Food-borne hepatitis A in a general hospital. Epidemiologic study of an outbreak attributed to sandwiches

In November and December 1973, an outbreak of food-borne hepatitis A occurred in a busy general hospital. Epidemiologic investigation implicated cafeteria-made sandwiches. Eventually, 44 clinical and 22 subclinical cases of hepatitis were diagnosed among hospital employees. In addition, at least seven persons in the community became ill with hepatitis after eating in the hospital cafeteria; hospital patients were not, in general, affected. Two cafeteria workers were potentially implicated in the spread of hepatitis; both would have had subclinical hepatitis during the probable transmission period. It was recommended that food-handlers with icteric hepatitis remain out of work for at least two to three weeks after the onset of jaundice, while food-handlers with subclinical hepatitis remain out of work for at least two to three weeks after the peak of enzyme level elevation.