Hepatitis a Outbreak on a Floating Restaurant in Florida, 1986

Abstract

In April and May 1986, the largest reported foodborne outbreak of hepatitis A in Florida state history occurred among patrons and employees of a floating restaurant. A total of 103 cases (97 patrons and six employees) were identified. The exposure period lasted 31 days (March 20-April 19), making this the most prolonged hepatitis A outbreak to occur in a restaurant that to date has been reported to the Centers for Disease Control. The exposure period was divided into time intervals (peak, early, late, and total) for calculation of food-specific attack rates. The authors showed that green salad was an important vehicle of transmission for each phase of the exposure period, with the highest adjusted odds ratio for the three-day peak exposure interval (March 28-30), 6.8 (p = 0.001). Non-salad pantry items and mixed bar drinks were also identified as vehicles of transmission; both were more important during the early interval of the exposure period than during the late interval. Two of six infected employees worked in the pantry and may have sequentially infected patrons. Though rare, this outbreak suggests that hepatitis A infection among employees may allow for transmission to patrons for prolonged periods of time. Prevention of such outbreaks requires prompt reporting of ill patrons with rapid identification of infected employees and correction of food handling practices.

Hepatitis A: Old and New

“…Consequently, the filtering of seawater by bivalves, with the potential for retaining infectious HAV particles resulting from fecal contamination, can lead to the transmission of infection to those who consume the seafood without adequate cooking. Spread of hepatitis A has been reported in the United States and Europe following consumption of contaminated lettuce (212), ice slush beverages (27), frozen strawberries (11,121,179), and salad food items (155,192). The global movement of food items that cannot be heated for viral inactivation may be a major cause of outbreaks in developed countries in the future.…”

Diagnosis of Hepatitis A Virus Infection: a Molecular Approach

“…HAV transmission has been associated with contaminated food and water (63,112,175,263). Outbreaks associated with consumption of mussels (70), clams (18, 100), contaminated lettuce (204), ice slush beverages, raw oysters (67), frozen strawberries (112,175), blueberries (27), raspberries (195,197), green onions (3,63,260), and other salad items (108,153,179) have been reported. The potential for extensive disease transmission is illustrated by the largest recorded hepatitis A outbreak, which occurred from consumption of sewagecontaminated clams and caused illness in 300,000 persons in Shanghai, China (263), and by outbreaks that extended to multiple states in the United States through widespread distribution of HAV-contaminated food (3,112,260).…”

Heat Inactivation of Hepatitis A Virus in Shellfish Using Steam

“…HAV infection is endemic in many developing countries, where it typically causes asymptomatic infections in children that develop life long immunity to re-infection (Lemon et al 1992). Foodborne outbreaks of illness are a concern in developed countries such as Canada where most of the adult population is susceptible to symptomatic illness (Lowry et al 1989;Doherty 2006). Hepatitis A illness is characterized by varying degrees of fatigue, loss of appetite, nausea, fever and jaundice (Krugman and Giles 1970).…”