Various Ohio Restaurants Contributed to the Hepatitis A Outbreak

Since the nationwide hepatitis A outbreak was first identified in 2016, 25 states have reported 22,295 cases and 216 related fatalities to the Centers for Disease Control and Prevention (CDC), as of July 19, 2019.

And one state has become the unfortunate outbreak leader during the April-July timeframe. As of July 22, 2019, the ‘Buckeye State’, Ohio has reported 3,220 hepatitis A cases. 

In Columbus, Ohio, the City Health Commissioner Dr. Mysheika Roberts said ‘the number of Hepatitis A cases is skyrocketing. As of July 22, 2019, there were 458 hepatitis A cases reported in Columbus & Franklin Counties.’   

“As the summertime festival season kicks off, I tell people whenever they are partaking of festival foods or things of that nature, they need to do a few basic things. One is they always have to make sure they wash their hands or have hand sanitizer available."

Dr. Roberts previously said on May 20, 2019, people need to ‘look for a little green sign on restaurant doors and windows, which means the place has met the health standards of Columbus Public Health.’ 

A partial list of Ohio restaurants reporting hepatitis A cases during 2019 are listed below:

• July 5, 2019, a case of hepatitis A was identified in a Rally’s restaurant employee working in Springfield, according to the Clark County Combined Health District. However, due to safe food handling procedures, the risk of transmission to patrons at Rally’s is low, a statement from the health district said in a press release. 
• April 22, 2019, Columbus Public Health officials said 13 local restaurants had employees who contracted a Hepatitis A infection since an outbreak started in June 2018, but the agency only alerted the public about two restaurants. Health officials said there were minimal risks with the other 11 restaurants and that's why the public was not notified. 
• April 17, 2019, the Cincinnati Health Department learned today of a possible hepatitis A exposure at a local restaurant. People who ate at the US Chili restaurant (Colerain Avenue) between March 28 and April 6, may have been exposed to hepatitis A from an ill worker. While we believe that there is a minimal risk of exposure to the hepatitis A virus, out of an abundance of caution, the Cincinnati Health Department is notifying the public so they can assess their risk of exposure. US Chili has been fully cooperating with the Cincinnati Health Department in this investigation. 
• April 10, 2019, Butler County health workers urged restaurants to require vaccinations of their staff and doctors to recommend the inoculations to all patients. Bailer said some restaurants with corporate ownership changed policies and now require new employees to get vaccinated before starting work, reported Cincinnati.com. 
• March 26, 2019, a case of hepatitis A was identified in a Frisch’s restaurant employee that worked in 2 locations: Urbana and Springfield. The Champaign Health District and the Clark County Combined Health District are working with the locations to vaccinate all of the restaurant employees. In this situation, the risk of transmission to patrons is extremely low due to safe food handling procedures being in place. A spokesperson from Frisch’s issued a statement saying, “We have fully cooperated with Health Department authorities, and appreciate their ongoing work in addressing this nationwide issue. The well-being of our guests and team members remains our paramount concern.” 
• February 28, 2019, the Preble County Public Health Department released a notice stating that an employee at the KFC restaurant in Eaton, Ohio, was diagnosed with hepatitis A. The government says that anyone who ate there from February 9 through February 20, 2019, may have been exposed to the virus, although the risk of developing hepatitis A from this exposure is very low.
• February 27, 2019, Frisch’s Restaurants paid to have their employees vaccinated in Franklin and Middletown after it was notified about employees with hepatitis A, said Warren County Health Commissioner Duane Stansbury, according to WCPO. 
• January 10, 2019, Clermont County Public Health identified a 2nd case of the hepatitis A virus in an employee of a Clermont County restaurant. Health departments are urging people who visited these restaurants to get vaccinated. “The restaurant management has been very cooperative and we are working with them to review safe food handling techniques,” said Assistant Health Commissioner Tim Kelly.

Recently, a study published in June 2019, investigated where and under what circumstances patients receive hepatitis A vaccination. This study found physician recommendations have been a top influencer of decisions to receive hepatitis A vaccinations. 

“In the context of enhancing patient care, our results underscore the need of increasing awareness among primary care providers of the Advisory Committee on Immunization Practices (ACIP) recommendations for vaccinating adults at increased risk for hepatitis A infection,” according to a statement from this research team.

“The CDC recommends the use of evidence-based strategies, such as provider reminder/recall systems, standing orders and provider education programs, to reduce missed opportunities to vaccinate eligible persons,” the research team said. 

Additionally, food-service workers represent another sizable, at-risk population since their daily responsibilities include directly handling food and drink, says the CDC.

According to previous studies, the restaurant market segment of the food-service industry has significant challenges. As an example, a 2015 study conducted by The Substance Abuse and Mental Health Administration, found the food services and hospitality industry to have the highest rates of substance use disorders of all employment sectors.

The spread of germs from the hands of food workers to food is an important cause of foodborne illness outbreaks in restaurants. It accounts for 89 percent of outbreaks in which food was contaminated by food workers, reported the CDC on June 18, 2019.

The Environmental Health Services suggest restaurant management and food safety programs should implement he follow prevention tactics:

• Review restaurants’ practices and highlight potential barriers to and supporters of hand hygiene.
• Know that efforts to improve hand hygiene in restaurants should address the factors that affect hand hygiene behavior.
• Revise food-preparation activities to lower the number of needed handwashings. 

There are 3 HAV vaccines approved in the USA: Vaqta, Havrix, and Twinrix, which are available at pharmacies in most states. 

Furthermore, immune globulin can provide short-term protection against hepatitis A, both pre- and post-exposure.

Recent hepatitis A vaccine news

• World Hepatitis Day 2019: Invest in Hepatitis Elimination
• Should Indy 500 Staff Validate Their Hepatitis A, Measles & Mumps Immunities?
• Florida’s Hepatitis A Outbreak Accelerating, But Officials Remain ‘Quiet’
• South Carolina Offers Free Hepatitis A Vaccines To Qualifying Residents

“Getting the Hepatitis A vaccine is the best way to prevent the infection; not only protecting you but also your loved ones,” says Anh Le, PharmD candidate, an intern for Brookshires Grocery Company. 

“The CDC recommends the vaccine for everyone from 1 year of age and older, and it is available at pharmacies and doctor offices, so stop by for more information and stay healthy,” Le said.