Hepatitis A

Hepatitis, an inflammation of the liver, comes in three forms: A, B, and C. A is on our "B" list as it is unique among the picornaviruses (single-stranded RNA viruses) to be foodborne. Forms B and C are transmitted by illegal drug use and unsafe sexual practices, and are not on our B list.

Hepatitis A is the most common form of hepatitis, with some 25,000 cases reported annually; the actual incidence is believed to be 10 times higher because of underreporting. It is a highly infections virus, requiring only 10-100 virions to initiate a frank illness with a touch of jaundice. Most US cases are seen in the western and southwestern states. Children age 5-14 have the highest incidence. Day-care centers contribute some 8% of cases and household contacts, another 14%. The prime source of infection appears to be contamination of fresh produce during harvesting, processing, and packaging. Hepatitis is a classic example of the fecal-oral route of microbial transmission, which means that a person unknowingly places in his/her mouth food that has been contaminated with fecal material of an infected individual. That' s why hand washing is not an option for food handlers. A single infected food handler can pass the virus on to dozens, even hundreds, of unsuspecting people [7].

Two recent hepatitis A outbreaks, one in Tennessee-Georgia-North Carolina and another in Pennsylvania, which engulfed 500 people who had eaten in a restaurant, were linked to scallions grown in Mexico. Viruses isolated from affected individuals in Pennsylvania were genetically similar to the viruses isolated from patients in the Tennessee-Georgia-North Carolina group. Epidemiologists from the CDC believe that at harvesting, a hepatitis A excreter handled the scallions, stripping off the outer layers, bundling them with rub-berbands, and contaminating all of them, leading to an outbreak. Should the contaminated scallions have contacted other foods or been used in another popular recipe, the outbreak could have been huge [8].

Of the 76 million foodborne illness events in the United States, 37% appear to be due to viruses. Between them, the Norwalk-like virus (noroviruses), rotavirus, and astrovirus account for 28 million estimated gastroenteritis cases. These are self-limiting, lasting 2-10 days with watery stools, abdominal pain, fever, and headache. These inflammations of the stomach and intestine are often referred to as "stomach flu," but are unrelated to the influena virus. These viruses inhabit raw fruits, vegetables, raw shellfish, and undercooked foods. They are refractory beasties capable of surviving 140-150°F cooking temperatures, and the rotavirus can survive on vegetables for days at 4°C—the temperature of refrigerator freezers [9]. Nevertheless, the quarter part of foodborne illness is preventable, and should be.

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