Morey Rebecca J, Collier Melissa G, Nelson Noele P
1 Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
2 Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
Public Health Rep. 2017 Jul/Aug;132(4):443-447. doi: 10.1177/0033354917710947. Epub 2017 Jun 13.
When food handlers become ill with hepatitis A virus (HAV) infection, state and local health departments must assess the risk of HAV transmission through prepared food and recommend or provide postexposure prophylaxis (PEP) for those at risk for HAV infection. Providing PEP (eg, hepatitis A [HepA] vaccine or immunoglobulin), however, is costly. To describe the burden of these responses on state and local health departments, we determined the number of public health responses to HAV infections among food handlers by reviewing public internet sources of media articles. We then contacted each health department to collect data on whether PEP was recommended to food handlers or restaurant patrons, the number of PEP doses given, the number of HepA vaccine or immunoglobulin doses given as PEP, and the mean number of health department person-hours required for the response. Of 32 public health responses identified from Twitter, HealthMap, and Google alerts from January 1, 2012, to December 31, 2014, a total of 27 (84%) recommended PEP for other food handlers or restaurant patrons or both. Per public health response, the mean cost per dose of the HepA vaccine or immunoglobulin was $34 139; the mean personnel cost per response was $7329; and the total mean cost of each response was $41 468. PEP is expensive. Less aggressive approaches to PEP, such as limiting PEP to fellow food handlers in nonoutbreak situations, should be considered in the postvaccination era. HepA vaccine for PEP provides long-term immunity and can be used when immunoglobulin is unavailable or cannot be administered within 14 days of exposure to HAV.
当食品从业人员感染甲型肝炎病毒（HAV）时，州和地方卫生部门必须评估通过已制备食品传播HAV的风险，并为有感染HAV风险的人员推荐或提供暴露后预防措施（PEP）。然而，提供PEP（如甲型肝炎[HepA]疫苗或免疫球蛋白）成本很高。为了描述这些应对措施给州和地方卫生部门带来的负担，我们通过查阅媒体文章的公共互联网来源，确定了针对食品从业人员HAV感染的公共卫生应对措施的数量。然后，我们联系了每个卫生部门，收集有关是否向食品从业人员或餐厅顾客推荐PEP、给予的PEP剂量数量、作为PEP给予的HepA疫苗或免疫球蛋白剂量数量以及应对所需的卫生部门人均工时的信息。在2012年1月1日至2014年12月31日期间从Twitter、HealthMap和谷歌警报中识别出的32项公共卫生应对措施中，共有27项（84%）为其他食品从业人员或餐厅顾客或两者推荐了PEP。每项公共卫生应对措施中，HepA疫苗或免疫球蛋白每剂的平均成本为34139美元；每次应对措施的平均人员成本为7329美元；每次应对措施的总平均成本为41468美元。PEP成本高昂。在疫苗接种后时代，应考虑采取不那么激进的PEP方法，例如在非疫情情况下将PEP限制在食品从业人员同行中。用于PEP的HepA疫苗可提供长期免疫力，并且在无法获得免疫球蛋白或在接触HAV后14天内无法接种免疫球蛋白时可使用。
