Hepatitis A: Common but Preventable

It must have been a strange anniversary party. Last December, public health officials

gathered in Vienna, Virginia for the one-year anniversary of the largest Hepatitis A outbreak in

U.S. history. That outbreak occurred near Pittsburgh where 600 people contracted the infection

from contaminated restaurant food. Three of them died.

That should not have happened. Proper hygiene and effective vaccines can control the

spread 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 A

may be somewhere between 100,000 and 250,000 cases per year. Young children have the

highest incidence of infection and those infections are often asymptomatic. As a result, children

with 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 virus

is 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 be

fueling an outbreak in New Hampshire this month and health officials are urging users to get

vaccinated.

Symptoms of infection include fever, nausea, abdominal pain, fatigue, brown urine, and

yellow skin and eyes from jaundice. It’s hard to miss the symptoms in adults, but blood tests are

still done to distinguish Hepatitis A from other forms of hepatitis. (Hepatitis viruses are

designated A through E, and G. If you’re wondering what happened to F, investigators thought

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they had discovered F in 1994, but it proved to be a false report. Hepatitis H will probably be

found 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

Arundel and Baltimore counties matching the state-wide average, and Queen Anne’s County

recording one case. Baltimore City, however, measured more than twenty cases of Hepatitis A

per 100,000 residents. 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 (unlike

Hepatitis 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. The

vaccines can be given to any healthy child over the age of two. Vaccination also is

recommended 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 vaccine

recipients include children living in areas with high rates of Hepatitis A, and people with chronic

liver 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 involved

infected food handlers in restaurants and at catered events. A worker showing symptoms—and

therefore infectious—potentially could infect large numbers of customers and guests by handling

raw 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-

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related outbreaks do occur they quickly become expensive events. Health departments have to

institute control measures, track down the sick and the exposed, and provide post-exposure

prophylactic sera to prevent illness.

Uncooked shellfish have been an occasional source of food-borne Hepatitis A outbreaks.

Oysters caused about 278 cases in Louisiana in 1973 and 61 cases in Florida in 1988. The

contaminating source was probably untreated sewage too close to the oyster beds. Maryland has

been spared similar shellfish outbreaks, but it might be something to keep in mind the next time

you sit down at the raw bar.

For more information about Hepatitis A vaccines visit: www.cdc.gov/nip/vaccine/hep.