Hepatitis Blog - Surveillance & analysis on hepatitis news & outbreaks

At least 565 cases of hepatitis A were associated with an outbreak at the Chi Chi’s Restaurant in Monaca, Pennsylvania, in 2003. There were 128 hospitalizations and three deaths. As a result of exposure to the restaurant food or outbreak cases, more than 9,000 persons were given an injection of immune globulin to prevent hepatitis A. Numerous secondary illnesses occurred when infected persons who had eaten at the restaurant infected their close contacts. This outbreak, and concurrent outbreaks, were associated with eating raw, or undercooked, green onions that had been grown in Mexico and served in restaurants.

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A warning for recent guests at an Allentown restaurant; you may have been exposed to Hepatitis A.

The Allentown Health Bureau is investigating a confirmed case of Hepatitis A in an employee at the Pasta Alla Rosa Restaurant on Hamilton Street.

While the Bureau says the employee only had limited food handling duties, they still recommend that anyone who ate at the restaurant between September 23 and October 7 receive vaccinations or immune globulin (antibodies).

The Bureau says that unvaccinated guests who ate at the restaurant during the previously mentioned time period should contact their health care provider to discuss post-exposure prophylaxis (prevention). The prevention is only beneficial if taken within 14 days of exposure. Guests at the restaurant who have already been vaccinated against Hepatitis A are protected and don’t need to take action.

The Bureau recommends that unvaccinated guests between the ages of 1 year and 40 years be vaccinated while unvaccinated guests over the age of 40 receive immune globulin.

Unvaccinated guests who don’t receive vaccination or immune globulin are advised to seek medical treatment if they begin to experience the following symptoms:

• Yellowing of eyes or skin

• White stool

• Dark urine

• Nausea

• Vomiting

• Diarrhea

The Allentown Health Bureau will make vaccine available next Monday. From 9 a.m. to 4 p.m., they will have a walk-in clinic at 245 North Sixth Street for unvaccinated guests between the ages of 1 and 40.

The Bureau also requested a supply of immune globulin from the Pa. Department of Health. The Bureau will offer it to unvaccinated guests over 40 once it becomes available.

James Halpin of the Fayetteville Observer reports that hundreds of people who recently dined or worked at Fayetteville's Olive Garden may have been exposed to Hepatitis A and are being told to get vaccinated to prevent an outbreak, according to the Cumberland County Health Department.

The only confirmed case as of Monday was an employee of the restaurant on North McPherson Church Road whose case spurred the warning, Health Department Director Buck Wilson said. It wasn't known how many people may have been exposed to the illness.

But anyone who went to the restaurant on July 25, 26, 28, 29 or 31, or on Aug. 1, 2 or 8, could have been exposed.

"The most important thing right now is to get anybody that was present in the restaurant during those dates vaccinated," Wilson said. "That's the No. 1 priority."

The early signs and symptoms of Hepatitis A appear two to six weeks after exposure and commonly include mild fever, loss of appetite, nausea, vomiting, diarrhea, tiredness, pain in the upper right side of the abdomen, dark urine, light color stool and jaundice.  It can also lead to liver failure and transplant.

An outbreak of Hepatitis A in the Snoqualmie Valley has county health authorities asking people to get vaccinated.

Matias Valenzuela, public education coordinator with the county’s public health department, said his office has responded to six confirmed cases in the Valley, all in adults.

The nonlethal virus spreads easily, Valenzuela said in a press release, and it can spread through close contact with a person with hepatitis A.

The illness can spread when an infected person does not wash hands adequately after using the toilet and has close contact with others, or prepares food or drinks for others.

Hepatitis A is a communicable (or contagious) disease that spreads from person to person. It is transmitted by the “fecal – oral route,” generally from person-to-person, or via contaminated food or water. Food-related outbreaks are usually associated with contamination of food during preparation by an HAV-infected food handler (CDC, 2009c). The food handler is generally not ill: the peak time of infectivity (that is, when the most virus is present in the stool of an infectious individual) occurs during the 2 weeks before illness begins. Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A (Fiore, 2004). In 1997, frozen strawberries were determined to be the source of a hepatitis A outbreak in five states (Hutin, et al., 1999), and in 2003, fresh green onions were identified as the source of a hepatitis A outbreak traced to consumption of food at a Pennsylvania restaurant (Wheeler, et al., 2005). Other produce, such as blueberries and lettuce, has been associated with hepatitis A outbreaks in the U.S. as well as other developed countries (Butot et al., 2008; Calder et al., 2003).

HAV is relatively stable and can survive for several hours on fingertips and hands and up to two months on dry surfaces, but can be inactivated by heating to 185°F (85°C) or higher for one minute or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (household bleach) in tap water (Advisory Committee on Immunization Practices [ACIP], 2006; CDC, 2009c; Todd et al., 2009). However, HAV can still be spread from cooked food if it is contaminated after cooking.

Although ingestion of contaminated food is a common means of spread for hepatitis A, it may also be spread by household contact among families or roommates, sexual contact, by the ingestion of contaminated water or shellfish (like oysters), and by direct inoculation from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play, unknown to their parents, who may later become infected from contact with their children.