Hepatitis A (Food Safety Issue)

What's the Problem?

Hepatitis A is a liver disease caused by the hepatitis A virus (HAV). HAV is found in the stool of infected people. Poor hygiene and unsanitary conditions facilitate the spread of HAV. HAV may spread within a household through close, intimate contact with an infected person. Eating food or drinking water contaminated with HAV can also spread HAV. Hepatitis A can cause mild "flu-like" symptoms, such as fatigue and loss of appetite, or more serious symptoms such as jaundice (yellow skin or eyes), nausea, vomiting, diarrhea, fever, or severe stomach pains. Children under five years of age are less likely than older people to have symptoms; however, children can be reservoirs of infection for older persons who may become much sicker when they become infected. Hepatitis A occurs in epidemics both nationwide and in communities. During epidemic years, the number of reported cases of hepatitis A has reached 35,000.

Who's at Risk?

Anyone can get hepatitis A, either as an isolated case or as part of a widespread epidemic. Each year thousands of people in the United States are infected with HAV and about one-fifth of them need to be hospitalized. The highest rates of infection are among children five to14 years of age and nearly 30% of all reported cases are among children younger than 15 years of age. A large number of cases occur under the age of 5, but many of these infections do not come to the attention of health professionals because young children often do not have symptoms.

A person is at increased risk for HAV infection if he or she: shares a household or has sex contact with someone who is infected with HAV; lives (especially children) in a region of the United States with consistently increased rates of hepatitis A; uses injection or non-injection illegal drugs; travels to countries where hepatitis A is common (e.g., Central or South America, Mexico, Asia [except Japan], and Africa); or is a man who has sex with another man. People with chronic liver disease have greater risk of adverse consequences of HAV infection. Hepatitis A, however, does not cause chronic liver disease, but does occasionally cause severe, life-threatening disease, most commonly in adults over 50.

Can It Be Prevented?

Yes. Hepatitis A vaccines are approved for people two years of age and older and are only approved for pre-exposure use. Immune globulin (a preparation of antibodies) can provide post-exposure protection for people who have been exposed to HAV. It should be given within two weeks of exposure to HAV to be effective. Immune globulin can also be used for pre-exposure (prior to exposure to HAV) protection from HAV infection and in children under two years of age.

The Bottom Line

Anyone can get HAV but certain groups of people are at increased risk. Symptoms of the disease can be mild (flu-like) to severe (jaundice). Occasionally, HAV can result in severe, life-threatening disease. Practicing good hygiene can limit the spread of HAV. These practices include washing hands: before preparing food, before eating, after changing a diaper, and after using the bathroom. Hepatitis A vaccines are safe, do NOT contain live virus, and are given in two doses, usually six to18 months apart. People who travel to areas where Hepatitis A is common should be vaccinated against hepatitis A, avoid raw foods, and drink bottled water.

Case Example

Three seventh-grade students complain they are feeling very tired and nauseous. One also has severe stomach pains, diarrhea, and vomiting. They go to the school nurse, who notes that one student has yellow eyes and skin. All three are sent home with directions to see their doctors. That afternoon, the jaundiced student is admitted to the hospital suffering from dehydration. Blood tests reveal the student has hepatitis A. The local health department is notified and a thorough investigation finds that all three students were recently infected with HAV and that they all ate salad at a local fast food restaurant about five weeks before the onset of symptoms. A food service worker who prepared the salads admits to having had diarrhea and stomach pains in the last couple of months. Blood tests on all food service workers at the restaurant reveal the symptomatic worker has evidence of recent infection with HAV.