The decision to give immune globulin to all of the personal contacts and all of the patrons who may have been exposed to an infected food handler should not be taken lightly. Organizing an IG clinic is difficult, time consuming, very costly, and consumes large quantities of immune globulin, which is a precious resource. The decision depends on a judgment regarding the likelihood of exposure to patrons.
If you were convinced that Anna B. followed proper food handling and hygienic procedures, an IG clinic would not be justified, even if she were infected. However, since Anna B. did not follow procedures, the results of her blood tests are important in decision making. Since she was positive for IgM anti-HAV (indicating that she had hepatitis), an IG clinic is clearly warranted, but if her blood tests had been negative, an Ig clinic would not be necessary.
The results of her blood tests are important to decision making here, but what if she had refused give a blood sample?
She can't be forced to provide a blood specimen, but she can be excluded from work.
The course of action is critically dependent on an assessment of whether the situation presents an "imminent health hazard."
Alfred DeMaria, Jr., MD
Chief Medical Officer and State Epidemiologist, Massachusetts Department of Public Health
Listen to Al DeMaria's comments by clicking on his picture.