Food Protection Trends - May/June 2017 - 221
vaccination of adults, including those who work in food
service. However, eradication will not be possible without
addressing all possible routes of viral spread, and food and
food handlers are a well-established hepatitis A risk factor.
PREVENTION OF HEPATITIS A THROUGH
VACCINATION OF FOOD HANDLERS
The strategy of vaccinating food handlers as a means
to control the spread of hepatitis A has been a topic of
interest since the first vaccine was licensed in 1995. The fact
that the vaccine is highly efficacious and has a remarkable
safety record has led many to consider policies requiring
mandatory vaccination of food handlers. This was indeed
the case in St. Louis County, where sequential outbreaks
of hepatitis A linked to food service handlers caused a
huge strain on local health resources (20). In response, the
county passed an ordinance in late 1999 requiring restaurant
handlers to be vaccinated (20). Subsequent analysis has
demonstrated that this policy has reduced the number of
hepatitis A outbreaks, thereby lowering the morbidity and
economic burden to St. Louis County (20). Recently, Bill
Marler, well known for representing victims of foodborne
illness, has renewed the call for mandatory vaccination in
response to a recent hepatitis A outbreak in Hawaii (15).
In his letter, Mr. Marler stated that restaurants have a moral
obligation to protect customers from serious disease and
reminded businesses of the need to protect themselves from
the potential multimillion dollar fallout that can occur if
people become ill or have to obtain PEP (15). An often-cited
paper asserted that vaccinating restaurant workers would
be unlikely to be economical (16). The authors claim that
litigation is not a serious concern for most businesses, as they
carry insurance to protect themselves from such losses (16).
Although this is likely the case for larger businesses, it may
not apply to smaller facilities and does not protect against
loss of business reputation. The study further claims that it
is not economically feasible for restaurants to vaccinate all
their employees (16). However, it is not clear why restaurants
would have to pay the costs of vaccination. Vaccination is
a requirement for employment in a number of industries,
including veterinary and healthcare establishments, and
employees are often responsible for paying for their own
vaccines prior to hiring. The economic analysis determined
that the chance of any individual restaurant incurring
an outbreak is outweighed by the costs associated with
vaccination (16). However, although the chance of an
individual restaurant being the source of an outbreak is very
low, the ramifications for that establishment are quite high.
Thus, although recent papers still quote this study, with its
claim that mandating vaccination for food service employees
is not cost effective (22), assumptions of the paper, now 15
years old, may no longer apply. These include the assertion
that the food establishment would have to absorb the cost
of the vaccines, the assumption that none of the employees
would have been vaccinated previously, and finally, the rising
costs of PEP and the popularity of the class action lawsuit
since the earlier paper was published.
There are therefore several reasons to consider vaccinating
food handlers. Foremost is the ACIP vaccination
recommendation of 2006. A decade has passed since
hepatitis A vaccination was routinely recommended for
all children. Therefore, in the coming decade, many of
the individuals entering employment in the food service
industry will already be vaccinated. Those who have missed
the vaccination, if they are both under the age of 18 and
unable to pay for the immunization, can receive it at no
cost through the federally funded Vaccines for Children
(VFC) program (4). The food industry should also consider
the precedent set by the medical industry in that proof of
vaccination is a requirement prior to hiring. Therefore, the
employer will not incur any costs associated with vaccination
of new employees. This approach and the current vaccination
schedule challenges the findings of earlier economic studies
suggesting that the cost of ensuring that employees are
vaccinated outweighs the risks (16, 22). The food industry
must also be aware that the costs of foodborne outbreaks
continue to rise as juries award large settlements to
victims of foodborne disease and class action lawsuits rise
in popularity among those persons potentially exposed.
The industry should also be aware the hepatitis A is an
obvious target for eradication and aggressive campaigns to
do so will not overlook the role of food and food handlers
in virus spread. Finally, the food industry does indeed
have a moral obligation to take as many precautions as
possible to protect consumers.
CONCLUSIONS
Lessons can be learned from the way the nation adopted
the hepatitis A vaccine for children, in that requiring
vaccination can be a gradual process for the food industry.
The most obvious first step would be to require proof of
vaccination for all new hires, who, in the food industry in
the upcoming years, will likely consist largely of young
individuals who were vaccinated as children. The high
turnover rate in the food industry would also increase
compliance, as employees who leave one establishment
would have to be vaccinated, or to show proof of immunity
to HAV, as infection results in lifelong immunity, prior to
entering as a new employee elsewhere. The next step would
likely be providing non-immune present employees with a
time frame in which to complete the vaccination series or risk
being fired. This time frame would best be determined by the
given establishment, but the sooner the better. It is important
to note that some districts offer tax breaks for businesses with
vaccinated employees and some insurance companies also
offer incentives. Eventually, vaccination would be mandatory
for all persons working in food establishments following a
gradual rollout of recommendations.
May/June Food Protection Trends
221
Table of Contents for the Digital Edition of Food Protection Trends - May/June 2017
Contents
Food Protection Trends - May/June 2017 - Cover1
Food Protection Trends - May/June 2017 - Cover2
Food Protection Trends - May/June 2017 - Contents
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Food Protection Trends - May/June 2017 - Cover3
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