Outbreaks of hepatitis A, Norwalk illness, and nonspecific viral gastroenteritis are associated with consumption of sewage-contaminated shellfish. Over 100 outbreaks have been reported in the United States during the past 50 years. Reported cases of shellfish-associated enteric virus illness are on the increase, whereas bacterial illness from shellfish is on the decline. As yet, there are no procedures for detecting hepatitis A virus, Norwalk virus and numerous other pathogenic viruses in environmental samples, but virus extraction and assay procedures for water and shellfish are available for the more easily cultivated enteric viruses. Current standards rely on bacterial indicators as a means to evaluate the sanitary quality of shellfish and their growing waters, but the adequacy of using bacteria as indicators of possible virus contamination is questionable. The feasibility of employing enteroviruses or rotaviruses as possible viral indiators is discussed. It is proposed that easily cultivated enteroviruses, such as poliovirus, be used as an interim indicator for the possible presence of human pathogenic viruses in seafoods, with the subsequent formulation of guidelines to limit the levels of virus contamination in shellfish.
PGI4 PREVALENCE AND INCIDENCE OF HEPATITIS A IN A UNITED STATES MANAGED CARE CLAIMS DATABASE
