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Craig B. Dalton, BMed, MMSc; Anne Haddix, PhD; Richard E. Hoffman, MD, MPH; Eric E. Mast, MD, MPH

Arch Intern Med. 1996;156(9):1013-1016.

Abstract
Background
In 1992, a food-borne outbreak of hepatitis A associated with a catering facility in Denver, Colo, resulted in 43 secondary cases of hepatitis A and the potential exposure of approximately 5000 patrons.

Objectives
To assess (1) disease control costs, including state and local health department personnel costs, provision and administration of immune globulin, and cost of extra hepatitis A serologic tests performed; (2) business losses; and (3) cost of the cases' illnesses.

Methods
Cost data were collected from hospitals, health maintenance organizations, health departments, laboratories, the caterer's insurance company, and the catering facility involved in the outbreak.

Results
The total costs assessed in the outbreak from a societal perspective were $809 706. Disease control costs were $689 314, which included $450 397 for 16 293 immune globulin injections and $105 699 for 2777 hours of health department personnel time. The cases' medical costs were $46 064, or 7% of the disease control costs.

Conclusions
The cases' medical costs and productivity losses were only a minor component of the total cost of this outbreak. The high cost of food-borne outbreaks should be taken into account in economic analyses of the vaccination of food handlers with inactivated hepatitis A vaccine.

(Arch Intern Med. 1996;156:1013-1016)

Author Affiliations
From the Colorado Department of Public Health and Environment, Denver (Drs Dalton and Hoffman); Epidemic Intelligence Service, Division of Field Epidemiology (Dr Dalton) and Prevention Effectiveness Activity (Dr Haddix), Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga; and Hepatitis Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention (Dr Mast). Dr Dalton is now with the Field Epidemiology Training Program, National Centre for Epidemiology and Population Health, Australian National University, Canberra.

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