First published in Honolulu Star-Advertiser. In a state dependent on tourism, food service workers should be vaccinated against Hepatitis A. My bet is Baskins-Robbins, Sushi Shiono, Taco Bell, Costco, Chili’s, Hawaiian Airlines and Tamashiro Market would now agree. According to the Hawaii Department of Health (HDOH), employees at Baskins-Robbins, Sushi Shiono, Taco Bell, Costco, Chili’s, Hawaiian Airlines and Tamashiro Market — have been diagnosed with hepatitis A. These restaurants and airline are NOT the source of the 135 people sickened with the as-yet-unsolved hepatitis A outbreak sweeping the island of Oahu — they are seven of the victims. However, because those food service workers worked while likely contagious, the HDOH is urging “all persons who have consumed food or drink products from these businesses during the identified dates of service should contact their healthcare provider for advice and possible preventive care” – a hepatitis A vaccine. Hepatitis A is a communicable disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact (the customer ingests feces of the worker), generally from person-to-person, or via contaminated food or water. Hepatitis A is the only foodborne illness that is vaccine-preventable. The Centers for Disease Control and Prevention (CDC) estimates that 83,000 cases of hepatitis A occur in the United States every year, and that many of these cases are related to food-borne transmission. In 1999, more than 10,000 people were hospitalized due to hepatitis A infection, and 83 people died. As more children have been vaccinated for hepatitis A as part of routine vaccination, those overall numbers have fallen. However, hardly a month passes without a warning from a health department somewhere that an infected food handler is the source of yet another potential hepatitis A outbreak. Absent vaccinations of food handlers, combined with an effective and rigorous hand-washing policy, there will continue to be more hepatitis A scares and outbreaks. And, in a state like Hawaii that is dependent on tourism, the impact can be even more concerning. Although CDC has not yet called for mandatory vaccination of food-service workers, it has repeatedly pointed out that the consumption of worker-contaminated food is a major cause of foodborne illness in the U.S. Vaccinations cost about $50. The major economic excuse that these preventive shots have not been used is because of the high turnover rate of food-service employees. According to CDC, the costs associated with hepatitis A are substantial. Between 11 percent and 22 percent of persons who have hepatitis A are hospitalized. Adults who become ill lose an average of 27 days of work. Health departments incur substantial costs in providing post-exposure vaccines to an average of 11 contacts per case. Average costs (direct and indirect) of hepatitis A range from $1,817 to $2,459 per case for adults and from $433 to $1,492 per case for children younger than 18. A CDC report shows that, in 2010, slightly more than 10 percent of people between ages 19 and 49 got a hepatitis A shot. If the food service industry will not step up to protect its customers (and itself), it is time for health departments to require vaccinations of food-service workers, especially those who serve the very young, the elderly and immune-compromised. It is moral to protect customers from an illness that can cause serious illness and death. Vaccines also protect businesses from the multimillion-dollar fallout that can come if people become ill or if thousands are forced to stand in line to be vaccinated to prevent a more serious problem. Vaccinating employees make sense — especially in a state so dependent on tourism. It is time to step up.