A dose of prevention: Vaccinations for hep A

In 11 states, hepatitis A rates twice U.S. average

Taking the approach that preventing an outbreak is much better than managing one, the 11-hospital Southern California Permanente Medical Group, based in Pasadena, has been offering hepatitis A vaccines to its food handlers.

So far, about 600 employees have been screened and immunized at a cost of less than $40,000, says Jodi Cassutt, MD, MPH, co-chair of southern California region employee health services for Kaiser Permanente.1

"In California, hepatitis A is endemic," says Cassutt. "That’s why we instituted this program. It’s been a pretty good selling point [to say], You’re not only protecting yourself, but all our [Kaiser Permanente] members and patients.’"

Updated guidelines from the Advisory Committee on Immunization Practices, issued last fall, stated that health care workers and food handlers are not at increased risk of contracting hepatitis A. However, in 11 states that have hepatitis A rates that are more than twice the national average, the guidelines recommend vaccination of children.2 Vaccination of other groups is left to local authorities, says Suzanne Cotter, MB, BCH, MPH, epidemic intelligence service officer at the Centers for Disease Control and Prevention in Atlanta.

"It’s certainly a reasonable approach [that Kaiser is taking]," she says. "We make room for that in our recommendation."

Specifically, the recommendation states: "Persons who work as food handlers can contract hepatitis A and potentially transmit HAV to others. To decrease the frequency of evaluations of food handlers with hepatitis A and the need for postexposure prophylaxis of patrons, consideration may be given to vaccination of employees who work in areas where state and local health authorities or private employers determine that such vaccination is cost-effective."

Cassutt noted that the immune globulin used to treat exposed individuals is in short supply, making it more difficult to respond to outbreaks.

When Kaiser tested food handlers, two-thirds of them showed immunity. About one-third of the non-immune workers declined the vaccination, or 11% of the total.

"We educate and encourage," says Cindy Lacy, regional employee health services manager. "Now we have this 11% identified, so if there is an outbreak, we know who to go right to [as a possible source]."


1. Eck EK, Shapiro S, Lacy CM, et al. Focused hepatitis A prevention through screening and immunization in healthcare setting supports national initiatives and avoids community-wide outbreaks. Presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections. Atlanta; March 8, 2000.

2. Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices. MMWR 1999; 48(RR12):1-37.