Hepatitis Blog

500 Immunized after Hepatitis A exposure at Lone Star Steakhouse

marler@marlerclark.com (Hepatitis Attorney) — Mon, 14 May 2012 14:36:35 -0800

The Vanderburgh County Health Dept. is urging diners who ate at Lone Star Steakhouse during the days an employee infected with Hepatitis A worked to receive a free vaccination.

Vaccines will be administered at the department's immunization clinic at 420 Mulberry St. every day from 10 a.m. to 6 p.m. until Thursday.

Dr. Ray Nicholson, the department's health officer, estimates that out of the nearly 1,500 patrons who dined at the Eastland Place restaurant from April 29 to May 3, around 500 have been immunized. The employee, a bartender, handled mostly drinks and some food.

Persons exposed to the virus have a window of 14 days for the vaccine to be considered effective. The health department states that customers who ate or drank at Lone Star between April 20-30 could also have contracted hepatitis A but shouldn't bother with the vaccine.

Victims can carry the virus for five days without showing symptoms and be infectious to others. Jaundice, a yellowing of the skin and eyes, can show up several days after symptoms first appear.

Hepatitis A is a viral infection of the liver that in some cases can cause death, but that happens usually when there is an existing medical complication. An average, healthy person does not typically die from Hepatitis A. It is far less damaging than Hepatitis B and Hepatitis C, which are far more likely to result in liver failure. The Hepatitis A virus is found on the feces of those infected and carry mostly by hands through close, personal contact.

Hepatitis A Shots still available for exposure at Lone Star Restaurant located in the Eastland Place Shopping Center

marler@marlerclark.com (Hepatitis Attorney) — Mon, 14 May 2012 10:02:35 -0800

The time window is rapidly closing for those patrons who dined at the Lone Star Restaurant located in the Eastland Place Shopping Center at 943 N. Green River Road Evansville IN, 47715 to receive their free Hepatitis A vaccine.

Hepatitis A vaccine will be provided at the Vanderburgh County Health Department at 420 Mulberry Street Saturday May 12 through Thursday, May 17, 2012 from 10:00 a.m. to 6:00 p.m. each day including Sunday. Those who have symptoms of illness should not attend the clinics but should seek immediate medical attention.

Symptoms of Hepatitis A include fever, fatigue, loss of appetite, nausea, vomiting, stomach pain, pale colored stools, and dark urine. Jaundice, a yellowing of the skin and eyes, may occur a few days after symptoms appear.

Persons MUST receive the vaccine within 14 days of exposure for the vaccine to be effective. Persons presenting for vaccine 14 or more days after exposure will not be vaccinated and instructed to seek medical care if they develop symptoms.

Anyone who ate or drank at the Lone Star between April 30, 2012 and May 3, 2012 may have been exposed and at risk of developing Hepatitis A. Persons who are fully vaccinated against Hepatitis A or have a previous history of Hepatitis A disease are considered protected from disease and not at risk.

The following chart shows the last day to be vaccinated for each day in question.

Date Food/drink Consumed from Evansville Lone Star - Last Day to Be Vaccinated

Monday, April 30, 2012 - Monday, May 14, 2012

Tuesday, May 01, 2012 - Tuesday, May 15, 2012

Wednesday, May 02, 2012 - Wednesday, May 16, 2012

Thursday, May 03, 2012 - Thursday, May 17, 2012

Persons who ate or drank at the Lone Star from April 20-April 29 could also get Hepatitis A, but should not receive vaccine because it is considered to be ineffective for exposure past 14 days. Those people should seek medical care if they show symptoms of Hepatitis A.

For more information, go to www.vanderburghgov.org/health and click on the Hepatitis button,

E-mail health@vanderburghgov.org, or call the Department at 435-2400 and select option 1.

Hepatitis A: Indiana Lone Star Employee Positive

marler@marlerclark.com (Hepatitis Attorney) — Thu, 10 May 2012 13:58:25 -0800

Hepatitis A is a viral infection of the liver. The incubation period (time of exposure to development of symptoms) is usually 2 to 7 weeks. Symptoms may include fever, fatigue, loss of appetite, nausea, vomiting, stomach pain, pale colored stools, and dark urine. Jaundice, a yellowing of the skin and eyes, may occur a few days after symptoms appear. Symptoms usually last one to two weeks but can last longer. Symptoms are more likely to occur in adults than in children. Severe complications are rare and occur more often in persons who have liver disease or a weakened immune system. Anyone with symptoms of Hepatitis A is encouraged to seek medical attention promptly.

Hepatitis A is spread person-to-person by the fecal-oral route and occurs when a person eats food or drinks a beverage contaminated by someone with the virus. Thorough hand washing after using the restroom, after changing diapers, and before touching or preparing food or drinks is the best way to control the spread of Hepatitis A.

The Vanderburgh County Health Department and the Indiana State Department of Health are investigating a case of Hepatitis A in a food worker at the Lone Star Restaurant located in the Eastland Place Shopping Center at 943 N. Green River Road Evansville IN, 47715-2418.

“We’ve been in contact with Lone Star and we wanted to let people know that they may have been exposed,” Dr. Ray Nicholson, Health Officer for the Health Department said.

Persons who were exposed and unvaccinated can receive a dose of Hepatitis A vaccine to help lessen the effects of the disease or prevent disease if given within 14 days of exposure. Persons who ate or drank at the Lone Star from April 20-April 26, 2012 could have been exposed to Hepatitis A, but should not receive vaccine because it is not effective for exposure past 14 days. Those people should seek medical care if they show symptoms of Hepatitis A.

Persons who ate at the Lone Star from April 27, 2012 to May 3, 2012 may also have been exposed to the Hepatitis A virus. The Vanderburgh County Health Department and Indiana State Department of Health are working to secure vaccine to offer to anyone who ate at the restaurant from April 27 to May 3, 2012. Information on immunization clinics will be released when the health department receives the vaccine. In the meantime, health officials say to remain on the alert.

1,000 Receive Hepatitis A Vaccines after exposure at Alabama McDonalds

marler@marlerclark.com (Hepatitis Attorney) — Sun, 15 Apr 2012 10:14:27 -0800

About 1,000 people received hepatitis A vaccinations through the Tuscaloosa County Health Department last week after it was announced that a local fast-food employee had been diagnosed with the virus.

But no one else has been diagnosed with the virus, which means it’s extremely unlikely that anyone else contracted it, said Dr. Albert White, area health officer for ADPH Area 3, which includes Tuscaloosa County.

“No other cases have been found, which makes it very unlikely that we had an outbreak,” White said.

Last week, the state health department announced that people who ate at the McDonald’s on McFarland Boulevard in Northport any time on March 14 or the morning of March 16 should seek a hepatitis A vaccination as soon as possible, because an employee at the restaurant had been diagnosed with the virus. It is standard practice to notify the public when someone who works in the restaurant industry is diagnosed with the virus, White said.

After the announcement, the county health department received a swarm of phone calls and a steady stream of concerned residents seeking vaccinations. The announcement was precautionary and does not mean that the food at McDonald’s was ever contaminated, White said.

Hepatitis A is a contagious liver disease that can range in severity from a mild illness that lasts a few weeks to a severe illness that lasts months, according to the Centers for Disease Control. Symptoms can include fever, loss of appetite, nausea, vomiting, diarrhea, tiredness, pain in the upper right side of the abdomen, dark urine, light stools and jaundice.

The virus is relatively rare. Nationally, about 20,000 new cases of hepatitis A are diagnosed in the U.S. each year, according to the CDC. There has been more than a 90 percent decrease in people with hepatitis A in the past 20 years.

Bad Bug Book - Foodborne Pathogenic Microorganisms and Natural Toxins - Second Edition - Hepatitis A Virus

marler@marlerclark.com (Hepatitis Attorney) — Sat, 07 Apr 2012 22:09:23 -0800

Bad Bug Book - Foodborne Pathogenic Microorganisms and Natural Toxins - Second Edition

1. Organism

Hepatitis A virus (HAV) particles are environmentally hardy organisms that can be transmitted by contaminated food, water, environmental surfaces (e.g., contaminated table tops, cooking utensils) and through direct or indirect person-to-person contact. Although HAV cannot grow in the environment, they are considered to be extremely stable under a wide range of environmental conditions, including freezing, heat, chemicals, and desiccation. Concentrations of disinfectants commonly used against pathogenic bacteria are not considered effective against these viruses.

There are six HAV genotypes (I-VI), as determined by RNA sequence analysis at the VP1-2A junction of the virus genome. Genotypes I, II, and III contain strains associated with human infections, with the majority of human strains grouped within genotypes I and III. Genotypes I-III have been further divided into sub-genotypes A and B for each genotype. Most non-human primate strains are grouped within genotypes IV, V, and VI. Despite the identification of multiple genotypes/strains, this is the only known serotype for HAV. Humans and several species of non-human primates are the only known natural hosts for HAV.

HAV is classified with the enterovirus group of the Picornaviridae family, genus Hepatovirus, and is comprised of single positive-stranded RNA genome of approximately 7.5 kilobases. This RNA molecule is protected from the environment by a protein capsid (“shell”) comprised of multiple copies of three or four proteins. HAV is a non-enveloped (i.e., no lipid-containing envelope), hydrophobic virus 22 to 30 nm in size, with icosahedral symmetry with 20 sides.

2. Disease

• Mortality: The overall death rate among people with hepatitis A (that is, liver involvement; the term “hepatitis A” is used to refer to the disease, not to the virus) is approximately 2.4%. Increased age (over 50 years old) slightly increases the death rate. Overall, hepatitis A accounts for < 0.001% of all foodborne-associated deaths. Although fulminant (severe, rapidly progressing) disease is rare, the mortality rate is much higher, at 70% to 80%, as noted in the Illness / complications section, below.

• Infective Dose: The infective dose of HAV is presumed to be low (10 to 100 viral particles), although the exact dose is unknown. The viral particles are excreted in the feces of ill people (symptomatic and asymptomatic) at high densities (106 to 108/gm) and have been demonstrated to be excreted at these levels for up to 36 days post-infection.

• Onset: In symptomatic patients, mean incubation phase is 30 days (range 15 to 50 days).

• Illness / complications: HAV infections can be asymptomatic or symptomatic. Infections usually are asymptomatic in children younger than age 6 and symptomatic in older children and adults.  When disease does occur, it is usually mild and recovery is complete within 1 to 2 weeks, although it may last up to several months, in which case it is also generally self-limiting. HAV infection is not considered to be chronic; however, a prolonged or relapsing disease lasting up to 6 months in 10-15% of patients has been reported. Patients feel chronically tired during convalescence, and their inability to work can cause financial loss.  An atypical, and rare, clinical outcome of acute HAV infection is fulminant hepatitis or fulminant hepatic disease, which occurs in less than 1% to 1.5% of cases. This more severe outcome of acute HAV infection and illness involves massive hepatic necrosis, with acute liver failure, and has a high case-fatality rate (70% to 80%).  The reasons for progression to acute, severe, or fulminant hepatitis remain unclear; however, it is known that patients with an underlying chronic liver disease are at particularly high risk for fulminant disease or liver failure. Factors that may play a role in severe hepatic disease progression include the nature of the host response (e.g., genetic, immunologic, or physiologic), the viral pathogen (e.g., strain virulence), and/or viral dosage (e.g., viral inoculums, patient viral load, or levels of viral replication).  A hepatitis A vaccine is available.

• Symptoms: Symptoms associated with HAV infection include fever, anorexia, nausea, vomiting, diarrhea, myalgia, hepatitis, and, often, jaundice. Jaundice generally occurs 5 to 7 days after onset of gastrointestinal symptoms; however, in 15% of reported jaundice cases, the jaundice was not preceded by gastrointestinal symptoms.

• Duration: Typically 1 to 2 weeks, although prolonged or relapsing cases may continue for up to 6 months in a minority of patients.

• Route of entry: HAV may cause infection through various routes. The route of entry for the foodborne infection is oral.

• Pathway: The exact mechanism of HAV pathogenesis is not fully understood. The route of entry for foodborne HAV typically is the gastrointestinal tract. From the intestinal tract, the virus is transported to the liver via the blood, where hepatocytes generally are thought to be the site of viral replication. The virus is thought to be excreted by the hepatocytes and transported to the intestinal tract via bile. However, some studies suggest that initial replication may occur in crypt cells of the small intestine.

3. Frequency

An estimated 1,566 cases of hepatitis A from consumption of contaminated food occur annually in the United States. This constitutes a small portion (1% to 1.5%) of the total number of patients infected with HAV. Overall, hepatitis A accounts for < 0.001% of all foodborne-associated hospitalizations in the U.S. Hepatitis A from any cause (i.e., not just the foodborne illness) has a worldwide distribution occurring in both epidemic and sporadic fashion. In the U.S., from 1980 through 2001, an average of 25,000 cases of hepatitis A was reported to the Centers for Disease Control and Prevention (CDC) annually. However, correcting for under-reporting and asymptomatic infections, CDC estimates that an average of 263,000 HAV infections, from all causes, occurred annually in the U.S. during this period.

Until 1995, the overall incidence of HAV infection in the U.S. was cyclic, with nationwide increases occurring every 10 to 15 years (Figure 1). Since 1995, the estimated overall number of reported HAV infections in the U.S. has been declining. This significant decrease (with the most significant decrease occurring in children) appears to coincide with the vaccination program, for children and adolescents 2 to 12 years old that began in the U.S. in 1996.

Incidence of Acute, Symptomatic Hepatitis A – United States, 1980-2008

Centers for Disease Control and Prevention. Accessed May 2011.

4. Sources

HAV is excreted in feces of infected people and can produce clinical disease when susceptible people consume contaminated water or foods. Cold cuts and sandwiches, fruits and fruit juices, milk and milk products, vegetables, salads, shellfish, and iced drinks are commonly implicated in outbreaks. Water, shellfish, and salads are the most frequent sources. Contamination of foods by infected workers in food-processing plants and restaurants also is common.

In the U.S., the estimated transmission rate of this virus by person-to person contact was 22%. Of that, 8% was associated with day-care settings, 5% with international travel, 5% with illegal injectable drug use, and 4% with consumption of common-source contaminated food or water. The transmission routes for 65% of cases are unknown. Low income, low education level, crowding, and lack of access to safe drinking water and sanitation facilities are associated with increased rates of HAV infection.

5. Diagnosis

Clinical diagnosis of an HAV infection can be achieved by performing the appropriate analytical tests on serum or stool specimens. HAV diagnosis is generally performed by immunoglobulin (Ig) anti-hepatitis A antibody tests, IgM or IgG, in which an increase in virus-specific serum antibody titers is indicative of a recent HAV infection. One notable limitation for these antibody- based tests is that they cannot readily distinguish a recent HAV infection from increased antibody titer due to immunization, which can lead to elevated IgG and/or IgM being elicited against HAV. In addition to antibody testing, which also includes the use of immunoelectron microscopy, the use of molecular tests premised on reverse transcription polymerase chain reaction (RT-PCR) can also be utilized. Commercial kits are available to assist in HAV diagnosis.

6. Target Populations

All people are considered susceptible to HAV infection. Immunity can be developed by exposure and/or immunization that elicit an immune response that confers long-term immunity. In the U.S., the percentage of adults with immunity increases with age (10% for those 18 to 19 years of age to 65% for those over 50 years old). The increased number of susceptible people allows common-source epidemics to evolve rapidly.

7. Food Analysis

Methods have been developed to detect HAV in the food commodities most often implicated in HAV-associated illnesses; most notably, produce and shellfish. The manner in which the food is analyzed is dependent on the presumed location of contamination. For example, produce methods generally use a method to wash the viruses from the surface, whereas shellfish methods extract the virus from the digestive tract. Following extraction, the viruses are concentrated to suitable levels, so that detection via RT-PCR can be performed. These methods currently used by specialized regulatory laboratories to analyze suspected food for HAV are undergoing rigorous validation to verify that they are suitable for routine analysis.

8. Examples of Outbreaks

Hepatitis A is endemic throughout much of the world. Major national epidemics occurred in 1954, 1961, and 1971. Foods continue to be implicated in HAV outbreaks, which continue to occur in the U.S. following consumption of contaminated produce and shellfish. The most notable recent HAV outbreaks, in the U.S., that were associated with foods include:

• 1987 - Louisville, Kentucky- lettuce (imported)

• 1998 - Ohio- green onions (Mexico/California)

• 2000 - Kentucky and Florida- green onions (from Mexico) or tomatoes (California)

• 2003 - Tennessee, North Carolina, Georgia, Pennsylvania – green onions (Mexico)

• 2005 - Tennessee, Alabama – oysters (Louisiana)  Case Example: In August 2005, at least 10 clusters of hepatitis A illness, totaling 39 people, occurred in four states among restaurant patrons who ate oysters. Epidemiologic data indicated that oysters were the source of the outbreak. Trace-back information showed that the implicated oysters were harvested from a specific Gulf Coast shellfish-growing area. A voluntary recall of oysters was initiated in September. HAV was detected in multiple 25-gm portions in one of two recalled samples, indicating that as many as 1 of every 15 oysters from this source was contaminated (Shieh, 2007).  Other examples include:

CDC Morbidity and Mortality Weekly Report: Hepatitis A Virus Provides a list of CDC Morbidity and Mortality Weekly Reports relating to this  organism.

NIH/PubMed: Hepatitis A Virus Provides a list of research abstracts contained in the National Library of Medicine’s  MEDLINE database for this organism.

Agricola: Hepatitis A Virus Provides a list of research abstracts contained in the National Agricultural Library  database.

9. Other Resources

• Shieh YC, Khudyakov YE, Xia G, Ganova-Raeva LM, Khambaty FM, Wood JW, Veazey JE, Motes ML, Glatzer MB, Bialek SR, and Fiore AE. 2007. Molecular confirmation of oysters as the vector for hepatitis A in a 2005 multistate outbreak. J. Food Prot. 70:145-150.

• HAV Definition and MeSH headings from the National Library of Medicine

As Many as 3,400 People Exposed to Hepatitis A at Alabama McDonald's

marler@marlerclark.com (Hepatitis Attorney) — Thu, 29 Mar 2012 21:58:42 -0800

The Alabama Health Department says customers of McDonald's at 2000 McFarland Blvd in Northport may have been exposed to hepatitis A through an infected employee.

The employee worked March 14 and 16. Health officials ask anyone who visited the restaurant on those days to seek medical attention as soon as possible. Officials estimate around 3,400 visited the restaurant during the two-day span.

Customers who visited the McDonalds between Feb. 28 and March 16 could have been exposed to the infection, according to the health department.

"Hepatitis A vaccine and immune globulin can prevent hepatitis A virus infection, but only when given within 14 days of exposure," said State Health Officer Dr. Donald Williamson.

The Health Department says exposed individuals should receive treatment no later than this Friday, March 30. Individuals previously vaccinated with hepatitis A vaccine are considered protected from this exposure.

No one else besides the McDonald's employee has tested positive for hepatitus A. The employee is recovering at home.

Hepatitis A Virus was possibly transmitted at McDonald's in Northport Alabama

marler@marlerclark.com (Hepatitis Attorney) — Wed, 28 Mar 2012 12:14:55 -0800

Customers of McDonald’s, located at 2000 McFarland Blvd, Northport may have been exposed to hepatitis A virus through an infected employee. If you visited this McDonald’s any time on March 14, 2012, or during breakfast hours on March 16, 2012, please contact your health care provider as soon as possible. If you do not have a health care provider, you may contact the Tuscaloosa County Health Department at (205) 562-6900.

According to Dr. Donald Williamson, State Health Officer, “Hepatitis A vaccine and immune globulin can prevent hepatitis A virus infection, but only when given within 14 days of exposure.” Therefore, individuals exposed on March 14, 2012, or March 16, 2012, should receive treatment no later than this Friday, March 30, 2012. Individuals previously vaccinated with hepatitis A vaccine are considered protected from this exposure.

Customers visiting this McDonald’s between Feb. 28 and March 14 may have been exposed and become ill. Signs and symptoms of hepatitis A virus infection appear 2 to 6 weeks after exposure and commonly include mild fever, loss of appetite, nausea, vomiting, diarrhea, tiredness, pain in the upper right side of the abdomen, dark urine, light stools, and jaundice (yellowness of eyes or skin). The disease varies in severity, from mild cases lasting 2 weeks or less to more severe cases lasting 4 to 6 weeks or longer. If you become ill, please contact your health care provider immediately.

Hepatitis A virus spreads when a person ingests contaminated food or water, or is exposed to contaminated objects. Persons are at increased risk of acquiring hepatitis A virus when they have been in close and continuous contact with an infected individual, particularly in a household. Frequent thorough handwashing with warm water and soap for 20 seconds is key to stopping the spread of hepatitis A virus. Handwashing should include the back of the hands, wrists, between fingers and under fingernails.

What the Hell is Hepatitis A?

marler@marlerclark.com (Hepatitis Attorney) — Sun, 19 Feb 2012 09:37:18 -0800

What is hepatitis A?

Hepatitis A is one of five human hepatitis viruses (hepatitis A, B, C, D, and E) that primarily infect the liver and cause illness. An estimated 80,000 cases occur each year in the U.S., although much higher estimates have been proposed based on mathematical modeling of the past incidence of infection. Each year, an estimated 100 persons die as a result of acute liver failure in the U.S. due to hepatitis A, but the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Hepatitis A is a communicable (or contagious) disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Food contaminated with the virus is the most common vehicle transmitting hepatitis A. The food preparer or cook is the individual most often contaminating the food, although he or she is generally not ill at the time of food preparation. The peak time of infectivity, when the most virus is present in the stool of an infectious individual, is during the two weeks before illness begins. Although only a small percentage of hepatitis A infections are associated with foodborne transmission, foodborne outbreaks have been increasingly implicated as a significant source of hepatitis A infection.

Hepatitis A may also be spread by household contact among families or roommates, sexual contact, ingestion of contaminated water, ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play to family members and other children and adults.

Symptoms of hepatitis A Infection

Hepatitis A infection may cause no symptoms at all when it is contracted, especially in children. Such individuals will only know they were infected (and have become immune ñ you can only get hepatitis A once) by getting a blood test later in life. The incubation period (from exposure to onset of symptoms) is 15-50 days, with an average of 30 days. Many children and most adults will experience the sudden onset of flu-like symptoms. After a day or two of muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever and malaise, jaundice (also termed icterus) sets in. Jaundice is a yellowing of the skin, eyes and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood. The urine will turn dark with bile and the stool will be light or clay-colored from lack of bile. When jaundice sets in, the initial symptoms begin to subside.

In general, the period of acute illness lasts from 10 days to three weeks, at which time affected individuals tend to recapture some sense of wellness. It is not unusual for blood tests to remain abnormal for six months (or more), prolonging recovery for up to a year. Most affected individuals show complete recovery within three to six months of the onset of illness. Relapse is possible, and although more common in children, it does occur with some regularity in adults.

Diagnosis and treatment of hepatitis A

There are blood tests widely available to accurately diagnose hepatitis A; blood samples are tested for hepatitis antibodies, which are present when the immune system responds to the hepatitis virus. Antibodies of the immune globulin (Ig) M variety, which indicate acute disease, and IgG antibodies, which stay positive for life, should both be measured.

Hepatitis A infection is an acute self-limiting disease. There is no specific treatment; treatment and management is merely supportive. The liver function tests generally improve as the affected individual begins to feel better. It is therefore well accepted that the need for rest is best determined by the person’s own perception of the severity of fatigue or malaise.

Preventing hepatitis A Infection

Hepatitis A infection is totally preventable. Ill food-handlers should be excluded from work. Commercial food workers and other individuals who prepare food for others must always wash their hands with soap and water after using the bathroom, changing a diaper, and before preparing food. Cooking food to a temperature of 185∞F or higher will inactivate hepatitis A.

After a known exposure to hepatitis A, administration of a shot of immune globulin should be considered. If administered within two weeks of the exposure, it will usually be effective in preventing or at least ameliorating the disease.

Hepatitis A vaccine is the best protection from hepatitis A infection. The vaccine is recommended for persons traveling to areas with increased rates of hepatitis A, men who have sex with men, injecting and non-injecting drug users, persons with blood clotting factor disorders (such as hemophilia), persons with chronic liver disease, and children living in regions of the U.S. with increased rates of hepatitis A. The vaccine may also help protect household contacts of those with hepatitis A infection. Vaccination of food handlers would likely substantially diminish the incidence of hepatitis A outbreaks. The vaccine is licensed for individuals aged two and older, but there is good evidence that the vaccine is safe and effective at one year of age.

References

Advisory Committee on Immunization Practices (ACIP), Fiore AE, Wasley A, Bell BP. (2006). Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep.55(RR-7):1-23.

Bialek SR, Thoroughman DA, Hu D, Simard EP, Chattin J, Cheek J, Bell BP. (2004). Hepatitis A Incidence and Hepatitis A Vaccination Among American Indians and Alaska Natives, 1990–2001. Am J Public Health. 94(6):996-1001.

Bownds L, Lindekugel R, Stepak P. (2003). Economic impact of a hepatitis A epidemic in a mid-sized urban community: the case of Spokane, Washington. J Community Health. 28(4):233-246.

Butot S, Putallaz T, Sánchez G. (2008). Effects of sanitation, freezing and frozen storage on enteric viruses in berries and herbs. Int J Food Microbiol. 126(1-2):30-35.

Calder L, Simmons G, Thornley C, Taylor P, Pritchard K, Greening G, Bishop J. (2003). An outbreak of hepatitis A associated with consumption of raw blueberries. Epidemiol Infect. 131(1):745-751.

Centers for Disease Control and Prevention (2009a). Disease Burden from Viral Hepatitis A, B, and C in the United States. Available at http://www.cdc.gov/hepatitis/PDFs/disease_burden.pdf).

Centers for Disease Control and Prevention (2009b). Surveillance for Acute Viral Hepatitis—- United States, 2007. Surveillance Summaries. 58 (SS03):1-27.

Centers for Disease Control and Prevention (2009c). Hepatitis A. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, McIntyre L, eds. 11th ed. Washington DC: Public Health Foundation, pp. 85-97.

Centers for Disease Control and Prevention (2009d). Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 58(36):1006-7.

CDC (2007). Update: Prevention of Hepatitis A after Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 56(41);1080-1084.

Detry O, De Roover A, Honore P, Meurisse M. (2006). Brain edema and intracranial hypertension in fulminant hepatic failure: pathophysiology and management. World J Gastroenterol. 12: 7405-7412.

Feldman, M, Friedman, LS, Sleisenger, MH. (2002). Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 80: 1571.

Fiore, AE. ( 2004). “Hepatitis A Transmitted by Food.” Clinical Infectious Diseases. 38:705-715.

Gilkson M, Galun E, Oren R, Tur-Kaspa R, Shouval D. (1992). Relapsing hepatitis A. Review of 14 cases and literature survey. Medicine. 71:14-23.

Hutin YJF, Pool V, Cramer EH, et al. (1999). A multistate, foodborne outbreak of hepatitis A. N Engl J Med. 340:595–602.

Jaykus L. (1997). Epidemiology and Detection as Options for Control of Viral and Parasitic Foodborne Disease. Emerg Infect Dis. 3(4):529-539.

Mayo Clinic. (2009). Hepatitis A. Available at http://www.mayoclinic.com/health/hepatitis-a/DS00397.

Piazza M, Safary A, et al. (1999). Safety and immunogenicity of hepatitis A vaccine in infants: a candidate for inclusion in the childhood vaccination program. Vaccine. 17:585-588.

Rawls RA and Vega KJ (2005). Viral Hepatitis in Minority America. J Clin Gastroenterol. 39:144–151.

Sagliocca L, Amoroso P, et al. (1999). Efficacy of hepatitis A vaccine in prevention of secondary hepatitis A infection: A randomized trial. Lancet. 353:1136-39.

Scharff RL, McDowell J, Medeiros L. (2009). Economic Cost of Foodborne Illness in Ohio. J Food Prot. 72(1):128-136.

Schiff ER. (1992). Atypical Manifestations of hepatitis-A. Vaccine. 10(Suppl. Vol. 1): 18-20.

Taylor R, Davern T, Munoz S, Han S-H, McGuire B, Larson AM, et al. (2006). Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes. Hepatology. 44:1589-1597.

Todd EC, Greig JD, Bartleson CA, Michaels BS. (2009). Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 6. Transmission and survival of pathogens in the food processing and preparation environment. J Food Prot. 72(1):202-219.

Wheeler C, Vogt TM, Armstrong GL, et al. (2005). An Outbreak of Hepatitis A Associated with Green Onions. N Engl J Med. 353: 890-897.

Willner IR, Uhl MD, Howard SC, Williams EQ, Riely CA, Waters B. (1998). Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States. Ann Intern Med. 128:111-114.

Lubbock's Cheddar's Casual Café Costs Public Health $250,000 Due to Hepatitis A

marler@marlerclark.com (Hepatitis Attorney) — Sun, 19 Feb 2012 08:47:03 -0800

Lubbock Avalanche-Journal reports that leftover vaccines from a Hepatitis A scare last year will be administered to those who took the first vaccination in hopes of providing extended protection against the disease.

An employee at Cheddar’s Casual Café contracted the viral illness last September, potentially exposing anyone who ate at the restaurant.

Bridget Faulkenberry, director of the Health Department, said about 2,200 vaccinations are left over — some for children and some for adults — for those who took the first vaccine.

Since this vaccination is not mandatory, the department will charge $15 per vaccine. The Health Department spent about $240,000 on the initial doses of vaccine last September, Faulkenberry said.

The charge will help recuperate some of that money spent last year, Faulkenberry said.

She said she expects to have leftover vaccines this time around, too, as not everyone will take another one, and some people who took the first vaccine were from out of town.

The vaccines will be administered by nurses from 11 a.m. to 6 p.m. April 3 and 9 a.m. to 3 p.m. April 5 in the Health Department at 1902 Texas Ave., Faulkenberry said.

The Health Department will send letters to those eligible for the vaccine, and the recipients must bring the letter to get the vaccination. The letter states clinic will be cash only.

About 2,700 people took the vaccine the first time, said Faulkenberry. There were no cases reported other than the initial one, Faulkenberry said.

Hepatitis A is a viral disease, affecting the liver and causing inflammation and malfunction of the liver cells, said Dr. Joe Sasin, medical director for the emergency department at University Medical Center.

Sasin said the second immunization, which is purely preventative, should last for several decades.

“It’s very, very important to get that second immunization, and high-risk groups definitely should get the vaccine,” Sasin said.

He said Hepatitis A usually is not life threatening unless dealing with the very young or very old, or people who have other health complications. Most people who have Hepatitis A get over it on their own, and are immune to it the rest of their lives.

Boise Idaho Cheesecake Factory Linked to Hepatitis A Risk

bmarler@marlerclark.com (Bill Marler) — Fri, 10 Feb 2012 17:11:53 -0800

According to the Idaho Statesman, an employee at the Cheesecake Factory on Milwaukee Avenue in Boise may have exposed some diners at the restaurant to Hepatitis A this winter. The Statesman's report is based on information from the Central District Health Department.

Health officials said the exposure may have occurred between Dec. 13 and Jan. 22.

The employee who was confirmed to have Hepatitis A wasn't involved in food preparation, and the risk to the public is "extremely low" -- but there was some possibility of exposure to diners, the health department said. The employee is said to have used good hand hygiene.

Hepatitis A is a liver disease caused by the hepatitis A virus. It is usually spread by eating or drinking food items that have been contaminated with hepatitis A from someone who hasn’t properly washed their hands after using the bathroom, but it is also spread easily when a person doesn't wash his or her hands after changing a baby's diaper.

Symptoms of the disease include: fever, loss of appetite, abdominal discomfort, jaundice, tiredness, nausea and dark urine. Anyone who ate at the Cheesecake Factory between Dec. 13. and Jan. 22 and has these symptoms is advised to see their doctor. Symptoms vary from mild to severe, lasting anywhere from a couple weeks to several months.

Health officials said the Cheesecake Factory, which is at 330 N. Milwaukee Ave., fully cooperated with the investigation.