Hepatitis A vaccine will be provided at the Vanderburgh County Health Department at 420 Mulberry Street Saturday May 12 through Thursday, May 17, 2012 from 10:00 a.m. to 6:00 p.m. each day including Sunday. Those who have symptoms of illness should not attend the clinics but should seek immediate medical attention.

Symptoms of Hepatitis A include fever, fatigue, loss of appetite, nausea, vomiting, stomach pain, pale colored stools, and dark urine. Jaundice, a yellowing of the skin and eyes, may occur a few days after symptoms appear.

Persons MUST receive the vaccine within 14 days of exposure for the vaccine to be effective. Persons presenting for vaccine 14 or more days after exposure will not be vaccinated and instructed to seek medical care if they develop symptoms.

Anyone who ate or drank at the Lone Star between April 30, 2012 and May 3, 2012 may have been exposed and at risk of developing Hepatitis A. Persons who are fully vaccinated against Hepatitis A or have a previous history of Hepatitis A disease are considered protected from disease and not at risk.

The following chart shows the last day to be vaccinated for each day in question.

Date Food/drink Consumed from Evansville Lone Star - Last Day to Be Vaccinated

Monday, April 30, 2012 - Monday, May 14, 2012

Tuesday, May 01, 2012 - Tuesday, May 15, 2012

Wednesday, May 02, 2012 - Wednesday, May 16, 2012

Thursday, May 03, 2012 - Thursday, May 17, 2012

Persons who ate or drank at the Lone Star from April 20-April 29 could also get Hepatitis A, but should not receive vaccine because it is considered to be ineffective for exposure past 14 days. Those people should seek medical care if they show symptoms of Hepatitis A.

For more information, go to www.vanderburghgov.org/health and click on the Hepatitis button,

E-mail health@vanderburghgov.org, or call the Department at 435-2400 and select option 1.

The clinic at 1235 Ramsey St. will be 9 a.m. to 11 a.m. for those who worked or dined at the North MacPherson Church Road restaurant on July 31. The clinic will resume normal hours Monday from 8 a.m. to 5 p.m. for those who ate there Aug. 1, 2 or 8.

Fort Bragg officials have also set up on-post screening clinics for soldiers and their families who may have been exposed to hepatitis A.

The vaccine is effective only within 14 days of infection. Those who dined or worked at the Olive Garden prior to July 31 should watch for signs of the illness and contact a doctor if they get sick.

Hepatitis A is a communicable (or contagious) disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Food contaminated with the virus is the most common vehicle transmitting hepatitis A. The food preparer or cook is the individual most often contaminating the food, although he or she is generally not ill at the time of food preparation. The peak time of infectivity, when the most viruses are present in the stool of an infectious individual, is during the two weeks before illness begins. Although only a small percentage of hepatitis A infections are associated with foodborne transmission, foodborne outbreaks have been increasingly implicated as a significant source of hepatitis A infection.

Hepatitis A may also be spread by household contact among families or roommates, sexual contact, ingestion of contaminated water, ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play to family members and other children and adults. We are involved in representing families of children who have suffered from this virus.

• Carl’s Jr. Hepatitis A Outbreak - Washington
• Chi-Chi’s Hepatitis A Outbreak - Pennsylvania
• Chipotle Grill Hepatitis A - San Diego, California
• D’Angelo’s Deli Hepatitis A Outbreak - Massachusetts
• Friendly’s Hepatitis A Exposure - Massachusetts
• Houlihan’s Hepatitis A Exposure - Illinois
• Maple Lawn Dairy Hepatitis A Outbreak - New York
• McDonald’s Hepatitis A Outbreak - Washington
• McDonald’s Hepatitis A Outbreak - Quad-Cities, Illinois
• Quizno’s Hepatitis A Exposure - Massachusetts
• Soleil Produce Hepatitis A Outbreak - California
• Subway Hepatitis A Outbreak - Washington
• Taco Bell Hepatitis A Outbreak - Florida

A judge in Rock Island County Court approved a settlement with the Milan McDonald's, which would give everyone a piece of half a million dollars.

Prosecutors said thousands of people went to the McDonald's in June of 2009, and may have been exposed to Hepatitis A. They said the settlement is meant to pay for the inconvenience of getting the shot and having to miss work.

If you think you should be a part of the class action suit, applications will be accepted at www.milanshotclass.com until September 30th.

The plaintiff, Quad-City area resident Cody Patterson, acting on behalf of himself and others, filed the suit July 21, 2009. It names the McDonald’s at 400 W. 1st St. and the restaurant’s owner, Kevin Murphy, as defendants. Compensation includes the cost of obtaining the shots and the value of lost time required to get the shots. The class does not include claims for those who became ill with the virus or employees of JKLM Inc. The suit claims to represent all of those who may have contracted or have been exposed to the illness while eating at the McDonald’s in June and July. Murphy said in a statement that he didn’t learn until July 13 about hepatitis A affecting the restaurant, his employees and customers. The suit claims Patterson ate food or drank a beverage from the restaurant eight or more times in June and July. It does not detail the extent of his illness.

In July 2009, the Rock Island County Health Department said that people who had dined at the restaurant between June 1 and July 15, 2009, may have been exposed to hepatitis A. The health department recommended that anyone who had eaten at the restaurant between those dates obtain immunoglobulin injections, or IG shots, to prevent hepatitis A.

Patterson is seeking compensation from JKLM Inc. for everyone who allegedly was exposed to the virus and who subsequently obtained the injections at the health department clinic or a private health care provider between July 15 and Aug. 31, 2009. The health department provided free inoculations to people who ate at the restaurant from July 6-10 and July 13-14, 2009. Two employees there were confirmed as having the disease.

If the settlement is approved, the judgment will release JKLM Inc. from all claims for damages caused to all persons allegedly exposed to the hepatitis A virus while dining at the restaurant and who subsequently obtained IG shots.

Spring is here and people who were bundled up in their homes all winter are finally ready to go out into the world, but as the vacation season begins, remembering food and water safety can help prevent painful vacation memories.

Hepatitis A is one of the most vaccine-preventable infections contracted by travelers. Similar to Travelers’ Diarrhea, another common traveler’s illness, Hepatitis A is spread through food and drink that has come in contact with infected people — often from traces of infected feces — who handle food.

Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus (HAV), according to the Mayo Clinic. It causes the liver to inflame, affecting its ability to function. Approximately 10 million people are infected with HAV each year. Symptoms, which often appear between two and six weeks of contraction, can include nausea, abdominal pain, fever, itching and jaundice.

The fatality rate from HAV is generally low, at approximately 0.3 percent. However, in adults older than 50 the fatality rate increased to 1.8 percent.

HAV infections are more common in developing countries, according to the Centers for Disease Control. Community-wide outbreaks are more likely to occur in developed countries.

“In most intermediate and high anti-HAV-endemic countries, many long-term residents are infected as children, at a time when they may not get symptoms,” according to the CDC. “Cases of hepatitis A in the resident population will be very low; however, travelers from low endemic settings such as the United States are at risk for HAV infection and should be protected.”

In 2006, 72 percent of travel-related HAV cases were associated with travels to Mexico and Central and South America, according to the CDC.

To protect against Hepatitis A while traveling:

• Avoid eating raw fruits and vegetables, or wash fresh produce with a vinegar-solution before consuming.

• Avoid raw or undercooked meats and foods, which could have been contaminated during harvesting or preparation.

• Beware of shellfish harvested from sewage-contaminated water.

• Avoid untreated tap water, including ice. Instead, opt for beverages made with boiled water or prepackaged with an intact seal.

• Avoid street-vendor foods, as they could be less regulated.

The best way to prevent HAV is getting a vaccine. In 2006, the HAV was added to the recommended vaccinations for children. The CDC recommends susceptible people traveling to or working in countries with have high or intermediate hepatitis A endemicity should be vaccinated or receive Immunoglobulin before departure. Immunoglobulin (IG) is an injection of plasma already containing the antibody for instant, but temporary protection of HAV.

Avoiding Hepatitis A is a very good idea:

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.

A health department spokesperson said a second dose of the vaccine or Immunoglobulin is recommended by the Centers for Disease Control and Protection, or CDC, six months or more after a first dose to provide the maximum protection available through immunization.

The people who should receive a second dose are those who consumed products originating from the McDonald’s restaurant in Milan, Ill., during July 2009.

The clinics will be 8 a.m. to noon and 1-4:30 p.m. on Thursdays this month: Feb. 4, 11, 18 and 25. They will be held at the Rock Island County Health Department, 2112 25th Ave., Rock Island. The clinics will be held on a walk-in basis, with no appointment needed.

The cost is $30, regardless of one’s county of residence; cash or check only (no debit/credit cards).

The original vaccinations were free because the shots were provided as a public health response to an outbreak and were administered to prevent illness in those possibly exposed to hepatitis A and to control the further spread of the disease. Since the second dose is not part of the outbreak response, there is a moderate charge to cover the cost of the vaccine itself. The department is not charging for administering the shots. The customary fee for a hepatitis vaccination at the health department would be $45.

In July 2009, there were two different injections administered, depending upon the client’s age. People through the age of 40 years received Hepatitis A vaccine. People 41 years and older received Immunoglobulin.

Those who received Immunoglobulin, not a first dose of hepatitis A vaccine, are encouraged to attend one of the Thursday clinics to receive their first dose of the vaccine. A small number of people received their first dose of vaccine from another health-care provider. They are welcome to attend health department clinics.

The first case of hepatitis A in the Quad city area was discovered last June. As we first reported back then, the first confirmed case of the liver illness was an employee at the Milan McDonald's. Over the next two months, a total of 34 confirmed hepatitis A cases were reported.

A state investigation has concluded most of the cases originated at the Milan McDonald's and most of the cases *would have been prevented* if only that one employee had properly washed hands.

The findings of the investigation by the Illinois Department of Public Health concludes "the index case was a food handler at the McDonalds in Milan, Illinois and had onset of illness June 11." Investigators also found "other possible sources in the community were ruled out."

And, "The source of the outbreak for the majority of outbreak cases was food eaten at the McDonalds, Milan, Illinois where a food handler worked while infectious and handled foods that were not later cooked."

The state investigation goes on to say that "if the first employee with hepatitis A had used proper hand-washing technique while working the transmission of hepatitis A through food would not have occurred."

And, "proper hand-washing by the index case would have prevented the majority of the cases in the community. Reporting of the index case by designated reporters before June 25 would have.. reduced the number of cases in the community."

Trinity Medical Center treated some of at least 32 patients who came down with the liver disease in July and August. The Rock Island County Health Department inoculated more than 5,324 area residents against the disease during vaccination clinics held in late July.

An investigation completed in early August by the Rock Island County Sheriff's Department concluded that Trinity Regional Health System and Metropolitan Medical Laboratory did not report cases of hepatitis A as promptly as required by law to the county health department, where the belated reports were not acted upon immediately because an employee was on vacation.

An Alpha, IL couple, Nichole and John Shannon, became the latest to sue McDonald’s and Milan, IL franchise owner Kevin Murphy in Rock Island County Circuit Court late last week. Mrs. Shannon was hospitalized from July 11-17, tested positive for the Hepatitis A virus, and suffered from liver damage, according the lawsuit.

The Milan McDonald’s was closed July15-17 on orders from the Rock Island County Health Department. The department took the action when a second McDonald’s employee was diagnosed with Hepatitis A on July 15.

At least 32 people testing positive for Hepatitis A are now associated in the Milan McDonald’s outbreak.   Counties in both western Illinois and eastern Iowa have contributed to the count. Eighteen of those cases are from Rock Island County where the fast food burger joint is located.

In addition to the injured, 5,324 people who made the mistake of dining at the establishment took advantage of the health department’s offer for free vaccines, which can prevent sickness from occurring after exposure. 

Those exposed to the virus and got shots are part of a class action lawsuit that has also been filed.

The lawsuit is being brought by Karie Fiegel and her 14-year-old daughter, both of whom ate at the Milan McDonald’s in early June, 2009. Hepatitis A Virus (HAV) has an incubation period of 15-50 days, and it was not until early July that Ms. Fiegel fell ill with nausea, vomiting, fever, and jaundice. She sought medical care, but her symptoms only intensified, and she was admitted to the hospital where she remained for three days. In the hospital, tests revealed that she had been infected with HAV. Hepatitis infects the liver, and Ms. Fiegel’s liver enzymes were found to be elevated during her hospitalization. Although she has been released, her liver enzymes remain elevated.

Meanwhile, her daughter also began experiencing symptoms of HAV infection. The teenager was tested and also diagnosed with Hepatitis A.

“There are 30 confirmed cases of HAV,” said William Marler, the family’s attorney. “Given the incubation period of hepatitis A, it’s possible that the outbreak is not over, and we may see additional illnesses. It is very important for anyone who ate at the Milan McDonalds in June to monitor their health—and their family’s heath—very carefully.”

A food worker at the Milan McDonald’s had Hepatitis A, and a series of mistakes exposed as many as 10,000 restaurant patrons to the virus before the restaurant was closed and cleaned (it has since re-opened). A separate class action lawsuit was filed July 21 on behalf of those who had to get Immune Globulin (IG) shots after exposure to HAV at the Milan McDonald’s restaurant. Almost five thousand people have already received shots in mass clinics coordinated by the Rock Island County Health Department. Eligible individuals are still joining the class action suit.

The lawsuit is being brought by Karie Fiegel and her 14-year-old daughter, both of whom ate at the Milan McDonald’s in early June, 2009. Hepatitis A Virus (HAV) has an incubation period of 15-50 days, and it was not until early July that Ms. Fiegel fell ill with nausea, vomiting, fever, and jaundice. She sought medical care, but her symptoms only intensified, and she was admitted to the hospital where she remained for three days. In the hospital, tests revealed that she had been infected with HAV. Hepatitis infects the liver, and Ms. Fiegel’s liver enzymes were found to be elevated during her hospitalization. Although she has been released, her liver enzymes remain elevated.

Meanwhile, her daughter also began experiencing symptoms of HAV infection. The teenager was tested and also diagnosed with Hepatitis A.

“There are 26 confirmed cases of HAV,” said William Marler, the family’s attorney. “Given the incubation period of hepatitis A, it’s possible that the outbreak is not over, and we may see additional illnesses. It is very important for anyone who ate at the Milan McDonalds in June to monitor their health—and their family’s heath—very carefully.”

A food worker at the Milan McDonald’s had Hepatitis A, and a series of mistakes exposed as many as 10,000 restaurant patrons to the virus before the restaurant was closed and cleaned (it has since re-opened). A separate class action lawsuit was filed July 21 on behalf of those who had to get Immune Globulin (IG) shots after exposure to HAV at the Milan McDonald’s restaurant. Almost five thousand people have already received shots in mass clinics coordinated by the Rock Island County Health Department. Eligible individuals are still joining the class action suit.

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.

Investigators from the Pennsylvania Department of Health initiated an investigation immediately and discovered that many, if not all, cases had eaten at Chi Chi’s restaurant in Monaca, Pennsylvania’s Beaver Valley Mall.

Along with the health department, the federal Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) conducted further studies of the outbreak. Preliminary analysis of a case-control study suggested that green onions were the probable source of the outbreak.

The onions had been shipped to the restaurant in boxes and were stored and refrigerated in buckets of ice. They were eventually chopped up and served in various dishes at the restaurant, often uncooked, as in the preparation of mild salsa.

“Preliminary trace-back information indicated that the green onions supplied to Chi Chi’s had been grown in Mexico.” Ultimately, over 650 people were sickened in the outbreak. The victims included at least thirteen Chi Chi’s employees and numerous residents of six other states. Four people died from their injuries, and more than 9,000 people obtained immune globulin shots as protection against the virus.

This is the story of one of those cases (click below to see short quicktime video):

According to health officials, at least 3,000 people ate at the Houlihan’s restaurant located at 1332 Commons Drive in Geneva between January 8 and January 19, when the infected individual was working. The Kane County Health Department inoculated 2,060 individuals against hepatitis A on Monday, Tuesday, and Wednesday this week, and stressed that those patrons who had consumed iced beverages were most at risk for infection. 

“Filing a class action makes sense in that people who received shots had similar injuries,” said William Marler, managing partner of Marler Clark. According to the lawsuit, class members will seek damages including lost wages, medical and travel expenses, and emotional distress related to the fear of becoming infected with the hepatitis A virus.

BACKGROUND: Marler Clark has represented members of class action lawsuits arising out of hepatitis A exposures linked to two Seattle Subway stores in 1999, a Spokane Carl’s Jr. restaurant in 2000, a Massachusetts deli in 2001, a Pennsylvania Chi-Chi-s restaurant in 2003, and Massachusetts Friendly’s and Quizno’s restaurants in 2004. In addition, Marler Clark has litigated high-profile food poisoning cases, including those that were linked to September’s spinach E. coli outbreak and the more recent E. coli outbreaks traced to lettuce served at Taco Bell and Taco John’s restaurants in the Northeast and Midwest, respectively. Marler Clark represented 51 victims of a Salmonella outbreak at a Chili’s restaurant in Vernon Hills, Illinois, in 2003, and Marler Clark and James Crawley together represented 35 children and teachers who became ill with ammonia poisoning after eating contaminated chicken tenders in school lunch at Laraway Elementary School in Joliet, Illinois, in 2002.