Hepatitis A Lawyer & Attorney : Marler Clark : Hepatitis A Blog

The Milan McDonald’s in Rock County, IL is doing normal business again, while health officials continue to clean up the Hepatitis A problem.

Another confirmed case of Hepatitis A brings the count for the outbreak to 26. Free inoculation clinics in Rock County handed out 5,366 does of either the Hepatitis A vaccine or immune globulin. 

Two restaurant employees may have exposed an estimated 10,000 customers of the Milan McDonald’s to Hepatitis A. Located just off I-284, many Milan McDonald’s customers were probably travelers just passing through the Quad Cities.

The latest victim in the outbreak lives in Henry County, IL, just one county east of the bi-state Quad Cities area.

There 15 confirmed cases in Rock Island County, five in Mercer County, two in Henry County, and one each in Warren and Woodford counties, all in Illinois, as well as two cases in Scott County, Iowa. All the cases are part of the outbreak connected to the Milan McDonald’s.

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If confession is good for the soul, Trinity Medical Center’s Vice President for Hospital Operations Kathy Cunningham must be feeling better tonight.

On behalf of hospital, she stepped forward today to admit Trinity dropped the ball in not reporting a June Hepatitis A case to the Rock Island County Health Department within 24 hours as required by Illinois state law.

Timely reporting of that case might have prevented the Hepatitis A outbreak now surrounding the Milan, IL McDonald’s, which potentially exposed 10,000 people to the virus.   To date, there have been 23 confirmed cases of Hepatitis A in the two-state Quad Cities metro area where Milan is located.

Cunningham told the media today the Rock Island County Health Department called Trinity on Monday, July 13^th, about the June case but the hospital was not able to locate any information about it. 

What they could not find was the record of the June 16^th positive test result for McDonald’s employee Cheryl Scram. In the current outbreak, she is “Patient Zero.”

The Trinity investigation found the hospital failed to timely report both the June case and three others in July. “It is with genuine regret we share the information that our process of reporting was not within the required time frame because patient safety is a number one priority for us,” Cunningham said.

Hepatitis A cases must be reported “as soon as possible, within 24 hours.” Anyone with Hepatitis A “shall not work as food handlers or in sensitive occupations during the period when infection control precautions apply.”

The Illinois National Electronic Disease Surveillance System (I-NEDSS), a web-based system, for reporting, and other electronic means can also be used. However, it appears Trinity mailed the June report to the Rock Island Health Department where it went un-opened. 

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The Hepatitis A outbreak associated with the McDonald’s in Milan, IL today is up to 23 confirmed cases, including two employees of the fast-food restaurant. 

Two new cases from Scott County, IA, which like Rock County, IL is part of the two-state Quad Cities region. All others known to be stricken with Hepatitis A are from the Illinois side of the Mississippi River.

The Rock Island Health Department later today is expected to provide more information on the dates the various Hepatitis A cases were reported to health officials.

There have been numerous questions surrounding those dates because in the final analysis, the Milan McDonald’s Hepatitis A outbreak is not simply about who is lying or who is inept in this single instance.   It is about whether the public health system for reporting and managing communicable diseases really works.

Like other states, Illinois requires all health care providers to notify local health authorities whenever they come across certain “reportable diseases”

In Illinois, the overall reporting requirements are found in Section 690.200 of the Public Health Code. Specific provisions for Hepatitis A are found in Section 690.450.

Interestingly, Hepatitis A cases must be reported “as soon as possible, within 24 hours.” Anyone with Hepatitis A “shall not work as food handlers or in sensitive occupations during the period when infection control precautions apply.”

In addition to a long list of health care providers who must report, under the Illinois code “any other person having knowledge of a known or suspected case or carrier of a reportable communicable disease or communicable disease death” is also legally obliged to report it.

How might these legal requirements apply to the facts on some key dates that are now critical to the Milan McDonald’s Hepatitis A outbreak?

June 16, 2009 – McDonald’s Employee Cheryl Schram learns from Trinity Medical Center in Rock Island, IL that she has tested positive for Hepatitis A.

June 25, 2009 – Cheryl Schram visits Milan McDonald’s and informs a manager known only as “Michelle” of her Hepatitis A status.   This is confirmed by at least one witness.

July 10, 2009 – Multiple cases of Hepatitis A reported to both county and state health officials.

July 13, 2009 – McDonald’s franchise owner Kevin Murphy says he first learns of the Hepatitis A outbreak from the Rock Island County Health Department.   The Illinois Department of Public Health first learns about the Cheryl Schram case, but does not know she was a food handler for McDonald’s until the next day.

July 15, 2009 – A second McDonald’s employee tests positive for Hepatitis A.

July 16, 2009 – There are 19 confirmed and two suspected cases of Hepatitis A, all involving people who ate at the Milan McDonald’s.

July 18, 2009 – The Rock Island Health Department announces free Hepatitis A vaccination and immune globulin clinics for the following Monday and Tuesday for all those who dined at the Milan McDonalds from July 6-10 and July 13-14, 2009.

July 20-21, 2009 – Of the estimated 10,000 who might have been exposed, about 4,000 take advantage of the vaccinations. The Milan McDonald’s is located just a couple blocks off the Interstate 280 beltway that goes around the Iowa-Illinois Quad Cities.   Thousands who were exposed to Hepatitis A are far down the road by now.

There are obvious questions from all this that do not have answers at this point. Did Trinity Medical Center report within 24 hours on June 16th or 17th that Cheryl Schram had testing positive for Hepatitis A?

If Trinity did so, it probably used the Illinois National Electronic Disease Surveillance System (I-NEDSS), a web-based system.

When, if so, did the Rock Island County Health Department read the report?    It would have included information on the Hep A patient and the attending physician. Finding out more would have required some investigation by the county health department.

Illinois law gives local health departments a lot of power to get investigations done. It requires businesses to cooperate and gives health officials emergency access to records. Finding out fast if someone with Hepatitis A is a food handler is clearly a major goal in the code.

How about the Milan McDonald’s manager who learned on June 25 that one of her employees, who she knew was recently released from the hospital, and now learns of the Hepatitis A diagnosis?

Illinois law obligates “any other person having knowledge of a known or suspected case… to contact local health officials that license restaurants to operate. The number is usually on the license on the wall by the phone. 

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A class action lawsuit was filed today in the Circuit Court of the Fourteenth Judicial Circuit of Rock Island County against McDonald’s Inc., and Kevin Murphy, the owner of the McDonald’s restaurant at 400 West First Street in Milan, Illinois. Marler Clark, the Seattle-based foodborne illness law firm, and the Illinois firm of Foote, Meyers, Mielke & Flowers LLC, filed the lawsuit on behalf of the named plaintiff, Cody Patterson, and all others who were forced to receive Immune globulin (IG) shots after being exposed to the hepatitis A virus (HAV) at the Milan McDonald’s.

An estimated 10,000 people were exposed to Hepatitis A at the Milan McDonald’s. If a person exposed to HAV can get a shot of IG within 14 days of exposure, they can avoid getting sick.

“This lawsuit is on behalf of the thousands of people who have to get IG shots because of exposure to Hepatitis A at McDonald's,” said William Marler, attorney on behalf of the plaintiffs. “These consumers chose McDonald’s in part because of the convenience, and now they have to wait hours in line or pay for a shot, and very likely miss work in order to do either one. Filing a class action suit on their behalf is a way to compensate them for the time, wage loss, and expense.”

“Our experience in handling large Hepatitis A exposures has allowed us to develop a system for helping as many people as possible recover for injuries sustained without the process being too taxing on individuals or the legal system,” continued Marler. “We filed a class action on behalf of the exposed who are able to avoid infection, and then help individuals who fall ill on a case by case basis.”

In 2007, Marler Clark represented members of a class action arising out of a hepatitis A outbreak at a Houlihan’s in Southern Illinois, where 3000 people received IG shots. Marler Clark represented 9000 people who received shots after a 2003 outbreak at a Pennsylvania Chi-Chi’s along with nearly 100 who became ill with HAV. The case of one individual resolved for $6,250,000. The firm also represented the state of Pennsylvania in recovering the cost of the investigation of the outbreak.

Marler Clark represented customers of Boston-area Quizno’s and Friendly’s Restaurant, both of which had HAV outbreaks in 2004. Additional HAV class action suits handled by Marler Clark include over 1,500 people who received shots after an HAV outbreak at D’Angeleo’s Deli in Massachusetts (2001) and 1,400 people after exposure at a Carl’s Jr. in Spokane, Washington (2000). Marler Clark has represented many victims who were unable to avoid infection and fell ill with HAV including suits against McDonald's, Subway and Taco Bell. The most recent group of cases involved those sickened at a San Diego-area Chipotle Grill in 2008.

Hepatitis A is a viral infection of the liver. The hepatitis A virus is commonly spread through the fecal-oral route, and symptoms include nausea, abdominal cramping, fatigue, and fever. In young children these symptoms can appear flu-like, but in some cases do not appear at all. Symptoms most often begin two to six weeks after exposure and can last several weeks. Preventative treatment (the IG shot) is only effective when administered within 14 days of exposure to the virus, after 14 days there is no treatment.

ABOUT MARLER CLARK: William Marler has been a major force in food safety policy in the United States and abroad. His food safety blog, Marler Blog, is read by over 1,000,000 people around the world every year. He and his partners at Marler Clark have represented thousands of individuals in claims against food companies whose contaminated products have caused serious injury and death. His advocacy for better food regulation has led to invitations to address local, national, and international gatherings on food safety, including recent testimony to US Congress Committee on Energy and Commerce. In 1998, Mr. Marler formed the not for profit, Outbreak Inc. He spends much of the year speaking on how to prevent foodborne illnesses.

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The chairman of the Rock Island County Board is calling for Sheriff Michael T. Huff to investigate the Hepatitis A outbreak linked to the McDonald's in Milan, IL. Democrat

Jim Bohnsack, who chairs the 25-member County Board, told the local News 8 that public health and tax dollars at stake, he wants to know whether the outbreak could have been avoided and who's at fault.

State budget cuts, according to Bohnsack, forced Rock Island County to cut two health department positions last month. He said he does not think the staff cuts have impacted how the county health department has handled the current outbreak.

With thousands of people are lining up in Rock Island County to receive Immunoglobulin (IG or Immune Globulin or Gamma Globulin) shots, the call for the sheriff to investigate should not come as a surprise.

"If our investigation shows the way I think I it's gonna be, McDonalds has got to be on the hook for that kind of money for all that expense that we've got", said Bohnsack.

IG is pooled/plasma-containing antibodies against a number of diseases like measles, rubella, varicella, and Hepatitis A. For protection against Hepatitis A after exposure, it must be given within two weeks of exposure and should be given concurrently with Hepatitis A to develop active immunity. A second dose of Hepatitis A is required six months later.

As many as 20 people have now been infected with Hep A due to their apparent association with the Milan McDonald's. The fast food outlet was apparently told by an employee in early June that she had been hospitalized for Hep A and the Milan McDonald's performed poorly in county health inspections conducted in April and July.

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Thank goodness for what is left of a free press. If not for the Quad-City Times and KWQC, the folks of Rock Island County would not know the following about the Hepatitis A outbreak:

From KWQC - Hepatitis A Outbreak Latest

• Rock Island County now has 14 with Hepatitis A. That brings the total number to 20 cases, with 11 people being hospitalized.
• Two workers at the Milan McDonald's tested positive for Hepatitis A butthose tests came back a month ago.
• Even though the first case was confirmed back in mid-June, the Rock Island County Health Department didn't close the McDonald's until this past Wednesday.
• The health department now says it didn't respond back then because it didn't know back then. The health department says it didn't find out about the case on June 9th until July 10th, a month later because the provider who diagnosed a Milan McDonald's employee with Hepatitis A back on June 9th did not report that case as required. As a result, another month went by before steps could be taken.
• The Health Department says in addition to the two confirmed cases at the Milan McDonalds, there are also confirmed Hepatitis A cases involving other local businesses.

From the Quad-City Times - Rock Island County to set up hepatitis A vaccination clinic Monday, Tuesday

• The Rock Island County Health Department will offer vaccination clinics Monday and Tuesday at Rock Island High School for those people who dined at a Milan, Ill., McDonald's restaurant connected to a recent hepatitis A outbreak. The clinics will be from 10 a.m. to 6 p.m. Hepatitis A vaccine will be given to people ages 1-40, while immune globulin will be administered to people under 1 year of age or over 40 years of age. Eligible recipients of the vaccines are those who consumed food or beverages at the Milan McDonald's from July 6-10 and July 13-14.
• If a person receives the vaccine or immune globulin more than 14 days after they have eaten at the Milan McDonald's, it might not provide protection.
• The county has procured enough Hepatitis A vaccine and immune globulin to vaccinate between 5,000 and 10,000 people who may have dined at the restaurant during the specified time periods.

So, there has been Hepatitis A at McDonalds since at least late May (ill worker diagnosed July 9 would have been infectious weeks earlier).  And, that working likely infected the other worker and customers over weeks.

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Local health departments continue to confirm 19 cases across Rock Island, Henry, Mercer and Woodford Counties. And those related to victims of the outbreak are starting to get vaccinated. According to QUAD TV, one family is struggling:

The Harts visited the Rock Island County health Department for their first shot in a series to combat Hepatitis A. Their son, Dylan, is infected with the disease. Angela Hart describes his symptoms, "He got a fever, thought it was just the flu, laid around didn't eat or drink much then his eyes were yellow so I took him to the doctor."

Her husband Shawn explains why they are frustrated, "11 year-old healthy boy then all of a sudden it's like somebody flipped a switch." Dylan Hart is not the only one. And as a precaution this McDonalds in Milan shut its doors and cleaned after the Rock Island County Health Department told them of their concerns. Shawn Hart, "I'm just hoping for the best, I hope he gets better and hopefully they find out where it came from and take care of it so nobody else has to go through it."

Angela Hart is angry, "They don't think about washing their hands and what it could do and now my baby is sick because someone didn't wash their hands."

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SPRINGFIELD, Ill. – Dr. Damon T. Arnold, state public health director, is reminding people of the importance of proper hand hygiene after reports of 11 confirmed and two suspected cases of hepatitis A were reported in residents living in Henry, Mercer and Rock Island counties. The Illinois Department of Public Health (IDPH), along with local health departments, is investigating to determine the source of the illness as quickly as possible.

“Hepatitis A is a virus that can be carried on the hands of an infected person who does not wash his or her hands thoroughly after using the bathroom. You can become infected by direct contact with a person who does not practice good hygiene or by consuming food or drink handled by an infected person,” said Dr. Arnold. “Your best defense against getting ill is to properly wash your hands –use soap and warm water and rub your hands for 20 seconds.”

Hepatitis A can also be spread in child day-care settings, especially if good hygiene is not practiced after changing diapers. It also is due to the close personal contact among children, who are still learning to practice proper hygiene.

Symptoms of hepatitis A include fatigue, poor appetite, abdominal pain, vomiting and sometimes fever. Urine may become darker and jaundice may then appear. Symptoms can appear from 15 to 50 days after exposure. If you have these symptoms, contact your doctor or a medical professional.

The infectious period begins about one week before the onset of symptoms if there is no jaundice (a yellowing of the skin and whites of the eyes). If jaundice occurs, the infectious period begins two weeks prior to that and last until seven days after the onset of jaundice. Because of the delay in symptoms, a person can transmit the virus without realizing it.

Along with proper hand washing, those who work in food service, health care or in occupations where hepatitis A may be spread, should not work while infectious. Those who have close contact with someone who is ill with hepatitis A should contact their physician about vaccination.

The disease is rarely fatal, and most people recover in a few weeks without any complications. Infants and young children tend to have very mild or no symptoms and are less likely to develop jaundice than are older children and adults. Not everyone infected with the virus will have all of the symptoms. There are no long-term effects. Once an individual recovers from hepatitis A, he or she is immune for life and does not continue to carry the virus. People experiencing symptoms should contact their physician. Physicians are reminded that confirmed or suspected hepatitis A is a reportable condition.

The Illinois Department of Public Health is continuing to investigate the source but reminds residents of the importance of proper hand washing for food service, day-care, and health care workers.

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The McDonalds in Milan, IL is closed and at the center of an investigation into a possible Hepatitis A outbreak.

It may be linked to either a customer or employee of the fast-food restaurant.

There were 19 confirmed cases of Hepatitis A reported in the area by Thursday afternoon that appear related to the McDonalds.

Rock Island County, where Milan is located, had the most with 13 cases. Six more were reported in in Henry, Mercer, Warren and Woodford Counties.

The mother of one McDonalds employee was upset by the news.
"I'm concerned for the public's welfare as well as my child," she said. Her daughter worked from 11-5 on Wednesday.

She accompanied her daughter to the Rock Island County Health Department. That's where employees are being screened for Hepatitis-A. "Hepatitis is a serious illness," she said. "It needs to be addressed, and I think they waited too long."

Theresa Foes, Rock Island County Health Department, said the investigation is underway, but does not yet have all the answers.

Hepatitis A is one of five human hepatitis viruses (hepatitis A, B, C, D, and E) that primarily infect the liver and cause illness. An estimated 80,000 cases occur each year in the U.S., although much higher estimates have been proposed based on mathematical modeling of the past incidence of infection.

Each year, an estimated 100 persons die as a result of acute liver failure in the U.S. due to hepatitis A, but the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

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Illinois health officials are reminding parents  they should get hepatitis A protection for their children.

The rate of child immunizations for hepatitis A is increasing, almost doubling nationally from 26 percent in 2006 to 47 percent in 2007.

The increase was attributed to the Advisory Committee on Immunization Practices in 2006 recommending immunization for all children in the United States - not just areas with high rates of the disease - and lowering its recommended age for the shot from two years to 12 to 23 months.

Hepatitis A is a liver disease caused by ingesting even microscopic amounts of fecal matter in food or other sources.

In Illinois, the immunization rate more than tripled from 12 to 37 percent, while still lagging behind the rest of the country. 

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Kathy Dopp of Safe Tables Our Priority (S.T.O.P.) advocates for a stronger federal food safety bill in hometown newspaper, the Battlecreek Enquirer. In doing so, she tells the story of her daughter's illness after contracting Hepatitis A from Mexican strawberries a decade ago.  Here's part of that story:

A few days later, she was in so much pain she couldn't stop crying as she struggled to keep food down and battle an extremely high fever. When I arrived at the emergency room with Hallie, teachers and other children from school were there with similar symptoms. She was quickly diagnosed with Hepatitis A, but it took several days until a health department investigation found that the strawberries were to blame for her illness and that of 260 other residents of our small Michigan town.

Hallie left the hospital after a week, but the problems didn't end there. She missed school and had to give up soccer and dance. And she faced social stigma when parents wouldn't allow their children to play with her out of fear that she would spread the disease. Her medication caused her to gain weight and she tired so easily that she was unable to play outside with her brother or friends. In many ways, Hallie was robbed of her childhood. She is 20 now, but still copes with a weakened immune system and the emotional effects of what happened.

S.T.O.P. is a national nonprofit organization dedicated to preventing illness and death from foodborne pathogens.  Dopp shares her opinion in the Battle Creek Enquirer.

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Hepatitis E, like Hepatitis A, is a virus that can be spread through food.  It does not get as much attention as Hepatitis A because it is thought to be rare.  But, how that is understood may be changing.

The prestigious Johns Hopkins Bloomberg School of Public Health is out with a study that concludes that exposure to the Hepatitis E Virus (HEV) is fairly common--but disease rarely follows the exposure.

The study found antibodies indicating exposure to HEV in 21 percent of the U.S. population between 1988 and 1994. HEV is a major cause of viral hepatitis in many developing countries, but how it is spread in developed countries is not fully known. The study is published in the July 1 issue of the Journal of Infectious Diseases.

“Our study shows that animals could play an important role in the spread of HEV in the U.S. Having a dog or pet in the home or consuming meats like liver and other organs were significantly associated with increased odds of exposure to HEV,” said lead author Mark H. Kuniholm, PhD, a 2007 graduate of the Bloomberg School of Public Health.

More can be found in the School's press release or by going to the JID site.

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