A review of interventions triggered by hepatitis A infected food-handlers in Canada

Table 2 Public health investigation of infected food handlers (n = 16, 1998–2004)

Items	Large PEP intervention (n = 6)	Limited PEP intervention (n = 10)
Case identification
Case confirmation and cause of infection
Laboratory confirmed case	6	7
Known cause of infection	2	1
Duties
Food/drink worker in restaurant/lounge	1	7
Food handler in produce/deli section, grocery/food store	4	0
Food worker in hospital food services/cafeteria	0	2
Food/veggie worker in food market	1	1
Hygiene practice
High standard/met requirements for food handling	4	6
Evidence of public health risk
Timing of discovery
Within 14 days of symptom onset	5	4
> 14 days of symptom onset	0	6
Estimated duration of public exposure in days*
Median (range) [# cases with data]	18.5 (4, 23) [n = 6]	8 (3, 45) [n = 9]
Qualitative estimate of the number of exposed individuals
Estimated number in hundreds or thousands	5	1
Unspecified number of clients over an exposed duration	1	9
Post-exposure prophylaxis intervention
Immunization
Vaccine (or vaccine and immunoglobulin)	3	2
Immunoglobulin	3	4
Doctor referral	0	4
Number of immunized individuals†	5750 (550, 19208) [n = 6]	All contacts [n = 2], 50 [n = 1]
Food safety inspection and control
Recall, remove & clean up potentially contaminated food	3	1
Risk communication
Eligibility criteria for vaccination	6	8
Communicate estimated risk to the public	6	9
Public health cost
Reported resources utilization and/or direct cost	5	2

Abbreviations: PEP: post-exposure prophylaxis.
Notes: *Estimated duration of exposure as specified in eligibility criteria for immunization, or number of days working while potentially infectious. †Median (range) [# cases with data] for large public health interventions and category (i.e., IG all contacts, IG 50 close contacts) [# cases with data] for limited public health interventions.

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