Sociology Small Assignment (See All Attachments)
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hepatitis-a_outbreak_case_study.docxHepatitis-A Outbreak Case Study
The investigation began on April 19 when the Smithfield Board of Health (BoH) was notified by the patient’s doctor that a worker at a restaurant called Your Average Jack had hepatitis A with symptom onset in mid-March. On the basis of the date of symptom onset, the worker was considered to have been potentially infectious during a three-week period during the month.
On April 25, the restaurant’s owners closed and cleaned the restaurant voluntarily. On April 27, an inspection by the local BoH and state department of health (SDH) found no sanitary-code violations. None of the 20 food handlers at the restaurant had symptoms of hepatitis A (although none were tested serologically for evidence of recent infection). The restaurant reopened after 19 food handlers received hepatitis-A immunization by the local BoH and one was excluded from work. In addition, food safety classes were offered to all staff at the restaurant to prevent the potential for future potential food-borne illnesses.
On May 20, the SDH was notified of six cases of hepatitis A among residents of Eastern County, all with illness onsets during May 8–15. By June 3, a total of 46 persons with hepatitis A were reported in Eastern County, with illness onsets during April 29–May 26, compared with no cases during the same period the previous year. Of the patients who could recall where they had eaten 2 to 6 weeks before illness onset, 35 of 46 (76%) reported eating at Your Average Jack, and 20 of 46 (43%) at a nearby restaurant called Surley’s. Eating at other restaurants was reported less frequently. Hospitals provided treatment and care for those that became ill, with follow-up as needed.
It is important to note that 2 of the 46 patients reported that they were employed as food handlers at Surley’s. Each had worked when he or she was potentially infectious and prepared foods that were not cooked after handling. On May 27, after interviewing food handlers at Surley’s, local BoH officials issued a public notice offering immunization to customers who ate uncooked or cold food prepared at Surley’s during May 14–23. Approximately 1,600 persons responded to the public notice and were administered a vaccine at a temporary clinic. The clinic was staffed by member hospitals of a newly formed regional local health emergency response coalition (HERC).
Investigators determined that the probable source of the hepatitis-A outbreak was the original food handler at Your Average Jack, who worked while infectious and subsequently contaminated food that was not cooked. Although the food handler with hepatitis A was the probable source, transmission from another food handler at Your Average Jack with unidentified or unreported hepatitis-A virus could not be excluded. This outbreak investigation highlights difficulties faced by public health officials when making decisions relative to hepatitis-A prevention.
In this investigation, determining the risk for transmission to patrons from the infected food handler, who handled uncooked foods while potentially infectious, was based on an assessment of self-reported activities such as gastrointestinal symptoms, personal hygiene, and glove use. The factors that led to transmission despite reportedly good hygiene cannot be determined.
This case study was adapted from Hepatitis A—A Public/Private Call to Action.
