Public Health hepatitis A investigation – update and important reminders to help prevent potential spread of illness

Public Health Sudbury & Districts continues to investigate and respond to two cases of hepatitis A in deli workers at the Real Canadian Superstore in Sudbury. To date, there are no laboratory-confirmed reports of illness related to consumption of food from the deli.

“The public has responded to Public Health’s calls to be immunized and to watch for symptoms of infections,” said Dr. Ariella Zbar, Sudbury & Districts Associate Medical Officer of Health. “Since the second case was announced last Thursday, we have seen almost 650 people in our clinics for immunization and 2835 people in total. Many others have called in for information,” said Dr. Zbar.

Anyone who consumed clerk-served deli meat or cheese, or meat and cheese from prepared deli trays purchased from the store between November 27 and January 2 may be at risk of hepatitis A infection and should watch for symptoms. Those people who have eaten this food within the last 14 days are eligible for immunization.

“Public health inspectors and nurses are conducting thorough investigations and follow up of these hepatitis A cases,” said Stacey Laforest, Sudbury & Districts Director of Health Protection. “This is a dynamic situation, and as we learn more, we are able to take additional steps to protect the public. For example, through follow up on the second case, additional information was shared with us about the specific work of food handlers and of the hepatitis A risk for certain workers. This has meant additional restrictions on how the deli food is handled and on some workers’ activities,” said Laforest.

Hepatitis A can survive for long periods outside of the body and it is known as a hardy virus. Public Health Sudbury & Districts states that this, combined with its long incubation period, mean that other cases of hepatitis A may occur.

“This is unfortunate but not unexpected given that people can be infectious even when they do not have any symptoms,” said Laforest. “The actions of Public Health to control the spread of hepatitis A will reduce the risks of the spread of hepatitis A, but unfortunately the risk cannot be reduced to zero,” she added.

Common symptoms of hepatitis A include fever, stomach pain or discomfort, dark urine, nausea and vomiting, diarrhea, tiredness, loss of appetite, clay or ash-coloured bowel movements, and jaundice (yellowing of the skin and whites of the eyes).

Hepatitis A is an illness that is easily spread from person-to-person through the fecal-oral route. The virus is found in the feces and blood of a person infected with the virus, and one common route of exposure can be food contaminated by infected food handlers. This can occur by directly handling already cooked or ready-to-eat foods with unclean bare hands or through food contact with dirty gloves. It is also spread through close personal contact with an infected person, such as through having sex, sharing cigarettes or e-cigarettes, caring for someone who is ill, or using drugs with others.

Hepatitis A can be avoided by:

  • Not working in a food service setting if you are a food handler experiencing symptoms.
  • Not handling or preparing food for anyone if you are ill.
  • Washing your hands often and thoroughly using soap and water. This is especially important after using the bathroom, changing a diaper, and before preparing or eating food.
  •  If wearing gloves, change them often. Gloves cannot be washed and reused.
  • Avoiding sharing common items such as cups and finger foods (for example, popcorn).
  • Always washing fresh fruits and vegetables such as strawberries and lettuce.

By the numbers:

  • As of January 6, 1958 clients have contacted Public Health for information about the illness and hepatitis A vaccination.
  • On December 15, 2019, Public Health was notified of the first case of hepatitis A in a food handler in deli of the Real Canadian Superstore, Sudbury. On January 1, 2020, the agency was notified of a second case in a food handler in the deli at the store.
  • To date (January 6, at 2 p.m.), 2835 hepatitis A vaccine doses were provided (2182 adult and 653 pediatric [less than 18 years of age]) at Public Health clinics.

Questions and Answers: Public health response related to reportable diseases.

What happens when Public Health is notified of certain diseases in our community?

  • Some people have asked about how Public Health is notified about, and how we respond to certain illnesses in our community.
  • Provincial legislation designates certain diseases that must be reported by health care providers to the local Medical Officer of Health.
  • Under this legislation, Public Health is then required to assess and take appropriate actions to prevent the spread of infectious diseases to others.
  • Public Health uses these reports of diseases to monitor the health of our community and to prevent infections from spreading.

What does Public Health do in response to reports of diseases?

  • Every report of a designated disease to Public Health is assessed to determine if public health actions are needed to protect others from the disease spreading.
  • These actions depend on the disease itself, but can include looking for the source of infection, interviewing cases or individuals who are infected, determining who may have been in contact with infectious people or other sources of infection, and putting in place appropriate control measures to limit or stop the spread of disease. All of this work is based on legal requirements and scientific rationale.
  • Public Health actions are based on real time information that is gathered as investigations proceed. Situations are often dynamic. If more is learned over time about the disease circumstances, public health actions may change and evolve with this new information to ensure the best possible actions are in place to protect people.

How does Public Health decide what actions to take?

  • Public Health investigations and actions are carried out in a step-wise and systematic way. The actions that Public Health takes are informed by new information that might come to light throughout the process of the investigation. The aim of all of this work is to protect people from the spread of disease.
  • Based on the findings of an investigation and the potential risk to the public’s health, we take action and put preventative measures in place.
  • Our decision-making process is based on specific protocols, always with the goal of protecting the public’s health.
  • Every situation and investigation is unique, and the actions we take to protect the public are in direct response to the situation, the findings, and any new information that is gathered throughout.
  • Public Health works closely with many people to investigate and to respond to public health threats. Public Health relies on the cooperative, timely and accurate information from many sources. Depending on the circumstances, these may include for example, from health care providers, individuals who are infected, families of infected individuals, local retailers, and citizens.
  • Public Health also works with multiple agencies to follow up on reports of designated diseases. These include for example, other public health units, the Ministry of Health, Public Health Ontario, hospitals, and health care providers.

This item was last modified on January 6, 2020