with the virus is a common vehicle transmitting hepatitis A. The food preparer or cook is the individual most often contaminating the food. He or she is generally not ill: the peak time of infectivity (i.e., when the most virus is present in the stool of an infectious individual) is during the 2 weeks before illness begins. Indeed, “viral gastroenteritis was reported as the most common food-borne illness in Minnesota from 1984 to 1991, predominantly associated with poor personal hygiene of infected food handlers.” (Jaykus, 1997).
In addition to infected food workers, fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A (Fiore, 2004). In 1997, frozen strawberries were determined to be the source of a hepatitis A outbreak in five states (Hutin, et al., 1999), and in 2003, fresh green onions were identified as the source of a hepatitis A outbreak traced to consumption of food at a Pennsylvania restaurant (Wheeler, et al., 2005).
Although ingestion of contaminated food is a common means of spread for hepatitis A, it may also be spread by household contact among families or roommates, sexual contact, by the ingestion of contaminated water, by the ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and by direct inoculation from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play, unknown to their parents, who may later become infected from contact with their children.
Hepatitis A is much more common in countries with under-developed sanitation systems. This includes most of the world: an increased transmission rate is seen in all countries other than the United States, Canada, Japan, Australia, New Zealand, and the countries of Western Europe. Within the United States, Native American reservations also experience a greatly increased rate of disease (MMWR Reccom. Rep., 1999).