PITTSBURGH (AP) -- The number of people sickened by a hepatitis A outbreak at a Mexican restaurant continued to climb Tuesday, with state health officials confirming at least 300 cases.
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November 12, 2003
By Robert H. Shmerling , M.D.
Harvard Medical School
What Is The Doctor's Reaction?
Hepatitis A is caused by a viral infection of the liver and is an unusual condition in many ways. On one hand, it is highly contagious, as suggested by this news article. Outbreaks occur among people living in close quarters or by food handlers, and suddenly hundreds or thousands of people are infected. On the other hand, many cases of hepatitis A are isolated to just one person, despite how easy it is to spread. Another contradiction is this: Hepatitis A is usually mild, and often causes no symptoms at all; yet it can also be serious, even life-threatening. Some people with a severe case of hepatitis A require a liver transplant, but fortunately, that is quite rare.
Stories such as this one, about an outbreak in Pittsburgh, are serious public health events. Identifying the source of the outbreak and limiting its spread is a big priority. However, it is likely that people who are infected spread it to others even before they know they have it.
As much worry as these outbreaks cause for affected communities, it is important to recognize that most hepatitis A is quite mild and harmless. The most common symptoms are fatigue, nausea, loss of appetite and a slight fever, which goes away over a period of days to weeks. In more severe cases, jaundice (a yellowing of the eyes and skin) occurs. Blood tests often demonstrate antibodies indicating past infection among people who never recall feeling ill.
What Changes Can I Make Now?
Learning how to prevent hepatitis A and seeking medical attention if you do develop this condition are the most important ways to respond to this news story. Until an outbreak actually occurs, it is impossible to predict the source of an outbreak. Do not assume that expensive, fancy restaurants are safer. On the other hand, it is probably true that restaurants whose employees regularly wash their hands and carefully follow local health codes are less likely to be the source of hepatitis A outbreaks. If you hear that a restaurant has been repeatedly cited for health code violations, it may be best to eat somewhere else. Your choice of foods and beverages, especially if traveling to developing countries, can also reduce your risk of hepatitis A. For example, if you catch your own shellfish from waters that are not inspected and tested, or if you drink water in a developing country where hepatitis A is common, you may be taking unnecessary risks.
There is a vaccination for hepatitis A that is recommended for certain situations including those with pre-existing liver disease (for whom even a mild case of viral hepatitis could be devastating), those who are traveling to areas where hepatitis A is common, and people who require frequent blood transfusions.
People living in an area where an outbreak occurs should follow the local news coverage closely, paying close attention to recommendations from public health officials. If you recently ate at the restaurant near Pittsburgh implicated in this outbreak, contact your own health-care provider for advice. Wash your hands often and well, and do not share your food, toothbrush, or dishes with others, at least for the next few weeks. For people who have been exposed to hepatitis A recently, an injection of antibodies can reduce the risk of infection, but only if given within two weeks of exposure.
What Can I Expect Looking To The Future?
A more aggressive enforcement of health codes in restaurants could reduce the incidence of hepatitis A outbreaks in the future, but it is unlikely that this approach will eliminate the risk altogether. Researchers may develop a long-lasting vaccination for hepatitis A that could become routine for children or adults, not just for those at highest risk.
You can expect occasional outbreaks of hepatitis A because it is unlikely this common virus will be eradicated any time soon. However, you can also expect public health authorities to quickly identify the source of an outbreak and take appropriate measures to limit spread. Just as hepatitis A can be spread quickly to a large number of people, so can information that can help contain it.
Related Areas:
Hepatitis A
Liver Disease
Food Safety
