On July 13, 2009, Rock Island County Health Department officials informed the McDonald’s corporate office that a McDonald’s franchise in Milan, Illinois had an employee infected with hepatitis A. The employee had been working at that restaurant over the past week. The next day, health officials went to the Milan McDonald’s and found that employees were washing their hands improperly and should have been wearing gloves when they had cuts, painted nails, or fake nails. The inspector provided the employees material about proper hand washing and hepatitis A.
On July 15, health officials returned for a full inspection. The inspection detailed a laundry list of violations, two of them critical, involving “hygienic practices” and “presence of insects/rodents.” It was also reported that after the first employee was confirmed positive with hepatitis A on June 9, another employee had been confirmed positive with hepatitis A on July 15. As a result, the Milan McDonald’s was ordered to close until all employees completed health histories, got vaccinated, and completed hand-washing training.
Though it was initially believed that the employee infections were not detected until July 13, evidence later surfaced suggesting otherwise. The second employee who contracted hepatitis A, Cheryl Schram, had been diagnosed on June 20 and told the restaurant a few days later, once she had been released from the hospital. Despite the highly contagious nature of her illness, she was permitted to return to work.
During the period when the infected employees had been allowed to work and handle food, it was estimated that as many as 10,000 people ate at that restaurant. This led to county health officials inoculating more than 5,000 local residents against the disease in order to contain the outbreak. Unfortunately, the damage had already been done and those infected were beginning to exhibit symptoms.
The Illinois Department of Public Health (IDPH) released a report of its investigation into the Hepatitis A outbreak on October 30, 2009. IDPH reported a final tally of 34 confirmed cases of Hepatitis-A with onsets from June 11 through August 10, 2009. IDPH concluded that food from the Milan McDonald’s was the source of the outbreak. IDPH explained:
The restaurant had inspection reports indicating issues with bare hand contact with food, employees reported no use of gloves when preparing foods not later cooked, during hand hygiene education the employees had difficulty in properly washing hands, and the index case in the community, a food handler at McDonalds, had a period of communicability and work history that match with the dates of onset of the majority of the other cases and she handed food that was not later cooked with bare hands. In addition, the case-control study showed that there was an elevated risk of hepatitis A associated with consuming food from the McDonalds in Milan, Illinois. Other possible sources in the community were ruled out.