State health officials announced last week that a food service worker in Cumberland County may have exposed diners to hepatitis A. We still don’t know where this occurred or how many people were potentially exposed to the contagious liver disease, because the Maine Center for Disease Control and Prevention won’t release the information.
But the agency was more forthcoming when a similar case arose a year ago.
Last October, approximately 100 people were potentially exposed to the hepatitis A virus during a church supper at the Durham Friends Meetinghouse. Here’s the health alert Maine CDC issued in that instance, which identifies the church and also references a women’s group luncheon affiliated with the meetinghouse.
This time around, the agency’s alert states only that the restaurant worker served food while contagious from Sept. 29 to Oct. 11 and that “restaurant patrons may be at risk for hepatitis A infection.” How many? Have they been identified and notified? We don’t know.
I posed those questions to John Martins, a spokesman for the Maine Department of Health and Human Services, which oversees Maine CDC. He didn’t respond to them in his email to me today. He said health officials were informed of the case on Oct. 27 and forwarded a statement that said “there is no additional risk for any person who may dine in this establishment at this time.”
We do know this didn’t occur in Portland or South Portland. Those two cities employ their own health inspectors, and officials from both say this case didn’t happen on their turf. Health inspectors with Maine CDC cover dining establishments in the rest of Cumberland County.
The state may not need to identify an establishment if officials can contact all of the potentially exposed people, such as at a catered event with a defined guest list. But Maine CDC is making the argument that releasing the restaurant’s name would risk identifying the individual worker who was infected, which remains confidential under state law. That suggests the restaurant employs a small staff.
“Maine CDC’s longstanding practice has been to only release details in situations where doing so would have a public health benefit,” the statement said. “This notice was released to raise awareness of Hepatitis A with providers, who are the primary audience of the Health Alert Network.”
Last week’s health alert states that public health staff determined diners were at risk after investigating the worker’s illness and “food and beverage preparation practices.” That could mean that food safety precautions weren’t followed.
Another distinction in the new case, as opposed to the circumstances last year in Durham, is that Maine CDC says it was notified of the worker’s illness after a 14-day post-exposure window during which individuals can be given a vaccine to prevent the disease from taking hold. It was too late for that by the time the agency was informed, so there was no point in notifying the public, they say.
Dr. Dora Anne Mills, who formerly headed the Maine CDC, points out even after the two-week window, “You can still get the vaccine and it can help to diminish your symptoms.” Doctors treating patients considered at risk for severe illness, such as those with chronic liver disease, may recommend the hepatitis A vaccine even to patients without exposure to the virus. Those with a suspected exposure would be more likely to get vaccinated.
Patients can also receive an injection of immune globulin to prevent illness.
Even if it’s too late to get immunized, people potentially exposed to hepatitis A should be alerted to the risk so they can be diagnosed properly and remain vigilant about personal hygiene to avoid passing the virus on to others, said Mills, who now serves as vice president for clinical affairs at the University of New England.
I’ve filed a Freedom of Access Act request for information about the Cumberland County case with Maine DHHS. I also asked why the Maine CDC staff position responsible for overseeing the agency’s response to hepatitis is vacant, according to the U.S. CDC website.
Martins, the DHHS spokesman, told me that the previous viral hepatitis prevention coordinator left in August and a new candidate has accepted the job. He noted that the coordinator’s primary role is to educate the public about hepatitis C, another form of the illness.
Both this case and the recent developments surrounding nurse Kaci Hickox have cast a worrying glare on state public health staffing. The state epidemiologist — tasked with preventing the spread of infectious diseases, tracking their causes and effect on the population, and responding to outbreaks — resigned in May, and hasn’t been replaced. The deputy state epidemiologist position also remains vacant, while the Maine CDC website lists a total of 12 vacancies for public health nurses. A representative from the Maine State Employees Association says there’s actually 14 unfilled positions, as two of the nurses listed have since left state service.
If you’re worried about your own risk, here are the basics on hepatitis A from the U.S. CDC:
- Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces or stool of an infected person.
- Symptoms can appear anywhere from 15-50 days after exposure to the virus. A person is considered infectious approximately two weeks before symptoms begin until one week after.
- Some individuals develop no symptoms. Adults are more likely than children to show signs of illness.
- Hepatitis A symptoms include fever, nausea, dark urine, clay-colored stool, jaundice, abdominal discomfort and loss of appetite.
- Severity can range from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A does not lead to chronic disease, unlike Hepatitis B and C.
- Almost all people who get Hepatitis A recover completely, though rarely the virus causes liver failure and death, more commonly in those aged 50 years and older and people with other liver diseases.
- Once you recover from Hepatitis A, you develop antibodies that protect you from the virus for life.