Published Date: 2007-02-21 20:00:03
Subject: PRO> Hepatitis A, restaurant - USA (TX)(02)
Archive Number: 20070221.0645

HEPATITIS A, RESTAURANT - USA (TEXAS) (02)
*******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 21 Feb 2007
From: Hollinger Blaine <blaineh@bcm.tmc.edu>

Re: Administration of immune globulin
---------------------------------------------
Experimental or epidemiological evidence that immune globulin [IG]
"is only effective if given within a 2-week period after exposure to
the disease" is not available, given the vagaries of dose and
exposure conditions that lead to acquisition of the virus, resulting
in longer incubation periods.
From a public health standpoint, the CDC avoids this controversy by
stating that "efficacy when administered >2 weeks after exposure has
not been established," which is an appropriate statement based on
analysis of the data (see: Prevention of Hepatitis A Through Active
or Passive Immunization: Recommendations of the Advisory Committee on
Immunization Practices (ACIP); MMWR, 19 May 2006 / 55(RR07);1-23
<http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.htm>).
Routine vaccination of children is an effective way to reduce
hepatitis A incidence in the United States. These updated
recommendations represent the final step in the childhood hepatitis A
immunization strategy (see: MMWR, 19 May 2006). But physicians and
other healthcare workers should appreciate the fact that immune
globulin given >2 weeks after exposure might still modulate or abort
the infection in some individuals. It would be helpful to know when
the source case became ill or jaundiced. IG should have been given to
other food handlers working in that establishment as soon as the
diagnosis was made, but the risk of transmission to patrons is
unlikely unless there are extenuating circumstances surrounding the
disease in the contact case (e.g., diarrhea, etc). In my opinion, the
restaurant should be responsible for costs related to the
administration of immune globulin to its patrons.
--
F. Blaine Hollinger, M.D.
Professor of Medicine, Virology & Epidemiology
Director, Eugene B. Casey Hepatitis Research Center and Diagnostic Laboratory
Baylor College of Medicine
One Baylor Plaza, BCM-385
Houston, TX 77030
USA
<blaineh@bcm.tmc.edu>
[ProMED-mail thanks Professor Hollinger for forwarding this advice. - Mod.CP]

See Also

Hepatitis A, restaurant - USA (TX) 20070220.0639
.....................cp/msp/dk

*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Become a ProMED-mail Premium Subscriber at
<http://www.isid.org/ProMEDMail_Premium.shtml>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.
############################################################
############################################################