Hepatitis A in a local restaurant: Considerations for food worker vaccination

In November 2011, the Greenfield Health Department was notified of a food worker at a large local restaurant with laboratory-confirmed hepatitis A. Previously, in 2010, the department offered hepatitis A vaccine to food workers with very limited success. Department staff immediately began epidemiological and environmental health investigations to determine source of infection and limit community spread of disease. The Department, in consultation with the Wisconsin Division of Public Health, held a testing and vaccination clinic for food workers at the restaurant. Participation at the clinic was strongly encouraged and ninety-two food workers required testing and vaccination to prevent the development of hepatitis A and limit potential disease transmission. The clinic was conducted using Department staff and contracted phlebotomists; laboratory testing performed by the Wisconsin State Laboratory of Hygiene. Since the Greenfield Health Department has routinely tracked staff time and resources during public health emergencies, all staff were directed to record time spent on hepatitis A activities during the week following the disease report. Additionally, the Department collected information on other applicable costs related to the investigation and clinic operations. Preliminary data demonstrate the total cost (both direct and indirect) to contain the disease – including staff time, phlebotomy, specimen prep and transport, vaccine, and testing – was approximately twice the cost of vaccinating the restaurant's food workers beforehand. To date, few research studies have determined the costs to contain a hepatitis A outbreak or the cost-effectiveness of hepatitis A vaccination. Though small in scale, this study suggests a potential paradigm for food worker vaccination.