I will spare you the list of hepatitis A cases that I have been involved with since 1998 when I represented 30 people exposed to an ill food handler in a Seattle, Washington Subway restaurant, including one child who suffered acute liver failure requiring an emergency liver transplant.

There have been dozens in the last 23 years, some with tragic consequences.  Yet, here we are once again.

Last week the Camden County New Jersey Health Department reported that it had been notified by a health care provider that a food handler employed at a Starbucks at 1490 Blackwood Clementon Road in Gloucester Township tested positive for hepatitis A and worked through the infectious period. On Wednesday, Nov. 17, the Department of Health was notified that a patient tested positive for hepatitis A. Based on the investigation, the Department of Health recommended any member of the public that patronized the Starbucks facility on Nov. 4, 5, 6, 11, 12 and 13 to get the hepatitis A vaccine.  Approximately 4,000 customers were exposed and to date 800 have received either hepatitis A vaccines or immunoglobulin shot to combat suffering an acute hepatitis A infection.

Hepatitis A is considered preventable via good personal hygiene practices such as thorough hand washing and glove wearing in a restaurant setting.

Hepatitis A is the only vaccine preventable foodborne illness. Hepatitis A vaccines are available, and nationwide are often given out free by local health departments, or at a cost of less than $100. Most people 25 and younger received the hepatitis A vaccine as part of their childhood vaccines.  However, this leaves a large portion of our population vulnerable – I would argue unnecessarily when they dine out.

However, here is what the CDC continues to say about vaccinating food handlers:

Why does CDC not recommend all food handlers be vaccinated if an infected food handler can spread disease during outbreaks?

CDC does not recommend vaccinating all food handlers because doing so would not prevent or stop the ongoing outbreaks primarily affecting individuals who report using or injecting drugs and people experiencing homelessness. Food handlers are not at increased risk for hepatitis A because of their occupation. During ongoing outbreaks, transmission from food handlers to restaurant patrons has been extremely rare because standard sanitation practices of food handlers help prevent the spread of the virus. Individuals who live in a household with an infected person or who participate in risk behaviors previously described are at greater risk for hepatitis A infection.

CDC, you miss the point, granted food service workers are not more at risk of getting hepatitis A because of their occupation, but if ill, they are a risk for spreading it to customers.  Also, food service are low paid jobs that certainly have the likelihood of being filled by people who are immigrants where hepatitis A might be endemic, or people who have been recently homeless.

However, the CDC does recommend vaccines, or an immunoglobulin shot for people exposed to a hepatitis A infected food handler.  From the CDC:

What should I do if I have eaten at a restaurant that has reportedly had a hepatitis A-infected food handler?

If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department who can help you to learn if you were recently exposed to hepatitis A virus at that restaurant, have not been vaccinated against hepatitis A, and might benefit from either hepatitis A vaccine or an injection of immune globulin. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.

The problem here is that the Starbuck’s employee worked while infectious during the first half of November, so there is limited time (14 days from exposure) to seem preventative treatment.

I will also spare you the numerous times I pleaded with the CDC, local and state health officials, and restaurants to require hepatitis A vaccinations for food handlers.  Let’s be clear, had the food handler who exposed patrons of the Camden County Starbucks been vaccinated against hepatitis A, we would not be having this discussion.

My guess is that the cost of a hepatitis A vaccine looks very appetizing to Starbucks at this point?  CDC, it is time to change your guidance.