Hepatitis scare pains restaurants in Tennessee
Uncertain of source of outbreak, customers stay away
By DAVID WAHLBERG
The Atlanta Journal-Constitution
4/22/05
LAFOLLETTE, Tenn. -- Most days, the adobe-styled El Pueblito Mexican Grill in this mountain town about 35 miles north of Knoxville is packed at lunchtime.
On Thursday, the crowd shortly after noon was slim.
But even that was better than last weekend, when hardly anybody showed up, said Mario Ruiz, assistant manager.
"Everybody is afraid to eat in this city," he said, blaming it on the hepatitis A scare.
The viral liver disease, often serious and occasionally fatal, has sickened 17 local residents in recent weeks. That includes a waitress at a Waffle House off I-75 in Clinton, about 20 miles south of LaFollette. Authorities say she may have exposed as many as 7,000patrons this month during the busy spring break road-trip season.
Tennessee health officials and the Centers for Disease Control and Prevention have alerted officials in other states to be on the lookout for hepatitis cases among travelers who stopped at the Waffle House. Unusual increases in cases of hepatitis A, among the diseases that states are required to report to the CDC, could be tracked by the agency's disease surveillance system.
Health officials believe the most likely source is a restaurant in LaFollette. But they have refused to name it, citing three reasons: They are not certain the eatery is the culprit, exposure there likely ended weeks ago and nothing can be done preventively for people who ate there then.
The restaurant's employees are being tested and if any results come back positive for recent infection, Dr. Paul Erwin, director of the East Tennessee Regional Health Office, said he would identify the facility.
Hepatitis A, which can be spread by food contaminated with infected feces, usually causes no symptoms until a month after exposure. In 2003, there were 7,653 cases reported nationally; the CDC estimates there were 33,000 actual cases that year.
For Ruiz and the other operators of the three dozen or so restaurants and fast-food outletsin this town of 7,000 people, the uncertainty and suspicion have taken a major toll -- in his case, a 60 percent drop in business.
"Usually these are full," Ruiz said, pointing to a room of 20 colorful tables, five of which were occupied. "I hope it gets better next week."
Residents also are upset. "Why don't they tell us which place it is? I think we have a right to know," said 61-year-old Cliff Caddell, as he ordered eggs and hash browns at the Old Country Kitchen, a diner he frequents.
Diner owner Judy Baird said hers is not the establishment targeted by health officials. Ruiz said El Pueblito also has been cleared; he put a sign out front saying so, which helped revive business a bit.
Erwin said he understands the community's concern -- and the national implications now that a Waffle House off a busy interstate is involved. "If we believed there was a public health benefit from disclosure, we would do it," he said.
Thirteen of the 17 hepatitis patients say they ate at the same restaurant but Erwin said none of its workers has tested positive for the disease so far. Additional results are expected today.
Injections of protective immune globulin have been given to more than 1,200people so far. Atlanta-based Waffle House estimates 7,000 people ate at the restaurant between April 1-15, when the sick waitress was working. The shots would still be effective for people exposed since April 5; Waffle House says 5,000 people ate at the restaurant April 5-15.
No Waffle House patrons have become sick, but health officials say it is too early for any April cases to have developed.
Instances of workers with hepatitis A at busy restaurants along freeways occur "a couple times a year," said Dr. Anthony Fiore, a CDC hepatitis specialist. He said immune globulin shots are sometimes offered but not always. The worker cases have rarely caused known outbreaks among customers, he said.
