Vaccine 19 (2001) 2138–2145 The economics of vaccinating restaurant workers against hepatitis A Martin I. Meltzer a, *, Craig N. Shapiro b , Eric E. Mast b , Christine Arcari b a Office of the Director, National Center for Infectious Diseases, Centers for Disease Control and Preention, Mailstop D-59, Atlanta, GA 30333, USA b Hepatitis Branch, Diision of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Preention, Atlanta, GA 30333, USA Received 4 February 2000; received in revised form 26 July 2000; accepted 26 September 2000 Abstract The economics of vaccinating restaurant workers against hepatitis A were studied using Monte Carlo simulation models, one with a restaurant-owner perspective, and one with a societal perspective. The restaurant model allowed for a different size, number of employees and employee turnover rate. Benefits were the avoidance of loss of business (including the possibility of bankruptcy) after publicity linking the restaurant to an outbreak associated with a case of hepatitis A in a food handler. Additional benefits in the societal model included reductions in costs of food handler-associated cases of hepatitis A. The outcome used was Net Present Value (NPV), allowing comparison between models. Regardless of the cost of vaccination ($50 – 140/employee), for a restauranteur to ensure that all employees were vaccinated at all times substantial costs were involved (i.e. negative NPV). Even a 75% probability of bankruptcy still resulted in negative NPVs at the 95th percentiles. For society, vaccination was only cost-saving (i.e. positive NPV) if done only during epidemics and if it cost $20/employee. Vaccinating restaurant employees is unlikely to be economical from either the restaurant owner or the societal perspective, even during hepatitis A epidemics. Published by Elsevier Science Ltd. Keywords: Economics restaurant; Food handlers; Hepatitis A; Vaccination www.elsevier.com/locate/vaccine 1. Introduction Foodborne hepatitis A outbreaks account for less than 10% of reported hepatitis A cases in the United States [1,2]. However, the costs of these outbreaks to food establishments and to society can be substantial. For example, the societal costs of a catering facility-as- sociated hepatitis A outbreak in Denver in 1992 were estimated to be over $800 000, and the company lost an estimated $26 250 in profits due to decreased business as a result of the negative publicity [3]. In addition, public notifications of hepatitis A virus-infected food handlers often involve considerable disease-control costs, due to activities such as administering immune- globulin to patrons. In the Denver outbreak, disease control costs totaled approximately $689 000, about 86% of the total costs [3]. With the availability of hepatitis A vaccine in the United States, routine vaccination of food handlers is a possible strategy to prevent foodborne hepatitis A. The US Public Health Service Advisory Committee on Im- munization Practices (ACIP) currently recommends considering vaccination of food handlers who work in areas where state and local health authorities or private employers determine that such vaccination is cost-effec- tive [4]. However, the economics of this approach have not previously been evaluated. This paper examines the costs and benefits of routinely vaccinating food han- dlers from the perspective of the restaurant owner (who would be expected to pay for part or all of the vaccina- tion), and from society. * Corresponding author. Tel.: +1-404-3715353; fax: +1-404- 3715445. E-mail address: qzm4@cdc.gov (M.I. Meltzer). 0264-410X/01/$ - see front matter Published by Elsevier Science Ltd. PII:S0264-410X(00)00396-0