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Hepatitis A cases create legislation flow

February 08, 2000

By: Danel Aguirre
Links: HB 1488, HB 1489, HB 1650, SB 736

State Capital Bureau

JEFFERSON CITY - The hepatitis A outbreak in St. Louis that left dozens seriously ill this fall and one death now is causing its own epidemic of legislation designed to reduce the chance of similar infections in restaurants and cafeterias.

Four members of the General Assembly have introduced bills that aim to increase the number of Missourians vaccinated against hepatitis A. Efforts are primarily focused on the inoculation of restaurant workers.

Under one of the proposals put forth by Rep. Harry Kennedy, D-St. Louis, a restaurant whose workers were not vaccinated would be forced to pay the state costs for treating the outbreak.

"It's pretty clear that our restaurants are not totally safe, as we have had big outbreaks all over the state in the last few years," Kennedy said.

More than $56,000 was spent last fall to inoculate almost 3,000 people after six incidents in St. Louis.

In December case, 59 customers contracted hepatitis A after eating at the Market Street Deli. The outbreak wasn't discovered until it was too late to prevent the disease. Two people had to undergo liver transplants.

The hepatitis A rate has fluctuated greatly in Missouri during the last 15 years.

About 715 cases were reported in Missouri last year, which is a slight increase over 1998, but much lower than the 1500 cases reported in 1992. Hepatitis A cases totalled 98 in 1985.

Kennedy said shots aren't the only answer.

"Vaccinations don't help if the hygiene doesn't improve," he said. "We need to establish better habits, so safety goes along with other values to avoid other problems that come from these activities."

None of the bills proposed would mandate restaurants to give shots to all workers. Nor would they effect the current rights to sue for damages by patrons who become infected from contaminated food.

Hepatitis A infections occur because of poor sanitary habits. The disease attacks the liver, and symptoms include stomach pain, diarrhea, low fever, pale stools, yellowish skin and eyes, dark urine and loss of appetite.

While the disease is rarely fatal, a Postal Service employee from St. Louis did die after contracting hepatitis A in January.

Children are most vulnerable, health officials say.

For that reason, Walker said she wants to mandate the vaccination of all children.

"Doing that we would see a drastic drop in hepatitis A cases," Walker said.

Rep. Todd Akin, R-St. Louis County, takes a somewhat different approach.

His bill would allow the state the charge a restaurant for the costs of handling a hepatitis A outbreak -- with a cap of $20,000.

Akin would waive that liability for restaurants that vaccinate their workers and follow the Health Department's food-handling procedures. Workers would be exempt from liability if they refused vaccination for philosophical or religious reasons.

A fourth proposal, this one by Sen. Betty Sims, R-St. Louis County, would give food businesses a tax credit equal to the cost of vaccinating workers. Her purpose, she said "is to give small income employers the opportunity to pay for the vaccines, which are expensive."

Nevertheless, Pamela Walker, director of the Health Department's environmental health division, said she doesn't think Missouri restaurants are unsafe. "I think our food suppliers are among the safest in the world," she said.