The public health cost of a hepatitis A outbreak: scallops edition

A recent twitter exchange about corporate food safety folks really becoming compliance teams highlights that all this food safety stuff is nestled somewhere in a web of risk, cost and benefit. Risk and benefit come down to public health and business risk metrics – which can be fraught with limitations and assumptions.screen-shot-2016-11-04-at-7-11-13-am

Risk-based decision making is the mantra in food safety. Picking out an intervention is a starts with a numbers game: calculating the likelihood of an action (like handwashing) and matching that with the prevalence of a pathogen in the system. This is the stuff that gets the math nerds like Schaffner excited (me too). Businesses are faced with risk, cost and benefit decisions daily.

Food safety teams that focus just on compliance are trusting that the compliance folks got the science and risk correct. Sometimes they do. But lawmaking is slow.

The cost part of the equation somewhat straight forward.

One cost that’s been debated in food service for over twenty years is whether or not employers or public health folks should require food handlers to be vaccinated for hepatitis A. Jacobs and colleagues arrived at the conclusion that the public health benefit of vaccinating for hep A doesn’t equal the costs – but doesn’t factor in all the bad publicity, hassle and incident management costs.

Or costs to the public health system. According to KHON2 300+ cases of hepatitis A is costing hundreds of thousands of public health dollars.

The Hawaii Department of Health says it’s spent approximately $336,100 to investigate and respond to the hepatitis A outbreak.

images-1Here’s how it breaks down: $304,600 were spent on normal staff work hours, and an estimated $19,750 went to pay for 300 hours of overtime work.

The rest went to pay for vaccines and lab specimen shipments to the Centers for Disease Control and Prevention, but the health department tells us that was covered by federal grant funds.

It took a lot of work for health officials just to pinpoint the source of the outbreak, including an online survey, numerous interviews with people, and visits to businesses.

Although officials identified the source — imported frozen scallops — they’re still not done with this outbreak. They’re now looking into a hepatitis-A-related death.

“The woman was in and out of the hospital really since she became ill in July, and so there were times where she needed a liver transplant,” said foodborne illness attorney Bill Marler. “She sort of seemed to rally. She got to go home for a little while, and then she was back in the hospital with complications.”

This entry was posted in Food Safety Culture, Food Safety Policy, Hepatitis A and tagged , by Ben Chapman. Bookmark the permalink.

About Ben Chapman

Dr. Ben Chapman is an associate professor and food safety extension specialist at North Carolina State University. As a teenager, a Saturday afternoon viewing of the classic cable movie, Outbreak, sparked his interest in pathogens and public health. With the goal of less foodborne illness, his group designs, implements, and evaluates food safety strategies, messages, and media from farm-to-fork. Through reality-based research, Chapman investigates behaviors and creates interventions aimed at amateur and professional food handlers, managers, and organizational decision-makers; the gate keepers of safe food. Ben co-hosts a biweekly podcast called Food Safety Talk and tries to further engage folks online through Instagram, Twitter, Facebook, YouTube and, maybe not surprisingly, Pinterest. Follow on Twitter @benjaminchapman.