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Seroprevalence of Hepatitis A Among Hospital Dietary Workers: Implications for Screening and Immunization

Department of Emergency Medicine, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY.

B. Barnett, MD

Department of Emergency Medicine, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY, BabsBarnett{at}yahoo.com

A. Napolitano, MD

Department of Emergency Medicine, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY.

J. Gressin, DO

Department of Emergency Medicine, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY.

C. Auerbach, PhD

Wurzweiler School of Social Work, Yeshiva University, New York, NY.

Hepatitis A is a self-limited, virally mediated infection of the liver. The usual mode of transmission is by the fecal-oral route. Employees of food-service establishments who are infected with the hepititus A virus can transmit the disease when handling food products. The Centers for Disease Control and Prevention recommends the use of the hepatitis A vaccine among dietary workers who may be at risk for contracting and spreading the disease. Because hepatitis A infection can often be a subclinical disease, the incidence of cases reported is not indicative of its true prevalence. The objective of this study was to document the seroprevalence of hepatitis A among hospital dietary workers. Dietary workers at a suburban hospital were interviewed to determine if they had been exposed to hepatitis A and if they had a history of hepatitis A infection. Serum was obtained from each subject and tested for the presence of hepatitis A antibodies. The Abbott HAVAB EIA kit was used for the detection of immunoglobulin G(IgG) and IgM hepatitis A antibodies. Of 119 subjects, 56 (47%) were women, and 63 (53%) were men; the subjects had a mean age of 42 years (range, 20-66). Fifty-one subjects (43%) were born in the United States, and 68 subjects (57%) were born outside of the United States. Of the 119 subjects, only 2 (2%) had a known history of hepatitis A infection, yet 67 (56%) had hepatitis A titers; 52 (44%) were susceptible to the disease. One subject had received the hepatitis A vaccine. Fifty-five of 68 foreign-born subjects (81%; 95% confidence interval, 71-91%) had hepatitis A antibodies versus 12 of 51 US-born subjects (24%; 95% confidence interval, 12-36%). The foreign-born subjects had a mean age of 28 years at the time of their arrival in the United States. In conclusion, a large number of foreign-born hospital dietary workers have hepatitis A antibodies without a history of disease. Immunization of this group of dietary workers may not have any beneficial effects, nor is it cost-effective.

Key Words: Food handlers • Immunity • Infection • Screening • Seroprevalence • Transmission • Vaccine • Virus

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