Charlotte restaurant owner says cost of vaccinating food handlers against hepatitis A worth it

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

Businesses are faced with cost/risk/benefit decisions daily.ART_vaccine_032711-copy_1

One 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. Authors of a 2000 Journal of Food Protection 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.

A Charlotte restaurant owner who dealt with a hep A exposure event says the cost to his business was more than the shots, and is suggesting that all food handlers should be vaccinated.

Charlotte restaurant owner is going on the offensive battling perception and health concern over Hepatitis A.

“The restaurant industry is thriving,” said Jon Dressler, owner of three Charlotte-area restaurants.

Last month, however, he received a call no one wants to get.

“We were contacted by the Mecklenburg Health Department that one of our employees had contacted Hep A while on vacation,” said Dressler. “It’s not a cleanliness issue, it’s not an internal issue. The health department didn’t have to shut us down.”

Rather than being upset, Dressler has another idea.

“It would be wonderful if all of Mecklenburg County restaurant workers were required to have the Hep vaccination,” said Dressler.

The National Restaurant Association reports there are 426,000 restaurant workers in North Carolina. The two-set vaccination is about $150 a person.  Meaning, it would cost close to $64 million to vaccinate all restaurant workers in the state.  No one from the state or Mecklenburg County health departments wanted to comment on camera about the need for the vaccine.  However, the CDC did put out a report.

“Slowly, but surely, all of my employees are being vaccinated,” said Dressler.

The restaurant owner isn’t taking chances, making all of his employees get the vaccine.  He admits it’s expensive, but it’s a cost he’s willing to take.

“You weigh the expense of the vaccination versus the expense of any lost business you might incur,” said Dressler.

Food: Hucksters and snake oil

While the Food Babe may have gotten some less than glowing press from the N.Y Times, two Australian food porn types have been thoroughly routed and lost their book deals.

SnakeOilIf only people wouldn’t initially fall prey to 21st century snake oil.

The paleo cookbook Bubba Yum Yum: The Paleo Way was due for release last week, but has now been cancelled by publisher Pan MacMillan in NZ and Australia amid health concerns over a recipe for babies.

The book apparently advocates baby milk formula based on liver and bone broth.

But co-author Pete Evans, who penned the book with blogger and actress Charlotte Carr, appears unperturbed by the news, taking to Facebook to announce: “Our nurturing new book ‘Bubba Yum Yum’ will also being [sic] released in the next week or two, so we’ll keep you updated [sic].”

Enthused about the project, which he wrote with Wes Carr’s wife Charlotte and naturopath Helen Padarin, he ended the post with: “We surly [sic] all are part of something very, very special… good things are coming! Good things are here!”

We have close to a 1000 people coming to the Melbourne town hall tomorrow for our Paleo Way Tour. I am so excited to share the stage with such truly inspiring, open hearted people!

Fresh off filming the sixth season of My Kitchen Rules, Pete is currently busy touring his Paleo Way cooking class through the country.

The tour is an offshoot his Pete’s TV show of the same name, which the Daily Telegraph reported has been green-lit for a second season.

Aussie mum Kim Reddy wrote an open letter to Pete Evans, asking him to “stop being a jerk and go back to being a chef.”

Simultaneously, publishing giant Penguin will pull Belle Gibson’s debut cook book after the author failed to defend accusations of falsely claiming to have cancer and explain why she withheld charitable donations.

The publisher has previously admitted never fact checking Ms Gibson’s story, which claims healthy living and natural therapies helped her treat multiple terminal cancers.

imagesMs Gibson has so far offered no evidence to support her claims of surviving cancers after rejecting conventional treatment. Former friends and leading medical experts have cast strong doubt over her story and purported diagnoses.

“Despite our best endeavours, Penguin Books has not received sufficient explanation from Ms Gibson, author of The Whole Pantry recipe book, in response to recent allegations,” a spokeswoman said.

“As such, we have been left with no other option but to stop supplying the book in Australia. We remain hopeful that we will receive the formal assurances we have requested in the coming days.”

It comes as next month’s overseas release of The Whole Pantry also is in doubt, with major US publisher Simon & Schuster confirming it will investigate Ms Gibson’s biography and charitable donations.

Global tech company Apple, which heavily promoted Ms Gibson’s app as one of the first to be made available on the Apple Watch device, has remained silent for almost a week despite mounting accusations and repeated requests for comment. Apple refuses to say whether it stands by Ms Gibson.

Gibson recently encouraged her followers to drink raw cow’s milk and discussed investing in a co-op.

She is facing criticism for ignoring the Victoria State government move to further restrict raw milk sales after one child died and four became seriously ill after consuming ‘cosmetic milk’ products.

Using her private Instagram handle of @onlybelle she told her followers to go #vegan, #notmilk, #rawmilk or #nomilk.

On an image showing a fridge of raw milk products she wrote: ‘Raw Milk is Not for Human Consumption!” with “F*** the government. Hahaha’

The 23-year-old has told her followers to avoid vaccinating their children.

The doctor video below from Jimmy Kimmel is fairly good (NSFV).

E. coli vaccine effective but seldom used in feedlot cattle

When it comes to foodborne illnesses, few rival E. coli for the damaging effect it can have on humans.

beef.cattleResearch shows that STEC-related bacteria cause more than 175,000 human illnesses per year with an annual direct economic cost ranging from $489 million to $993 million, said Kansas State University agricultural economist, Glynn Tonsor.

Shiga toxin-producing E. coli, often referred to as STEC O157 or simply E. coli, is naturally occurring in cattle and though it does no harm to the cattle, can make humans sick. In some cases it is lethal. To reduce the chances that beef leaving their plants is contaminated with the pathogen, beef processors have implemented hazard control steps and also test their beef products for the presence of E. coli before they leave the plant.

Another potential way to reduce prevalence of E. coli is to vaccinate cattle in feedlots long before they are shipped to processing plants.

“Immunization through vaccination has been a commercially available pre-harvest intervention to reduce E. coli shedding in cattle for about five years,” said Tonsor, who is a livestock marketing specialist with K-State Research and Extension. “Despite demonstrated substantial improvement in human health the vaccine offers, it has not been widely adopted.”

In a recent study he, along with K-State colleague Ted Schroeder, also an agricultural economist, took a closer look at the potential economic impacts of incorporating animal vaccination into E. coli pre-harvest control practices.

A fact sheet is available at Market Impacts of E.coli Vaccination in U.S. Feedlots. Study results have been published in the Agricultural and Food Economics Journal.

The study made clear two primary reasons most feedlot managers don’t use E. coli vaccines. Because cattle themselves are not adversely affected by the pathogen, the presence of E. coli does not hinder cattle feeding efficiency so there are no production costs for feedlots directly associated with the prevalence of E. coli. In other words, it costs no more to feed cattle that have E. coli than it does to feed cattle that don’t.  

Further, there is no well-established market that compensates producers for vaccinating for the pathogen. So generally, the price paid for cattle coming out of feedlots is the same whether the vaccine was used or not. Because administering the vaccine adds costs without direct economic incentives, most cattle feeders choose not to, Tonsor said.

Key findings from the K-State study include:

  • Given the current market setting, producer adoption of E. coli vaccination protocols is likely to remain limited. If such vaccinations were implemented, it would cost U.S. feedlots $1.0 billion to $1.8 billion in economic welfare loss over 10 years if demand didn’t increase with premiums for vaccinated cattle.    
  • Retail or export beef demand increases could spur adoption by feedlot producers. Considering different scenarios, the study found that retail beef demand increases of 1.7 percent to 3.0 percent or export beef demand increases of 18.1 percent to 32.6 percent would be necessary to generate sufficiently higher fed cattle prices to offset the costs associated with vaccination.
  • Production cost decreases to either beef retailers or wholesalers (packers) could also provide an incentive for feedlot producers to vaccinate. The study indicated that cost declines of 2.2 percent to 3.9 percent for retailers or alternatively production cost declines of 1.2 percent to 2.2 percent for packers would be necessary to generate sufficiently higher fed cattle prices to cover feedlot adoption costs, making producers economically neutral to adoption.

“A key point of this research is that limited use of E. coli vaccinations in U.S. feedlots is consistent with the lack of current economic signals for producers to expand adoption,” Schroeder said. “Unless there is a substantial change in market signals presented to feedlot operators, limited use of E. coli vaccinations can be expected in the future.”

Vaccines work: So says Kristen Bell (and Israel)

Data on long-term impact of universal national vaccination programmes against hepatitis A are lacking. We aimed at evaluating the impact on hepatitis A incidence of the Israeli toddlers-only universal routine two-dose vaccination programme against hepatitis A initiated in 1999.

kristen-bell1All hepatitis A episodes reported to the national surveillance system from 1993 to 2012 were analysed in relation to the vaccination programme and coverage. Mean vaccine coverage in Israel between 2003 and 2010 was 92% for the first dose, given at 18 months of age, and 88% for the second dose, given at 24 months.

The annual hepatitis A incidence declined from a mean of 50.4 per 100,000 in the period between 1993 and 1998 to a mean of <1.0, during the period from 2008 to 2012, representing a reduction of >98%. The decline was evident in all ages and ethnicity groups, including unvaccinated populations.

Of the 1,247 cases reported nationwide between 2002 and 2012, the vaccination status could be ascertained in 1,108 (89%). Among them, only 20 (2%) were reported be vaccinated with one dose and three (<1%) received two doses.

The sustained results of this long-term impact study suggest that a toddlers-only universal routine two-dose vaccination programme is highly effective and practical. These findings underscore the importance of sustainability in both the surveillance systems and vaccination programmes and will aid to determine vaccination policies.

The impact of a national routine immunisation programme initiated in 1999 on Hepatitis A incidence in Israel, 1993 to 2012

Euro Surveill. 2015;20(7)

Levine H, Kopel E, Anis E, Givon-Lavi N, Dagan R.

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21040

http://www.today.com/parents/kristen-bell-get-vaccinated-whooping-cough-if-you-want-hold-2D80499716

And Penn and Teller (NSFV).

Say it ain’t so: Over 100 tourists got hep A from strawberries in Egypt, 2013

A multistate outbreak of hepatitis A virus (HAV) among European travelers returning from Egypt occurred between November 2012 and April 2013.

chocolate-food-luxury-strawberry-Favim.com-538433A total of 14 European Union (EU)-European Free Trade Association (EFTA) countries reported 107 cases. Twenty-one cases from six countries were affected by strains of sub-genotype IB harbouring identical RNA sequences, suggesting a common source outbreak.

An international outbreak investigation team interviewed a number of cases with a trawling questionnaire to generate hypotheses on potential exposures. Some of these exposures were further tested in a case–control study based on a more specific questionnaire. Both trawling and case–control questionnaires aimed to collect cases’ vaccination details as well as epidemiological information. Most cases participating in either questionnaire (35/43) had been staying in all-inclusive hotels located along the Red Sea.

The case–control study found cases associated with exposure to strawberries or mango (multivariable analysis p value: 0.04). None of the 43 cases interviewed in any of the two questionnaires had been vaccinated. The most common reasons for non-vaccination was unawareness that HAV vaccination was recommended (23/43, 53%) and perceiving low infection risk in all-inclusive luxury resorts (19/43, 44%). Vaccination had not been recommended to five of the six cases who sought travel medical advice before travelling.

Public health authorities should strongly reinforce measures to remind travellers, travel agencies and healthcare providers of the importance of vaccination before visiting HAV-endemic areas, including Egypt.

 

Multistate foodborne hepatitis A outbreak among European tourists returning from Egypt– need for reinforced vaccination recommendations, November 2012 to April 2013

Eurosurveillance, Volume 20, Issue 4, 29 January 2015

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21018

First partially successful vaccine developed against prion disease in deer

Investigators at the New York University School of Medicine have developed a weakly successful vaccine against Chronic Wasting Disease (CWD) in white-tailed deer[1]. CWD is a prion disease which is common in cervids and can cause progressive, irreversible degeneration and death. Though I could not locate any evidence of this disease making the species jump like bovine spongiform encephalitis did, the authors contend that given the large numbers of deer and elk suffering from this disease, there is a possible risk for human infection as well.

amy_deer(3)In this study, the investigators comment in the abstract:

In the current study, white-tailed deer were orally inoculated with attenuated Salmonella expressing PrP, while control deer were orally inoculated with vehicle attenuated Salmonella. Once a mucosal response was established, the vaccinated animals were boosted orally and locally by application of polymerized recombinant PrP onto the tonsils and rectal mucosa. The vaccinated and control animals were then challenged orally with CWD-infected brain homogenate. Three years post CWD oral challenge all control deer developed clinical CWD (median survival 602 days), while among the vaccinated there was a significant prolongation of the incubation period (median survival 909 days; p = 0.012 by Weibull regression analysis) and one deer has remained CWD free both clinically and by RAMALT and tonsil biopsies. This negative vaccinate has the highest titers of IgA in saliva and systemic IgG against PrP. Western blots showed that immunoglobulins from this vaccinate react to PrPCWD. We document the first partially successful vaccination for a prion disease in a species naturally at risk.

References:

1.Goñi, F., Mathiason, C., Yim, L., Wong, K., Hayes-Klug, J., Nalls, A., Peyser, D., Estevez, V., Denkers, N., Xu, J., Osborn, D., Miller, K., Warren, R., Brown, D., Chabalgoity, J., Hoover, E., & Wisniewski, T. (2015). Mucosal immunization with an attenuated Salmonella vaccine partially protects white-tailed deer from chronic wasting disease Vaccine, 33 (5), 726-733 DOI: 10.1016/j.vaccine.2014.11.035

Further Hepatitis A case in UK school

Health officials are planning to vaccinate all children and staff at a Portsmouth school following a further case of Hepatitis A.

hepatitis.AChildren from selected classes at Devonshire Infant School were vaccinated in November after seven cases of the infection in one family.

Public Health England (PHE) said the further case suggested “transmission may have occurred within the school”.

The vaccination is now being offered to all 180 pupils and about 30 staff.

It is also being offered as a precaution to the children and staff at Fledglings pre-school.

Vaccines work: Report shows sharp decline in U.S. hepatitis A cases

A new report shows there has been a sharp decline in hepatitis A cases throughout the United States. An analysis of federal data found that hospitalization rates have fallen from 7.2 to 2.9 patients per million patients admitted to hospitals from 2002 to 2011.

berry.blend.hep.aHepatitis A cases have fallen by almost 90 percent over the past 20 years marking this increased decline as another major step forward in the fight against the potentially deadly liver disease. Vaccines like Twinrix, which protect against both Hepatitis A and B, can make a big difference.

“Hepatitis A vaccination is very important for everyone, especially travelers to high risk countries,” said Melanie Kohr, Vice-President of Clinic Operations for Passport Health. “Travel trends are on the rise, and if more people are vaccinated against this potentially deadly disease, then the likelihood of spreading it when a traveler returns greatly declines. This can play a critical role in national health in the long term and for the health of close family members no matter the situation.”

Enterotoxigenic E. coli worldwide are closely related

The strains of enterotoxigenic Escherichia coli (ETEC) that infect adults and children in Asia, Africa, and the Americas, have notably similar toxins and virulence factors, according to research published ahead of print in the Journal of Bacteriology. That bodes well for vaccine development, says corresponding author Åsa Sjöling, now of the Karolinska Institutet, Stockholm, Sweden. ETEC infects 400 million people annually, or 5.3 percent of the world’s population, killing 400,000.

Holding-sick-belly-25-per-centIn the study, Sjöling et al. set out to determine whether the heat labile toxin (LT) had become more toxic over time, and whether the bacterium had evolved to secrete more of it. LT causes the “travelers’ diarrhea” that so frequently afflicts Americans abroad, and that plagues residents of many low and middle income countries. But they found that over the 30 year period from which they had isolates, the two most potent toxin types, LT1 and LT2, had changed little but had spread globally.

“When new ETEC strains acquire either LT1 or LT2 they seem to have a much better chance to persist and spread,” says Sjöling. Colonization factors, the compounds the bacterium uses to adhere to the lining of the human got, also remained conserved over time, and the most common colonization factors identified globally were often associated with LT1 and LT2.

The research results from a collaboration between the University of Gothenburg (where Sjöling did this research), which has the world’s largest collection of ETEC strains, and sequencing experts at the Sanger Institute, Cambridge, UK. “We soon saw that strains with similar toxin variants and colonization factor profiles often remained closely related despite having been isolated on different continents, with time spans between those isolations ranging up to 30 years,” says Sjöling.

The paper is published concurrently with a paper in Nature Genetics by many of the same authors. In that paper, investigators developed whole-genome sequence data for 362 ETEC strains over 30 years, in 20 countries. “This research strengthens our belief that it is possible to target a broad range of ETEC groups with one vaccine,” says Gordon Dougan of the Sanger Institute, a coauthor of both papers.

“We believe that the vaccine developed at the University of Gothenburg will be protective and useful globally since this vaccine is based on the toxin types and colonization factors we found to be most successful worldwide,” says Sjöling.

While ETEC was believed to vary widely from place to place, the Nature Genetics investigators traced many of the 21 lineages to an individual bacterium that acquired the genetic information needed to infect humans between 51 and 174 years ago, and then spread. That, in turn, suggests that the bacterium is stable, and that it is unlikely to become vaccine-resistant, and that the vaccine will be effective worldwide in both children and adults, says Sjöling. 

Austin, TX Whataburger food handler diagnosed with hepatitis A

If I were a food business owner I’d be worried about hepatitis A. Individuals can shed the virus without showing symptoms and even a Hep A positive handwashing superstar will result in lineups outside the business or at the health department while patrons get their post-exposure shots.images-7
Authors of a 2000 Journal of Food Protection  paper on the cost effectiveness of vaccinating food handlers 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.
According to KXAN, an Austin outlet of Whataburger the famed Texas fast food chain is going through the crisis stuff right now – and it will cost them business even without patrons getting sick.
Health officials are wanting to alert the public about possible hepatitis A exposure at a Whataburger in Central Austin. A restaurant employee there at the 2800 Guadalupe St. location has been diagnosed with the hepatitis A virus.
 
While health officials say transmission of the infection to customers is not likely, the Austin/Travis County Health and Human Services Department is recommending people contact their doctor if they ate at that specific Whataburger between Aug. 7 and Tuesday and fit the following criteria:
  • are 75 years old or older
  • are immune-compromised
  • have chronic liver disease or have had a liver transplant
  • have clotting-factor disorders
  • are experiencing hepatitis A symptoms
A bit out of the norm; the usual public health response is to administer protective post-exposure IgG shots to all.