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Reuters Health Information (2003-06-19): Hepatitis A case evades U.S. investigators


Hepatitis A case evades U.S. investigators

Last Updated: 2003-06-19 16:03:12 -0400 (Reuters Health)

NEW YORK (Reuters Health) - 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.

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