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This week’s Morbidity and Mortality Weekly Report (MMWR) from the CDC is our Best Read because it summarizes an outbreak at a restaurant chain in Virginia. In 2021, a restaurant worker who was not vaccinated for Hep A worked at three different locations of the chain for two weeks while he was infectious. Ultimately, there were 51 cases, 31 hospitalizations, and three deaths. It led to a $14 million settlement and two of the three affected locations filing for bankruptcy. This case got so bad in part because it was caught late - the employee delayed seeking medical attention and didn’t tell the health department that he worked in restaurants, both of which hampered a proper response that could have helped minimize exposure and brand damage. By the time people knew they’d been exposed, it was outside of the window when prophylactic vaccination could help prevent illness. That may have contributed to a very low vaccination uptake - only 1 in 5 eligible (unvaccinated) employees got the Hep A shot. One study showed that nearly 20% of restaurant workers had used drugs in the preceding month, which translates to 3 million restaurant employees, all of whom are at higher risk for Hep A. There are a few key takeaways for restaurants here:
We often think that hand sanitizers are just as effective as soap and water for combating viral spread, which may be true for some bugs but can be a dangerous trap with norovirus. Noro is a particularly hardy virus, which can live on surfaces for weeks and is hard to destroy. Hand sanitizers rely on alcohol to break down the cells of the virus, but noro has a hard protein shell called a capsid that protects it, and alcohol doesn’t get through it. Instead, the physical motion and friction of rubbing soap and water together in your hands physically breaks down the hard barrier protecting the norovirus particles. It’s important to wash thoroughly for 30 full seconds ("Happy Birthday" twice) and get under the nails and between fingers since even just a few microscopic particles are enough to make someone sick.
Religious exemption requests are more common after anti-vaccine sentiment rose during the COVID pandemic. Hepatitis A is one vaccine that was developed using fetal stem cell lines, so it’s a similar line of reasoning as religious objectives to the COVID vaccine (along with rubella, rabies, Hep B, and others). First, give your legal team a call - they may already have a lot of this worked out. If the religious exemption is deemed sincere by your legal team, you likely need to work with the employee and the local health department to determine whether you can offer a reasonable accommodation. That said, if the employee works in food service, it’s possible that you don’t need to accommodate that belief if it compromises workplace safety. Keep your health department and legal team looped in at each step while you work together to determine the best next steps.
Widespread Community Transmission of Hepatitis A Virus Following an Outbreak at a Local Restaurant in Virginia | MMWR