BRANSON, Mo. (AP) — Linn Smith watched warily for two years as a stubborn wave of hepatitis A washed across the Midwest, making its way toward Branson, where 60,000 tourists a day visit restaurants, ice cream stands and concession booths.
At the same time, she saw the needs of the U.S. military and a manufacturer’s recall gobbling up the local supply of immune globulin or IG — medicine used to stifle hepatitis infections in exposed people.
Ms. Smith, head of Branson’s health department, had good reason to fear the potentially explosive effects of the contagious disease among food-service workers: Through 1996, cases in southwestern Missouri rose almost 400 percent over those in 1995, to 637 from 127. And everyone who comes in contact with a carrier should have a shot of immune globulin.
“I truthfully thought, ‘What am I going to do if I don’t have any IG and they send me a war to fight?'” she said.
Late last year, she took up the only weapon she could find: a year-old vaccine gaining popularity across the country as other tourism-dependent communities consider mandatory immunization of food workers.
Hepatitis A, passed orally or through human waste, usually by people with poor personal hygiene, causes liver inflammation. Symptoms include fatigue, abdominal discomfort, vomiting, fever, dark urine and jaundice.
The disease runs in cycles, according to the Centers for Disease Control and Prevention, sticking to one region for three years or so, then backing off for a decade or more.
Although food workers make up less than 5 percent of hepatitis A cases, the greater worry is exposure. A single infected worker can create a logistical nightmare when authorities try to warn people who had contact with him, especially if they are tourists on the move.
And with the low supply and rising costs of immune globulin, Ms. Smith said preventing the illness rather than curing it becomes the paramount concern.
The hepatitis A vaccine gained federal approval last year. Unlike vaccines for polio and measles, however, the CDC does not recommend blanket inoculation because of the cost and because the disease responds to treatment.
In December, the CDC shifted slightly and began recommending the vaccine for food-service workers.
Ms. Smith’s initiative in Branson was touted recently in the Food Protection Report, a monthly newsletter that monitors the activities of the CDC and the U.S. Food and Drug Administration and goes to thousands of health officials across the country.
“I don’t know of any other jurisdiction in the country that’s taken the progressive step that Branson has taken in getting people immunized against hepatitis A,” said Charles Felix, the newsletter’s publisher. “In that sense, it really is a model.”
The first shot of vaccine gives a person immunity for up to 10 years. A booster shot can make that immunity last a lifetime. Each shot of vaccine costs $40, more than double the immune globulin shots, but lifetime immunity would make the vaccine cheaper in the long run.
The price of immune globulin has soared in recent years. In 1990, a dose cost about 50 cents. It now runs about $18. Most of the increase has to do with supply and demand.
Immune globulin is now made in only two places — the state health departments in Massachusetts and Michigan. A private company pulled its product from the shelves last year and declined to upgrade its process when federal officials changed manufacturing standards. Military activity in the Persian Gulf and Haiti had further depleted the supply.
Immune globulin shots contain antibodies taken from donors that provide temporary resistance to the disease. In contrast, the vaccine contains killed hepatitis A virus, which causes the body to create antibodies of its own and provides much longer-lasting protection.
Hoping to keep at bay an epidemic that would require large quantities of the immune globulin, health officials in St. Louis, Seattle and San Diego, as well as Branson, are considering making vaccines mandatory, beginning with food workers, Ms. Smith said.