Foodborne Illness – Hepatitis A

1. What is the infectious agent (pathogen) that causes this infectious disease? The U.S. Government requires that sewage be treated to eliminate pathogens. This includes bath water, toilet water, and storm run-off. These fluids may carry pathogens for many water borne disease, including giardiasis and hepatitis A. This involves collection and sedimentation of sewage waters, separating solid matter (sludge) from the liquid (effluent) portion of sewage. The effluent is chlorinated to kill pathogens before it can be released in to lakes or rivers. The sludge is burned or dumped. Some advanced methods of treatment us a secondary treatment following the primary treatment. This is done by transferring the fluid in to tanks filled with a population of microorganisms that decompose more than 90 percent of the organic wastes and eliminate pathogens by competition. It is then chlorinated before being released in to rivers or lakes. Many sewage treatment plants use additional chemicals that also eliminate pathogens.

2. How is the infectious agent transmitted through food or water? Hepatitis A is the only common vaccine preventable food borne disease in the United States (Fiore 2004). It is one of five human hepatitis viruses that primarily infect the human liver and cause illness. This may result in liver failure and death. It is transferred through food or water that is contaminated with fecal matter that has the HAV virus. Other potential sources of infection are, men having sex with men; travel to countries where the HAV virus is endemic, and from contaminated drugs, and needles following illicit drug use, consumption of food contaminated with the HAV virus, water that is contaminated, or by transmission of blood that is contaminated with the HAV virus. Approximately one-third of the population has been previously infected with HAV (Fiore, 2004; Centers for Disease Control and Prevention, 2009a).

3. What is an example of a real life outbreak of this foodborne illness in the United States? In late October of 2003, in Beaver County, Pennsylvania, 650 confirmed cases of both primary and secondary HAV were linked to a local restaurant, Chi Chi’s at Beaver County Mall. The victims included, at least 13 employees of Chi Chi’s restaurant, and numerous residents of six other states. Four people died as a consequence of their hepatitis A illnesses. In addition, over 9,000 people who had eaten at the restaurant were potential exposed, or came in contact with ill people. The people, without Hepatitis A (but were exposed to Hepatitis A) received, Immune Globulin shot as protection against hepatitis A. One man, Richard Miller, had to have an emergency liver transplant to save his life, only 10 days after eating at the restaurant. The FDA issued a statement dated, December 9, 2003, reaffirming that this outbreak was associated with eating raw or uncooked green onions.

4. What are the clinical symptoms, duration of the disease, and treatment if any? Children with HAV often have no symptoms. Adult symptoms include: fever, loss of appetite, tiredness, nausea, abdominal pain, dark urine, and jaundice (yellowing of the skin). Once a clinical infection is established there is no specific treatment for Hepatitis A. Duration of the disease is less than 2 months. If you want short term protection of the disease, a HAV immune globulin vaccine can be administered within 2 weeks of exposure to the disease, and it only last 3-5 months. For long term protection, children 2 years of age, and older can receive the HAV vaccine prior to exposure. There are 2 shots required for the HAV vaccine.

5. What steps can be taken to prevent further outbreaks? Always wash your hands after coming in contact with soiled toilets, linens, or changing diapers, after using the bathroom, before eating or handling food. Drink filtered water, and make sure that the water used in the home is properly filtered as well. If you are traveling outside the country make sure to only drink bottled water. You may boil water prior to use to prevent any viruses. Make sure to properly cook your food. Always wash your hands prior to handling any food and prior to eating.