Hepatitis E in a food handler--a rapid risk assessment to guide the public health response.

OBJECTIVE The Australian Capital Territory Health Directorate was notified of a food handler with hepatitis E virus (HEV) infection. To guide the public health response, a rapid risk assessment was undertaken to determine the risk of transmission of HEV from the infected food handler to restaurant patrons. METHOD The literature on HEV was reviewed and expert advice sought from clinical and public health specialists. This was supplemented by results of a site investigation and a case interview. The risk rating was determined to be the product of the likelihood of transmission and the consequence of the infection. RESULTS The food handler was likely to have been infectious at the time he was working at the restaurant. He had handled high-risk foods, and the site inspection revealed potential opportunities for transmission. HEV is not common in Australia and it was assumed that the population was non-immune and hence susceptible to the disease. Therefore, there was a low but possible likelihood of transmission of HEV. If infected, HEV has the potential for major consequences in vulnerable populations especially among women who are pregnant. The overall level of risk was considered to be very high. DISCUSSION The general public and health practitioners were alerted to enable early identification of symptoms and prompt disease management. There were no secondary cases of HEV associated with this event. In the absence of published guidelines and limited evidence, a risk assessment framework was a useful tool to inform public health decision-making.