Does hepatitis patient belong in restaurant?

DEAR DR. GOTT: Should a person with hepatitis be a restaurant cook? Is there any danger to the customers?

DEAR READER: Hepatitis refers to inflammation of the liver and to a group of viral infections that affect the liver. There are actually five types: A, B, C, D and E.

A is contracted from the hepatitis A virus. It is spread through the ingestion of food or drink contaminated by infected feces. This is one reason why it is mandated that employees in the food industry wash their hands following a visit to the lavatory during their work shift.

B is contracted from people infected with the hepatitis B virus. The highest concentrations are found in blood. While lower concentrations are spread through bodily fluids such as found in open, oozing wounds, vaginal secretions and semen.

C is most commonly transmitted through contaminated blood and not generally through sexual contact. Contaminated needles for body piercing or tattoos and blood transfusions received prior to 1992 are often to blame. Prior to 1992, advanced screening tests were not available; however, since then, infection through transfusion has been obliterated. Other common issues that could cause infection include alcohol, drug or autoimmune-induced hepatitis, people in the health care field who could inadvertently be exposed to infected blood, people with hemophilia (a blood-clotting disorder) and those on hemodialysis because of kidney failure. C is considered to be the most serious of the hepatitis viruses, so I will go into more depth, assuming this is the type of infection to which you refer.

Most people with early-stage C are unaware they have a problem because there are no symptoms. When symptoms do occur, they can be mild and are often attributed to other causes. A person may have muscle and joint pain, poor appetite, tenderness in the area of the liver and fatigue. As the disease progresses, the most common telltale symptoms are low-grade fever and jaundice (yellowing of the skin and eyes).

Diagnosis is typically made accidentally when a physician orders routine blood work as part of a complete examination. If a problem is suspected, testing may include laboratory work or liver biopsy. While a biopsy isn't vital, it can confirm the severity of the disease and will likely have a bearing on the treatment provided. A positive diagnosis for C doesn't necessarily indicate a person will require treatment. For example, a physician may choose to withhold treatment if only minor liver irregularities are noted.

Standard treatment for C is weekly injections in combination with oral medication taken twice each day for an extended period of time, usually 24 to 48 weeks, depending on the type.

D is transmitted through infected blood and mucosal or percutaneous contact and is found only in people who carry the hepatitis B virus. It is uncommon in the United States.

E is transmitted through the ingestion of fecal matter and is common in countries that have poor sanitation and contaminated water supplies.

Vaccination for A and B are available; however, there is no effective vaccine at this stage for C. Home remedies and lifestyle changes include avoiding any medication that has the potential for liver damage, avoiding illegal-drug use, needle sharing, tattooing and body piercing.

Finally, to answer your question, it depends what type of hepatitis you are referring to, whether the person has been treated and whether he or she takes all possible precautions to prevent exposure. There are precautions and regulations in the food industry to prevent contamination. If you are concerned, speak with your regional public-health office to find out what your area's restrictions are.

Dr. Peter H. Gott is a retired physician and the author of several books, including "Live Longer, Live Better," "Dr. Gott's No Flour, No Sugar Diet" and "Dr. Gott's No Flour, No Sugar Cookbook," which are available at most bookstores or online. His website is www.AskDrGottMD.com. Copyright 2010, United Feature Syndicate Inc.