Facing an epidemic of hepatitis A, Spokane County's top health official is about to declare an emergency.
Dr. Kim Thorburn, director of the Spokane Regional Health District, wants everyone who prepares or serves food for a living, is an intravenous drug user or spends time in jail to be vaccinated against the viral infection.
About 13,000 people work in restaurants and bars in Spokane County, according to the state Department of Employment Security. Those figures don't include cafeteria workers in schools and businesses.
Thorburn said she'll probably declare an epidemic emergency within a week. That would give her authority to order hospitals, insurance companies and restaurant owners to help pay for vaccinations.
The health district would administer some vaccinations, with taxpayers picking up the cost of $82 for each person inoculated.
Thorburn said she wouldn't order anyone to get the shots.
Most insurance companies typically don't cover the cost of hepatitis A shots because the illness is rare and the most effective vaccination is new.
The traditional inoculation, immune globulin, prevents the flu-like symptoms that accompany hepatitis A, but doesn't prevent its spread.
Hepatitis A rarely kills. But "people can get very, very sick. They can wish they were dead," Thorburn said.
So far this year, there have been more than 100 confirmed cases of hepatitis A in Spokane County. For every confirmed case, there probably are 10 others who think they have the flu, Thorburn said.
Last year, there were eight confirmed cases.
A majority of this year's cases involve people who live in the Spokane Valley and northeast Spokane, Thorburn said. About a third of the cases are IV drug users, and a good many involve people who recently spent time in jail, although the infection doesn't seem to be spreading among inmates.
Unlike AIDS and hepatitis B, hepatitis A isn't spread through needles. But people who use needles "are high on drugs and not meticulous about hand-washing," Thorburn said. In such cases, the infection could be spread through shared food or cigarettes, she said.
Inoculating jail inmates would be an easy way to catch a large number of people who are at risk for the infection, she said.
Despite the recent Spokane statistics, health officials say most hepatitis A outbreaks in the United States are caused by poor sanitation among food servers.
Early this month, health officials warned patrons of the Sunset Junction restaurant, 1801 W. Sunset Blvd., that a worker there was infected. Another confirmed case involved a worker who served food at a Nov. 8 event at Spokane Valley United Methodist Church.
A worker at Gloria's Steak House in Prichard, Idaho, also was diagnosed with hepatitis A this month.
Stuart Ellison, president of the Spokane Restaurant and Hospitality Association, said restaurants do everything they can to prevent hepatitis A outbreaks, if for no other reason than to prevent bad publicity.
Paying for shots would be "a huge burden," particularly for small restaurants and those with lots of employees, said Ellison, manager of Saks Family Restaurants. Still, he said, owners would not take lightly a recommendation from Thorburn.
"Obviously, everybody's first concern would be the health of the public," he said.
