All food workers could face vaccinations

In response to a series of hepatitis A outbreaks at restaurants and catered events across L.A., county officials said Tuesday they might require food-service workers in all 25,000 eateries to be vaccinated for the virus.

County supervisors voted unanimously Tuesday to ask health officials to examine the costs and benefits of such a requirement, which also would extend to 300 catering companies and 270 wholesale producers.

The proposal comes a week after officials announced that a prep cook at a Wolfgang Puck catering firm was diagnosed with hepatitis A. Health officials issued a warning to 3,500 people who had attended 13 events catered by the company, including a high-profile bash Feb. 14 celebrating this year’s Sports Illustrated swimsuit issue.

There have been other high-profile incidents of hepatitis A outbreaks over the last two years, including one at the posh Cafe Pinot eatery in downtown L.A., another involving a Hollywood catering firm and a third that centered on an Olvera Street restaurant.

Officials acknowledged that the vaccinations could be a massive undertaking -- possibly involving more than 100,000 workers -- but said they were trying protect the public health.

“We need to ensure that those who are involved in the handling of food are safe and healthy,” County Supervisor Mike Antonovich said. “The public is vulnerable.”

If county supervisors did approve mass vaccinations, Los Angeles County would join only a handful of municipalities across the nation that require hepatitis A shots containing antibodies for food workers, including Las Vegas and St. Louis.

Some health experts are skeptical.

Hepatitis A is characterized by inflammation of the liver. It is rarely fatal. Symptoms include fever, chills, abdominal pain, vomiting, light-color diarrhea, dark urine and jaundice, which is indicated by yellowish skin and eye color. The virus can be passed from person to person as a result of improper sanitation during food handling.

Dr. Jonathan E. Fielding, the county’s director of public health, said workers who prepare uncooked food such as salads are most likely to pass on the disease, especially if they do not wear gloves. Nevertheless, he cautioned that the risk of infection even then was very low.

“Every time we have an exposure ... it causes a lot of public concern, and it’s both expensive and disturbing to a lot of people,” he said. “I want to be clear: The risk in those cases is quite low. It’s an increased risk. But it’s not like you’d expect 15% to 20% of patrons getting sick.”

Los Angeles County has seen about 400 cases of Hepatitis A in each of the last two years.

Gianni Ferialdi, a co-owner and cook at Tony’s Bella Vista in Burbank, said he thought a hepatitis A vaccine requirement would be a good idea. But he said the inoculations could cost more than $200 per person, and with about 15 full- and part-time employees, he couldn’t afford to do it unless the county was able to get him a discount.

“Business is way down for us, so we couldn’t afford it,” Ferialdi said. “And another thing: We get new people all the time. That’s another problem.”

Some health experts are doubtful that mass vaccinations offer diners true protection.

Dr. Ashok Jain, an emergency room physician at Los Angeles County USC Medical Center and an occupational and environmental medicine specialist, said mandatory vaccinations could give restaurant owners a false sense of security.

Vaccinated workers would be protected from becoming ill from hepatitis A but if, for example, a family member had the virus, the food worker’s fingernails could be contaminated with it, which could carry the virus to work.

The most important and effective thing, Jain said, is to educate workers on proper hygiene: telling food handlers to make sure nails are properly trimmed, changing clothes when coming to work, not scratching hands, and washing hands every time before you enter the kitchen. Touching a dirty doorknob while leaving a bathroom could contaminate just-washed hands.

Jain said he also would recommend that restaurants give workers preemployment health screenings and annual checkups, noting that many may be part-time employees or students who have no health coverage.

A U.S. Centers for Disease Control and Prevention study in the journal Vaccine in 2001 said “vaccinating restaurant employees is unlikely to be economical from either the restaurant owner or societal perspective.” The study said that a restaurant owner would incur substantial expense to ensure that all workers were vaccinated all the time and that it would be unlikely to result in reduced costs for society if there were an outbreak.

Hepatitis A outbreaks can be severe, and the source of contamination can be linked to an infected food handler at a restaurant or to produce that was tainted while being harvested or processed. The nation’s largest hepatitis A outbreak occurred in 2003, when about 600 people were sickened and four died after eating at a restaurant outside Pittsburgh; the outbreak was linked to tainted green onions.

High-profile but unrelated outbreaks hit Los Angeles in 2005. At the Olvera Street restaurant, 15 patrons became ill. Nineteen people were sickened by lettuce at a catering company used by the entertainment industry. That outbreak was suspected of being transmitted by baby green lettuce.

The Cafe Pinot outbreak affected five workers and a customer, and as a precaution the county urged hundreds of patrons to get shots containing antibodies to protect themselves against the disease.

County officials found no fault with hygiene practices at the three establishments when they were inspected.

About 7,000 people become ill with the disease annually in the U.S. Though most recover with medical attention, hepatitis A kills about 100 each year.

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jack.leonard@latimes.com ron.lin@latimes.com

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About hepatitis A

What are the symptoms of hepatitis A?

Symptoms include fever, chills, abdominal pain, vomiting, light-color diarrhea, dark urine and jaundice, which is indicated by yellowish skin and eye color. It causes an inflammation of the liver.

How is it passed?

The virus is often passed from person to person as a result of improper sanitation during food handling. It can involve workers who contaminate food with fecal matter and it can spread easily within a household. It can take 15 to 50 days from exposure for a patient to show symptoms.

How serious a virus is it?

Most people recover from hepatitis A within two months but some can be sick for as long as six months. In rare cases, it’s fatal.

How many cases are there a year?

About 7,000 people become ill with the disease annually in the U.S. Hepatitis A kills about 100 each year. Los Angeles County has recorded about 400 cases in each of the last two years. One in five victims is hospitalized. After you get the virus, you cannot get sick from it again.

Does the vaccine work?

Yes, in almost all cases.

Sources: Times reports; U.S. Centers for Disease Control and Prevention