The nationwide Hepatitis A outbreak has still yet to burn out. The U.S. Centers for Disease Control and Prevention (CDC) says 37 states have reported widespread Hepatitis A outbreaks since 2016, affecting nearly 43,000 people, with over 25,000 hospitalizations and 391 deaths. The Division of Viral Hepatitis at the CDC has actively assisted state and local health departments with Hepatitis A cases since 2017. As of October 2021, nine states, mainly in the West, have declared their Hepatitis A outbreaks as over. However, with Hepatitis A infections still active across the country, health officials advise business owners – including restaurateurs – to be aware of the virus and its symptoms and take precautions to help prevent outbreaks. 

Hepatitis A is a devastating worldwide infectious disease of the liver caused by the Hepatitis A virus (HAV). According to the CDC, the source of most reported foodborne Hepatitis A outbreaks has been HAV-infected food handlers present at the point of sale (such as in a restaurant) or who prepare food for social events (such as weddings). A single HAV-infected food handler can transmit HAV to dozens or even thousands of people and cause a substantial burden to public health. 

Hepatitis A is preventable by vaccine and by practicing proper hygiene techniques, as well as effective cleaning, sanitization, and disinfection. Learn more about the Hepatitis A outbreak, the warning signs, and how to protect your restaurant staff and patrons. 

Recent Restaurant-Related Hepatitis A Clusters

Restaurant and food-service workers may be at a higher risk of contracting Hepatitis A than workers in many other industries since their daily responsibilities include directly handling food and drink, person-to-person contact when serving meals and drinks to patrons, and interacting with discarded food items that individuals have touched or partially eaten. When illnesses are communicable by touch alone, their impact can be disastrous, devastating entire communities and even states, much like what we’ve been witnessing with this ongoing nationwide Hepatitis A outbreak. 

"One Hepatitis A-positive food-service worker can infect large numbers of customers and cause thousands of others to seek preventive vaccines," says Food Safety News. 

Though the scope of the impact from the Hepatitis A outbreak varies from state to state, the ease of transmission has made this particular Hepatitis A outbreak especially impactful in a short period. 

Here are just a few recent instances of restaurant-related Hepatitis A outbreaks: 

• Nearly 4,000 meals in Charlotte, North Carolina, were exposed to Hepatitis A after a Hardee’s restaurant employee contracted the infection in 2018. 
• In August 2019, it was announced that a single food handler in Mendham, New Jersey, had become infected with Hepatitis A and was deemed likely to be responsible for 27 other people becoming ill with the disease, one of whom died. 
• The State of Florida faced major outbreaks of Hepatitis A in 2019 and 2020, with 5,111 cases of Hepatitis A reported since 2018. According to the Florida Department of Health, cases in the state drastically slowed down in 2021, with 155 cases reported as of October. 
• Earlier this month, it was announced by the Roanoke City and Alleghany Health District in Virginia that one person died and another required a liver transplant after contracting a Hepatitis A infection linked to a Roanoke-based restaurant chain outbreak that sickened at least 44 people. 

What is Hepatitis A & How Does It Spread? 

Hepatitis A is a highly contagious disease that attacks the liver. It is the most common type of hepatitis reported in the U.S. The illness is caused by the Hepatitis A virus (HAV), which is found in the blood and stool of infected people. In recent years, Hepatitis A outbreaks have occurred from several different sources, including person-to-person transmission through close contact with an infected person and foodborne transmission through ingestion of contaminated food. Contamination can occur when infected individuals do not wash their hands properly after using the restroom and touch other surfaces or food items. A person infected with HAV can spread the disease to others anytime from 1 to 2 weeks before symptoms appear, through one week after symptoms occur. 

HAV can survive outside the human body on food and surfaces for a long time. It can survive for several days under refrigeration and is not destroyed by freezing. The virus is killed when heated to 185ºF (85ºC) for one minute and with food-contact sanitizing solutions such as Vital Oxide. 

Hepatitis A can range from a mild illness lasting a few weeks to a severe illness lasting several months. Unlike Hepatitis B and C, HAV infection does not cause long-term, chronic liver disease. Most people who become infected with Hepatitis A are only sick for a few weeks. However, in rare cases, HAV infection can cause liver failure and death. Hepatitis A continues to be one of the most frequently reported, vaccine-preventable diseases in the U.S., despite FDA approval of hepatitis A vaccine in 1995. For long-term protection, the Hepatitis A Vaccine is the best method of prevention.

Related: Hepatitis A, B, and C: Overview & Disinfection Guidelines

What Are the Symptoms of Hepatitis A? 

According to the World Health Organization (WHO), symptoms of Hepatitis A range from mild to severe and can include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine, and jaundice (yellowing of the eyes and skin). Not everyone who is infected will have all the symptoms. Additionally, a person infected with Hepatitis A can transmit the disease to other people even if they do not have any signs of the disease. The only way to diagnose Hepatitis A is by a blood test. 

Individuals with Hepatitis A may show no symptoms for up to four weeks after being exposed to the virus, making the spread very difficult to contain. The symptoms of Hepatitis A infection can also mimic the common flu or severe gastrointestinal illness, making the disease hard to categorize once symptoms do finally appear. 

What Should A Restaurant Operator or Manager Do if an Employee Tests Positive for Hepatitis A?

Upon learning a member of your restaurant staff has contracted Hepatitis A, it’s crucial that you contact your local health department immediately to learn about the next steps and the proper protocol for handling a reported case of Hepatitis A within your establishment. 

The Food Marketing Institute (FMI) has created an in-depth information guide and action plan for restaurant owners to use in the event a guest or member of restaurant staff contracts Hepatitis A, which includes actions like monitoring restaurant staff for any symptoms of Hepatitis A, educating staff on proper sanitization and handwashing procedures, and only allowing infected employees to return to work only after receiving a medical release from an attending physician and after consulting with your local health department. 

What Can Food-Service Establishments & Restaurants Do to Help Prevent Hepatitis A from Spreading? 

A food-service worker with Hepatitis A can transmit the virus to patrons by contaminating surfaces, utensils, or food. If recognized early, steps can be taken to prevent transmission to others. 

According to food safety experts, improved sanitation, food safety, and immunization are the most effective ways to help prevent the spread of HAV. Here are a few quick tips for preventing Hepatitis A in restaurants and food-service establishments:

• Train food-service workers and restaurant staff on the dangers of Hepatitis A, symptoms to look out for, and how it can be prevented. 
• Food-service workers and restaurant staff should wash hands frequently with soap and water for at least 20 seconds. Hands must be washed after using the restroom, eating, smoking, coughing, sneezing, taking breaks, handling garbage and other soiled items, and before handling or preparing food. 
• Employees should always avoid bare-hand contact with ready-to-eat food, including garnishes and rearranging cooked food on a plate. 
• Any employees who are sick should not come to work.

• Restaurant owners and managers should monitor employees for symptoms. Be aware of whether employees are showing any signs or symptoms of the infection. 
• Frequently and effectively clean and sanitize or disinfect surfaces with Vital Oxide to prevent the spread of Hepatitis A and other pathogens. 

Vital Oxide: The Ideal All-in-One Cleaner, Food-Contact Sanitizer, & Disinfectant for Restaurants and Food-Service Establishments 

Infection prevention is vital in preventing the spread of Hepatitis A and other pathogens. Consistently cleaning and sanitizing or disinfecting surfaces can help lower the risk of being exposed to Hep A through cross-contamination. It’s important to note that most cleaning and sanitization products do not kill Hepatitis A. To check if a product kills Hep A, read the label. The product label should say “effective against” or “kills'' Hepatitis A. Follow instructions on the label. View Vital Oxide’s full label here. 

Vital Oxide is unique in that it’s an all-in-one solution; it’s an effective multi-purpose cleaner, NSF-registered food-contact sanitizer (no rinse required on food-contact surfaces), and EPA-registered hospital-grade disinfectant that is tested and proven to kill several strains of viral hepatitis, including Hepatitis A. Additionally, Vital Oxide meets surface disinfection recommendations from OSHA’s Bloodborne Pathogen Standards for Hepatitis A, as well as Hepatitis B, Hepatitis C, and HIV-1. Vital Oxide is free from harsh chemicals, nauseous fumes, and harmful residues – making it the ideal solution for restaurants and food-service establishments. 

Related: Using Vital Oxide to Clean, Sanitize, & Disinfect Your Restaurant

Food-Prep Surfaces to Sanitize to Help Stop the Spread of Hep A: 

• Beverage and ice equipment 
• Cutting boards (before and after each use)
• Countertops, prep-tables, work surfaces, etc. (before and after each use)
• Food-contact equipment (can openers, slicers, grinders, mixers, etc.)
• Glassware, dishes, cookware, and utensils 
• Refrigeration units 

When sanitizing food-contact surfaces, always use an approved food-contact sanitizer to avoid chemical contamination. Vital Oxide is designated by NSF International as a “no-rinse required” food-contact surface sanitizer. This versatile multi-purpose solution can be used full-strength or diluted for multiple applications. 

How to Sanitize Food-Contact Surfaces with Vital Oxide: 

Mix 1-part Vital Oxide to 9-parts water. For all food-contact surfaces, including glassware, utensils, cookware, and dishware, scrape and pre-wash, then wash with an effective detergent. Rinse with potable water, then sanitize by immersion in the product for 1 minute (or longer if specified by government sanitary code). Place on a rack or drainboard to air dry. Do not rinse or wipe. 

For food-contact immobile surfaces (food processing equipment, countertops, tables, appliances, etc.), remove all visible food particles and soil by cleaning and rinsing with potable water. Apply Vital Oxide by wetting thoroughly and let it stand for 1 minute (or longer if specified by local government sanitary code). Let surfaces drain and air dry. Do not rinse or wipe.

Restaurant Surfaces to Disinfect to Help Stop the Spread of Hep A: 

• Touchscreens
• POS systems, keyboards
• Phones
• Menus 
• Doorknobs, railings, light switches
• Kitchen surfaces (sinks, countertops, floors, walls, etc.)
• Bathroom surfaces (faucets, sinks, toilets, floors, walls, etc.) 
• ATMs
• Tables
• Chairs, stools, benches, etc. 
• Highchairs and booster seats 
• Takeout stations
• Drink machines
• Condiment and napkin holders 
• Floors

How to Disinfect Non-Porous Surfaces with Vital Oxide: 

Follow these instructions for disinfecting pre-cleaned, hard, non-porous surfaces such as glass, plastic, painted wood, laminate, chrome, stainless steel, polyurethane-coated hardwood floors, glazed ceramic tile, sealed concrete, and linoleum floors, the exterior of appliances, cabinet handles, counters, doorknobs, tables, exterior toilet surfaces, faucet handles, handrails, keyboards, light switch covers, patio furniture, sinks, stovetops, telephones, toys, walls, and waste containers. Vital Oxide must come in contact with the contaminant to effectively disinfectant the surface. Remove any surface barrier between Vital Oxide and the contaminant such as dirt, grime, or organic matter by cleaning before the disinfection application. Vital Oxide may be used for this pre-cleaning step.

To disinfect pre-cleaned, hard, non-porous surfaces, apply Vital Oxide full-strength (undiluted), wetting thoroughly with spray, sponge, mop, or by immersion in solution. Allow surfaces to remain wet for 5 minutes or 10 minutes for virus inactivation (refer to Vital Oxide’s label for contact times). To disinfect against Hepatitis A, Vital Oxide should be allowed to dwell for five minutes. In cases where more frequent disinfection of surfaces results in a possible buildup of dry disinfectant residue, a wipe down with a moist towel or microfiber cloth of surfaces that come into contact with clothing (chairs, stools, benches, etc.) will prevent any possible discoloration of fabrics.

Additional Resources 

• World Health Organization (WHO) – Hepatitis A
• Centers for Disease Control and Prevention - Hepatitis A
• Mayo Clinic - Hepatitis A
• Vital Oxide User Guide 

At Vital Oxide, we’re proud to offer a revolutionary disinfectant powerful enough to kill 99.9% of viruses and bacteria without harsh chemicals. Follow us on LinkedIn and Instagram (@vitaloxideofficial) for more great cleaning and disinfecting tips. If you have any questions, please Contact Us or Send Us a Message on Facebook. We're here to help.