Editor’s note: This is the companion story of a two-piece news package we are presenting today. The main story describes the ongoing, multi-state outbreak of Hepatitis A and how states are addressing it. Most case counts in both stories are as of April 30. However, some of the main outbreak states have since updated their counts, which are not reflected on accompanying maps.

Food-related outbreaks of Hepatitis A are often associated with contamination of food during preparation. That can happen when a foodservice worker is infected by the highly contagious liver disease.

Person-to-person transmission of Hepatitis A occurs via the “fecal-oral route,” meaning infected food handlers who don’t practice good enough hand-washing techniques can contaminate the foods and beverages they prepare or serve. And, because the peak time of infectivity usually occurs a couple of weeks before symptoms appear, food handlers often don’t even know they are infected and therefore continue to work.

Food handlers include people who stock produce aisles in grocery stores and those who maintain self-serve snack and beverage machines in convenience stores and gas stations.

Hepatitis A symptoms may not occur until several weeks after exposure and may include abdominal discomfort, fever, malaise, muscle aches and a yellowing of the skin called jaundice. In severe cases, Hepatitis A causes liver failure and death.

While the Centers for Disease Control and Prevention recommended in 2006 that all children 1 to 2 years old be vaccinated, the CDC has not recommended Hepatitis A vaccinations for food service workers.

Some local public health officials have hosted vaccination clinics for restaurant workers in recent months as reports of infected foodservice workers, but the vaccination is not required by federal or state laws..

One Hepatitis A-positive foodservice worker can infect large numbers of customers and cause thousands of others to seek preventive vaccines. Illnesses and vaccines can cost thousands if not millions of dollars, and can cost restaurants its viability either by a downturn in customers or civil lawsuits.

All of this is preventable by a vaccine.