Thousands of People Might Have Been Exposed to Hepatitis A by a Starbucks Employee—Here's What to Know


Local health officials are urging Starbucks customers in Gloucester Township, New Jersey, to get vaccinated against hepatitis A after a café employee tested positive for the infection. The employee worked through an infectious period on November 4-6 and then again November 11-13, potentially exposing co-workers and customers to hepatitis A, the Camden County Health Department said in a November 18 release.

Until all employees were vaccinated against hepatitis A, the Starbucks location closed. The health department is also recommending vaccination for customers who haven't already been vaccinated against the virus but who were at the store on any of the same days as the infected employee.

County spokesman Dan Keashen told CNN that "the exposure is probably in the thousands." "Starbucks says that that location is busy, as most are. They're saying they have an average of 600 patrons a day and some are return patrons maybe going multiple times a day," Keashen told CNN.

As of November 21, the county had administered 800 hepatitis A vaccines at the pop-up clinics it had created, Keashen told CNN, with 17 Starbucks employees also getting the shot. So far, no one from this exposure has tested positive for hepatitis A.

Hepatitis is highly transmissible, but it's possible to prevent sickness and transmission, even after you've already been exposed. Here's everything you need to know about hepatitis A—including how to protect yourself from it.

RELATED: The 5 Types of Viral Hepatitis, Explained

First, what is hepatitis A?

Hepatitis means "inflammation of the liver." Hepatitis A is a liver infection that's caused by the hepatitis A virus (HAV), according to the Centers for Disease Control and Prevention (CDC). There are a few types of hepatitis—A, B, and C probably being the most recognized—and each one is different.

The primary differences are how they spread and how long the conditions last. "Hepatitis B and C are generally transmitted by bodily fluid, and these two conditions can result in chronic disease, including cancer," Mindie H. Nguyen, MD, a hepatologist at Stanford Health Care and professor of gastroenterology and hepatology at Stanford School of Medicine, tells Health. Hepatitis A, on the other hand, is an acute infection that's not likely to cause chronic issues. It also spreads differently than the other forms of hepatitis.

The hepatitis A virus is present in the blood and stool of someone who's infected. It spreads through oral-fecal transmission, which is when someone ingests the virus without knowing it, whether through close contact with an infected individual or ingesting food or drink that's been contaminated with the virus. Even microscopic amounts of stool or blood could result in an infection, and it can remain viable outside the body for months, according to the CDC. Once a person has the virus, it's highly transmissible.

Usually, transmission is related to poor hygiene and unsanitary conditions, Shahid M. Malik, MD, clinical assistant professor of medicine in the division of Gastroenterology and Transplant Hepatology at the University of Pittsburgh Medical Center, tells Health. "That's why hepatitis A is a much bigger issue elsewhere in the world than in the United States," he says. (Just to note, an inspection found "no evidence of food safety violations," according to the Camden County Health Department. The push for vaccinations among those who might have been exposed was out of an "abundance of caution.")

RELATED: What to Know About Hepatitis C Screenings—And Who Should Get One

When do people get vaccinated against hepatitis A?

Vaccination against the virus became routine in 1999, which Dr. Malik cites as another reason infections are considered rare in the US. The CDC recommends a hepatitis A vaccine as part of a routine vaccination schedule; usually, the two-dose series is given to babies starting at 12 months. And even if they didn't get it as babies, it's recommended that children up to 18 years of age still receive their two doses.

But depending on your age, it's possible the vaccine wasn't part of your routine vaccine schedule. Even if the vaccine wasn't part of your routine vaccination, it's still possible that you got the vaccine if you have certain medical conditions that put you at risk for hepatitis A complications, according to Dr. Malik—for example, if you have chronic liver disease, you've probably been vaccinated.

If you've had hepatitis A before, you also have antibodies that should protect you for the rest of your life. But because you may not have had symptoms after being exposed to the virus, Dr. Malik says it's best to get vaccinated (especially if you live in an area where there's an outbreak). The good news is, once you're vaccinated, you're protected for life. And the vaccine is so effective that you likely won't get a breakthrough case. "If you're a healthy person, you're almost 100% protected," Dr. Malik says.

At the moment, you probably don't need to worry about a hepatitis A outbreak. Instead, focus on preventing the disease the best you can. That means practicing good hygiene, says Dr. Malik, especially washing your hands thoroughly and frequently. If you believe you were exposed to hepatitis A in the last two weeks, you can get a vaccine to decrease transmission of the virus to others and to potentially decrease symptoms. "The vaccine is harmless, and we know it works very well," says Dr. Nguyen.

RELATED: Why Isn't There a Hepatitis C Vaccine—And When Can You Expect One?

What are the symptoms of hepatitis A?

The virus usually incubates for up to 28 days before people start to experience symptoms, according to Dr. Malik. But not everyone experiences hepatitis A the same way. Some people a have mild case with fewer, less severe symptoms; others develop more symptoms and get sicker. According to the World Health Organization, some of the most common symptoms of hepatitis A include:

  • Fever
  • Abdominal discomfort
  • General malaise
  • Loss of appetite
  • Nausea
  • Diarrhea
  • Dark-colored urine
  • Jaundice (yellowing eyes and skin)

A good majority of otherwise healthy individuals who develop these symptoms get better without needing any specific medications, according to Dr. Nguyen. Plus, there's no specific treatment for hepatitis A, so Dr. Nguyen says doctors usually focus on helping people manage their symptoms.

Again, some people may get more severe infections. According to Dr. Nguyen, a very small fraction of people experience prolonged jaundice or itching related to hepatitis A. "But the risk of acute liver failure where someone would need to be hospitalized is exceedingly low in otherwise healthy people," she says. "In people with compromised immune systems or underlying chronic liver disease, such as hepatitis B or C, the risk of mortality is significantly higher."

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