By Kevin Besey, Director // MDARD Food and Dairy Division
Public health officials and the Michigan Department of Health and Human Services (MDHHS) continue to see an elevated number of hepatitis A (HAV) cases in our state, and we need your help to stop the spread and prevent additional illnesses or possible outbreaks in your food establishment.
Since the beginning of the outbreak in August 2016, public health response has included increased healthcare awareness efforts, public notification and education, and outreach with vaccination clinics for high-risk populations. No common sources of food, beverages, or drugs have been identified as a potential source of infection.
HAV is highly contagious and usually transmitted when infected persons do not wash their hands properly after going to the bathroom and then touch other objects or food items, or having close contact with other people. Those with history of injection and non-injection drug use, homelessness or transient housing, and incarceration are thought to be at greater risk in this outbreak setting. Notably, this outbreak has had a high hospitalization rate of around 85 percent of confirmed cases.
People infected with HAV are most contagious from two weeks before onset of symptoms to one week afterward. Symptoms usually start within 28 days of exposure to the virus with a range of 15-50 days. These symptoms can include jaundice (yellowing skin and whites of eyes), fever, diarrhea, tiredness, loss of appetite, nausea and vomiting, stomach pain, dark-colored urine and pale or clay colored stool. Not everyone who is infected will have all the symptoms.
In response to the outbreak, the Michigan Department of Agriculture and Rural Development (MDARD) has provided guidance documents to all licensed food and dairy facilities in Michigan, including a poster with important information for employees. These were distributed by mail and electronically when email addresses were available. MDARD food inspectors and local health department sanitarians are also distributing printed materials to their licensees and providing additional resources as requested.
Here are a few steps every food establishment should take:
Encourage vaccination. HAV is a vaccine preventable disease. If your employees have private health insurance coverage, encourage them to see their doctor or pharmacist and get vaccinated. If your food establishment is located within the outbreak area, free or low-cost vaccination options may be available through your local health department.
A little prevention goes a long way! Follow safe food handling guidelines, including thorough, frequent handwashing. Wear gloves when handling food, and clean and sanitize often with an approved sanitizing solution. Focus on areas that are frequently handled or touched, including kitchen surfaces, ice machines, door knobs and light switch plates. In general, cleaning and sanitizing methods effective against norovirus will also be effective against HAV. For guidance on cleaning and sanitizing following an HAV outbreak or to use to prevent an outbreak in your food establishment, visit www.michigan.gov/foodsafety.
Educate your employees. Talk with your employees about the current HAV outbreak and make sure they know the symptoms. Emphasize the importance of good hygiene, especially hand washing. Hang the poster provided by MDARD in a place where your employees can easily read it. Remind your employees to stay home if they are sick and to immediately report to you if they (or a household member or a close personal contact) have symptoms or have been diagnosed with HAV.
Report HAV in your establishment. If you find out about an infected food worker or have a worker with HAV symptoms, immediately notify your local health department and ask what to do next. Send the worker home immediately and ask your regulatory authority (MDARD or your local health department) for guidance on when the employee can return to work. Implement an immediate cleaning and sanitation regimen for your entire facility.
With your assistance, we can stop the spread of hepatitis A and help keep your employees and customers healthy. For more information on hepatitis A, including information about the current outbreak area and copies of guidance documents, visit www.michigan.gov/hepatitisAoutbreak.