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Health department explains hepatitis A stats, risk assessment

Times-Tribune - 12/22/2018

Dec. 22--WHITLEY COUNTY -- 183.

That's the number of establishments throughout all of Whitley County that serve prepared, ready-to-eat food. That's also the number of establishments that the Whitley County Health Department must inspect, both routinely and when there is a reported health issue. That number includes not only restaurants, but school buildings, hotels, the hospital, roadside mom-and-pop stores--everything.


That's the number of reported cases of hepatitis A in food service workers in all of Whitley County since August 2017.

It's no secret that Kentucky is currently suffering from one of the worst outbreaks of hepatitis A in the country, with Whitley County, specifically, ranking among the highest of all reported cases in the state. Yet, the number of those cases involving food service workers remains extremely low. The number of cases caused by a food service worker who has tested positive for hepatitis A? Even lower, according to Tamara Phelps, interim director for the health department.

"If you'll look at statistics, there's not been one case of anyone getting sick from a food worker during this outbreak," said Phelps. "That's not just here. That's all over the state of Kentucky."

Since the beginning of the current outbreak last year, the Kentucky Department for Public Health website shows that there have been 3,122 reported cases through Dec. 8. In Whitley County alone, there have been over 150 reported cases in that time.

Phelps spoke to members of the Corbin City Commission earlier this week, where she said that the three reported cases of hepatitis A in food workers only represents 1.8 percent of the county's population who have been diagnosed with the virus. To put that number into perspective, the National Safety Council website shows that the odds of dying from heart disease are one in six, or approximately 16.6 percent, meaning that you likely have a better chance of dying from heart disease caused by the food itself than you do of contracting hepatitis A from it.

The three cases of the virus reported in Whitley County food workers have also all been deemed "low risk." That label has proved polarizing, however, as many commenters on the Times-Tribune's Facebook page concerning Phelps' appearance before the city commission were upset with the terminology, with many stating that the public should be able to evaluate the level of risk for themselves. The health department is not the one who makes that determination though.

When the health department is notified of a positive diagnosis in a food worker, a thorough inspection is performed at the establishment. Any and all information collected from that inspection--including factors such as what that specific worker's duties are, the last time the worker was physically present at the establishment, if proper food-handling procedures are being followed, etc.--is then put into an algorithm created by the Centers for Disease Control and Prevention, which is what calculates the risk factor for possible transmission. That information is also sent to the Kentucky Department for Public Health, who provides the direction for how such cases are handled.

"All of our guidance comes from Frankfort. We don't make it up," said Phelps.

Despite the low number of cases in food workers and the lower potential for transmission of the virus through food, the health department takes each and every report seriously. Paul Lawson, health environmentalist (AKA "the health inspector") for the health department, personally performs the bulk of the county's inspections of establishments that serve food.

When the health department is notified of a possible infectious issue concerning food, Lawson is most likely the person to be dispatched to investigate. It is his inspection that helps produce a risk factor determination by the CDC and state. And yes, he knows what he's doing.

With a four-year degree in environmental health science and two decades of work as an inspector with the health department, Lawson is also a registered sanitarian by the state and undergoes continual training each year as part of his position.

A major complaint from the public--one that Lawson called the "biggest" he receives--is due to seeing food service workers not wearing gloves while handling food. Lawson said it was easily his chief complaint even before the outbreak began. Though gloves are required for handling ready-to-eat foods, such as lettuce and tomato that have been washed and are ready to be used or cooked meats, they aren't required during earlier processes of food preparation. That is why it isn't uncommon to find food workers tossing around pizza dough with their bare hands, because properly cooking the food kills the germs and bacteria.

Over the past few weeks of hepatitis A coverage, there have been many commenters on the Times-Tribune's Facebook page suggesting that food service workers be required to wear gloves to help prevent the continued spread of the virus. While gloves are obviously helpful to some extent in preventing germs and bacteria from transferring from a worker's hands to food items, if not used properly then they are nothing more than a false sense of security.

"I'll be honest with you, I'm not a big advocate for gloves. I know the public wants to see everyone with gloves on. It gives them that nice, warm, fuzzy feeling, but gloves are abused way more than they are used properly," said Lawson.

And if appropriate hand-washing procedures aren't followed before gloves are used?

"It completely defeats the purpose," said Lawson.

Ultimately, the chances of contracting hepatitis A are far greater by doing typical, everyday things, such as pushing around a cart at a store, getting gas or shaking someone's hand, than they are from food contamination. That is why hand-washing is such a vital part of prevention.

"Hygiene has always been really important, and it still is. That's something that I really look for," said Lawson. "The thing that's hard to get people to understand is you can't see bacteria."

According to the CDC, proper hand-washing procedure consists of wetting your hands with clean, running water, lathering you hands and between your fingers for at least 20 seconds, rinsing them under clean, running water and then drying your hands with a clean towel.

Getting vaccinated is the other key component in defending against hepatitis A. Most health insurance providers are also now paying for the cost of the vaccine, with the out-of-pocket cost being approximately $65. The health department, as well as most doctor's offices and pharmacies carry the vaccine.

Phelps said that the health department will also be hosting a vaccination clinic in conjunction with Dayspring Family Health Center sometime next month. More information will be provided on the clinic once it becomes available.

For more information about the ongoing epidemic, visit chfs.ky.gov and click on the "Hepatitis A Outbreak Page" link on the righthand side of the page.


(c)2018 The Times-Tribune (Corbin, Ky.)

Visit The Times-Tribune (Corbin, Ky.) at www.thetimestribune.com

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