After a Hardee's hepatitis A scare, here's what the county could do to reduce risk

As hundreds of Hardee's customers line up for hepatitis A vaccinations at county health clinics, some say Mecklenburg County should be more aggressive in ensuring food-service workers are vaccinated against the highly contagious liver disease.

The county said it doesn't have the power to mandate that restaurant workers are vaccinated. But the health department could offer the vaccinations for free, or at a discount, to people handling food.

"They need to rethink whether they want this thing to pop up again," said Seattle attorney Bill Marler, who specializes in food illness cases. "It will happen again. It's Hardee's today. It will be pick your restaurant tomorrow. Offering these vaccinations at discount rates makes sense."

Four years ago, an employee at a northeast Charlotte Papa John's restaurant became ill and was diagnosed with hepatitis A.

Mecklenburg and Cabarrus health officials scrambled to offer a free vaccine for hundreds of people who had eaten at the restaurant. A customer sued the pizza chain, which settled the lawsuit.

The Papa John's case was similar to this week's scare at a Hardee's restaurant on Little Rock Road near Charlotte Douglas International Airport. A Hardee's employee who handled food was discovered to be one of five people in a small Charlotte hepatitis A outbreak, and the Mecklenburg County Health Department has scrambled to offer vaccinations to people who ate at the restaurant from June 13 to 23.

The county said the restaurant served 4,000 meals during that 10-day window. The county said 1,193 people had received a vaccination on Wednesday, the first day the shots were offered at two county clinics. Only 255 people had been vaccinated by mid-afternoon Thursday, though the county expected clinics to be busier over the weekend.

This year, 12 people in Mecklenburg have been diagnosed with hepatitis A. That is smaller than some outbreaks nationwide, including Michigan, where as many as 800 people have been infected this year.

Marler represented customers in the Charlotte Papa John's case in 2014. He said he is likely to file a lawsuit this week against the Hardee's restaurant on behalf of its customers.

Hepatitis A is found in the feces of infected people. It's usually spread by fecal to mouth contact.

Risk factors include being homeless and not having access to a place to wash hands; men having sex with men; people who use recreational drugs; and being in close proximity to others who are already infected.

In the early 1990s, St. Louis County in Missouri had several hepatitis A outbreaks related to food-service workers, according to a U.S. National Library of Medicine National Institutes of Health study.

After the county passed a mandatory vaccination program for food-service workers in 2000, the number of outbreaks essentially ended.

"Following implementation of this new ordinance, there has been a 10-fold decline in hepatitis A cases and the number of hepatitis A outbreaks has dropped to zero and remained that way for 15 years," the study said.

In the Hardee's case, there has been no evidence that the fast-food employee spread the virus to any customer.

In Louisville, Ky., the local health department has responded to an outbreak of hepatitis A this year by offering the vaccine for $25 — half of the normal $50 cost, according to the Louisville Courier-Journal.

Mecklenburg's health director, Gibbie Harris, said in an interview Wednesday that health inspectors encourage restaurants to make sure their employees are vaccinated. But state law prohibits the county from requiring a vaccination, she said.

But she said it would be theoretically possible for the county to offer the vaccine to all county restaurant workers at a discount, or free. The vaccine costs $62.83.

For a fast-food worker making $7.25 an hour, a vaccine would wipe out an entire day's pay.

"That would be helpful if we could make it for free," Harris said.

Harris said that decision would be made by Mecklenburg commissioners, who ultimately oversee the health department.

Some commissioners this week demurred on whether the county should spend tax dollars to get more restaurant workers vaccinated. One problem, some said, is that commissioners don't have the expertise to make such a decision.

Republican Commissioner Jim Puckett and Democratic Commissioner Pat Cotham said they weren't sure whether an expanded vaccine program is a good idea. They said the health department should be overseen by a board of health professionals instead of commissioners.

"I don't have the expertise to know," Puckett said.

Democratic Commissioner Dumont Clarke said food service establishments need to do more.

"Everyone is looking to government for the solution and forgetting that the food service industry has an extraordinary economic incentive to make sure their employees are taking the very simple steps that will prevent the spread of Hep A from a worker to a customer," Clarke said in an email.

Clarke said the idea of a more stringent vaccination program is "intriguing." But he said he wanted to hear from experts at the health department.

The N.C. Restaurant Association, a lobbying group, said restaurants "take sanitation and safety very seriously." The organization said restaurant workers must wash hands, often use disposable gloves and stay home when sick.

It said it opposes any consideration of mandatory vaccinations. It said it would support reduced-cost or free vaccinations for restaurant workers.

The group said there are 482,000 restaurant and food service workers in the state. It's not clear, however, how many of those people handle food. The industry is also highly transient.

The county is offering free vaccinations for Hardee's customers.

Vaccinations are available 3-8 p.m. Friday at the Hal Marshall Building, 700 N. Tryon St.

Vaccinations are available 10 a.m. to 3 p.m. Saturday and Sunday at the Hal Marshall Building.

The county may add more clinic hours if needed. The county also said Thursday that people who ate at the Hardee's during the 10-day window can get a free vaccination at any county health clinic in the state.

At the Northwest Health Department Clinic Wednesday, there was a line of about 50 people waiting outside to get vaccinated.

One man said he was "shocked" to learn he might have been exposed. Another Hardee's customer, Eric Bailey of Charlotte, said he stopped at the fast-food restaurant after flying home from a business trip.

"I haven't had fast food in a month, and I haven't eaten at Hardee's in three years," he said.

Bailey said he ate at Hardee's on June 12, one day before the 10-day window in which the county said customers needed a vaccination.

"I was concerned," he said. "I decided I had better do this."

Hardee's parent company, CKE, issued a statement about the employee.

"Although the health department determined a mandatory closure was unnecessary, out of an abundance of caution for our employees, guests and community, we supported the franchise owner’s voluntarily (temporary) closure of the restaurant," the statement said.

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This story was originally published June 28, 2018 at 3:23 PM.