For goodness sake – vaccinate.

A case of hepatitis A has been diagnosed in an employee who handled food at Popeyes Louisiana Kitchen located at 7777 Burlington Pike, Florence, Kentucky (within the T/A Truck stop facility).  An ongoing investigation of the facility found that this employee worked during a period of time when ill or infectious, which included the dates of March 17 through April 5.

While it is relatively uncommon for restaurant patrons to become infected with the hepatitis A virus due to an infected food handler, anyone who consumed food or drink at Popeyes Louisiana Kitchen during the dates listed is recommended to receive a vaccination if it is within two (2) weeks of exposure as protection from becoming ill.  If it was during the dates listed but it has been longer than two weeks since the specific time you were there, it is recommended that you still get the vaccination although it will be outside the window to protect you from contracting the illness if you were exposed at this establishment.

Anyone who consumed food or drink at this Popeyes during the stated time period should monitor their health for symptoms of hepatitis A infection up to 50 days after exposure; wash their hands with soap and warm water frequently and thoroughly, especially after using the bathroom and before preparing food; and stay at home and contact their healthcare provider immediately if symptoms of hepatitis A infection develop.

The establishment’s management is cooperating with the investigation and response activities.  It has implemented enhanced disinfection steps to address surfaces that may have been contaminated.  Employees who worked with the involved employee have been informed to get hepatitis A vaccination to protect against the virus.  Co-workers have a greater risk of exposure due to prolonged close contact with the case.  Vaccination of associated food service workers helps to protect them against infection, which further protects the public.  Handwashing and related hygienic practices have been reinforced with the restaurant management and employees.  Additionally, the Health Department has directed restaurant employees to self-monitor for any symptoms of Hepatitis A that may develop over the next 50 days.

Hepatitis A is a viral infection of the liver that can cause loss of appetite, nausea, tiredness, fever, stomach pain, brown colored urine, light colored stools and diarrhea.  Yellowing of the skin or eyes (jaundice) may also appear.  People may have some or none of these symptoms.  It could take up to 7 weeks after being exposed to the virus for someone to become ill.  Children often do not exhibit symptoms.  Any person who believes they may have symptoms of hepatitis A should contact their healthcare provider.  Additional information regarding Hepatitis A can be found at nkyhealth.org.

Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. The virus spreads when an infected person does not wash his/her hands adequately after using the toilet or engages in behaviors that increase risk of infection.  Careful hand washing, including under the fingernails, with soap and water, along with vaccination of anyone at risk of infection, will help prevent the spread of this disease.

New cases of hepatitis A have been trending downward over the past couple of months as local steps to control the outbreak have been making an impact.   However, Kentucky is still experiencing a hepatitis A outbreak.  Northern Kentucky has experienced 299 cases of hepatitis A in the outbreak thus far while Kentucky has experienced 4,381 cases.

As a result, the Northern Kentucky Health Department continues to encourage hepatitis A vaccination for the general public to protect against contracting the illness from any source of exposure.  Hepatitis A vaccine is given in two doses, six months apart. The first shot provides short-term protection and the second shot provides long-term protection. Although the vaccine is available at most doctor’s offices, pharmacies, and retail clinics, people should speak with their healthcare provider about wanting to get vaccinated. People with health insurance or Medicaid should be able to get the vaccine for free, but are recommended to check with their health insurance provider for coverage information.  NKY Health can also provide the vaccine at the county health centers to those on Medicaid, and on a sliding fee scale to those who do not have insurance, as well as those who have insurance that does not cover the vaccine.

For anyone who ate at the Western Sizzlin Restaurant in Ooltewah TN, around the time of March 10-20, 2019, they are advised to get their hepatitis A vaccine. The health department confirms that an employee of the restaurant worked during that time period in a food handling role while contagious with hepatitis A. Special vaccination clinics are being offered at 3rd Street, Sunday 3/24 1-6PM, Monday 3/25 8AM-6PM, and Tuesday 3/26 8AM-6PM, and at the Ooltewah health center Monday 3/25 8AM-6PM, and Tuesday 3/26 8AM-6PM. Additional protective measures, such as immune globulin injections, may be indicated for some people. For more information read below, or if you have any questions, please call the Epidemiology section at 423-209-8190.

The current number of cases (above) is significant because normally about 0 to 1 cases are reported to our Epidemiology section each year. We have to view this in light of the fact that both Middle Tennessee and other states around the country (Arkansas, California, Indiana, Kentucky, Michigan, Missouri, Ohio, Utah, and West Virginia) are experiencing outbreaks of hepatitis A. The Chattanooga-Hamilton County Health Department’s objective at this point in time is to take action to prevent the spread of the disease locally. Hepatitis A is vaccine-preventable and washing one’s hands before eating, preparing food and drink, or after changing diapers is one of the best ways to protect oneself.

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus (HAV). It is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water. Hepatitis A is a self-limited disease that does not result in chronic infection.
What are the symptoms?

Most adults with hepatitis A have symptoms, including fatigue, low appetite, stomach pain, nausea, and jaundice, that usually resolve within 2 months of infection; most children less than 6 years of age do not have symptoms or have an unrecognized infection.
What are the major risk factors?

Those considered at high risk for hepatitis A infection in the larger Middle Tennessee outbreak include:

  • People who abuse drugs
  • People experiencing homelessness, and
  • Men who have sex with men.

Get the safe and effective hepatitis A vaccine, available from any of our clinics for free to those who are in the high risk groups.

Wash hands frequently and thoroughly before eating, before preparing food or drinks, and after changing diapers.

Avoid recreational drug use.

Using appropriate protection during sex.

How serious is this disease?

The disease can be mild in most people, serious in some, and can result in hospitalization or death. During a similar outbreak in San Diego County, California, from September 1, 2017, to January 23, 2018, 589 cases were reported with 404 (68.6%) hospitalizations and 20 (3.4%) deaths. Notably, this outbreak has had a high hospitalization rate among those infected with hepatitis A.

On August 15, 2016, the Hawaii Department of Health (HDOH) identified raw scallops served at Genki Sushi restaurants on Oahu and Kauai as a likely source of an ongoing hepatitis A outbreak. The product of concern was identified to be Sea Port Bay Scallops (Wild Harvest, Raw Frozen) that originated in the Philippines (states “Product of the Philippines” on the box) and were distributed by Koha Oriental Foods.

As a result, HDOH ordered this product embargoed (not to be sold, purchased, or consumed) throughout the state, and the temporary closure of all Genki Sushi restaurants on Oahu and Kauai.

As of November 30, 2016, HDOH has identified 292 cases of hepatitis A. Seventy-four have required hospitalization. Findings of the investigation suggest that the source of the outbreak is focused on Oahu. Eleven individuals are residents of the islands of Hawaii, Kauai, or Maui, and seven visitors have returned to the mainland or overseas. Onset of illness has ranged between June 12, 2016 and October 9, 2016.

The FDA and CDC are supporting the HDOH in the investigation of hepatitis A virus (HAV) infections linked to scallops supplied by Sea Port Products Corp. On August 17, 2016, the FDA, HDOH, CDC, and state partners informed Sea Port Products Corp. that epidemiological, laboratory, and traceback information indicated that their scallops are the likely source of illnesses. On August 18, 2016, Sea Port Products Corp. initiated a voluntary recall of three lots of frozen Bay Scallops produced on November 23 and 24, 2015. The lot numbers for the recalled scallops are 5885, 5886, and 5887. The products were distributed to California, Hawaii, and Nevada. According to Sea Port Products Corp., the recalled products are not intended for retail sale. The FDA is working with the recalling firm to ensure their recall is effective and that recalled product is removed from the market.

The FDA’s traceback investigation involved working with HDOH to trace the path of food eaten by those made ill back to a common source. The traceback investigation determined that Sea Port Products Corp. imported the scallops that were later supplied to certain Genki Sushi locations in Hawaii, where ill people reported eating.

On August 17, 2016, FDA laboratory analysis of two scallop samples, which were collected on August 11, 2016, were confirmed positive for hepatitis A. These samples were imported by Sea Port Products Corp. and were produced on November 23 and 24, 2015.

Beginning in September 2016, several states, the CDC, and the FDA investigated a several states, CDC, and the FDA investigated a multistate outbreak of foodborne hepatitis A. Epidemiologic and traceback evidence indicate that frozen strawberries imported from Egypt are the likely source of this outbreak. Although no discovery has been done to date to confirm how the Egyptian strawberries made it to consumers, we have learned that Tropical Smoothie had a bulk purchasing agreement with Patagonia. Patagonia bought from VLM Canada. It is also our understanding that VLM Canada bought from ICAPP and that VLM USA was the importer. It appears that the strawberries entered the US in Norfolk into VLM USA’s possession and then were transferred to Preferred Freezers Storage, Inc. in Chesapeake into Patagonia’s possession.  From there, ITI picked up the berries and delivered them to either Sysco Hampton Roads or Sysco VA.  Sysco delivered them to Tropical Smoothie franchisees.

Nearly all ill people interviewed reported drinking smoothies containing strawberries at Tropical Smoothie Café locations prior to August 8, in a limited geographical area, including Maryland, North Carolina, Virginia, and West Virginia, but there have been a small number of cases outside of that geographic area with no Tropical Smoothie Café exposure.

In total, 134 people with hepatitis A have been reported from nine states: Arkansas (1), California (1), Maryland (12), New York (3), North Carolina (1), Oregon (1), Virginia (107), West Virginia (7), and Wisconsin (1). Of these cases, 129 people reported eating a smoothie containing strawberries from a Tropical Smoothie Café, and five cases reported having no exposure to Tropical Smoothie Café. There have been no cases reporting illness from this same exposure since September 23, 2016. The latest illness onset date among these cases was October 1, 2016. The investigation into these cases is ongoing. Of the 134 cases, 52 ill people have been hospitalized, and no deaths have been reported.

FDA traceback information indicated that the frozen strawberries served in the Tropical Smoothie Café locations were from the International Company for Agricultural Production & Processing (ICAPP), imported from Egypt. On August 8, 2016, Tropical Smoothie Café reported that they removed the Egyptian frozen strawberries from their restaurants in Maryland, North Carolina, Virginia, and West Virginia and switched to another supplier out of an abundance of caution. Information available at this time does not indicate an ongoing risk of hepatitis A virus infection at Tropical Smoothie Cafés.

On October 30, 2016, the International Company for Agricultural Production & Processing (ICAPP) recalled all of its frozen strawberries that were imported into the U.S. since January 1, 2016. The recalled products were distributed for sale to and use in food service establishments nationwide. The FDA reports that hepatitis A virus contamination was found in four samples of ICAPP frozen strawberries.

Erie County officials are urging anyone who recently ate at Destiny’s on Fillmore in Buffalo to be vaccinated for Hepatitis A after the virus was identified in a worker at the restaurant.

According to Erie County Executive Mark Poloncarz, anyone who at as a dine-in or takeout customer between February 27, 2019 and March 11, 2019 is eligible to recieve a free Hepatitis A vaccine provided by the Erie County Department of Health. The vaccine clinics will be held on March 13 and March 14, from 3 pm to 8pm, at the Elim Christian Fellowship located at 70 Chalmers Avenue in Buffalo.

Officials say people who ate at the restaurant between February 9 and February 26 may have been exposed but will “not benefit from Hepatitis A vaccine to prevent infection from this exposure.” Everyone is encouraged to monitor their health for symptoms for 50 days after consuming food from the establishment.

The Erie County Department of Health has provided the following information on Hepatitis A.
Symptoms of Hepatitis A can include:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored stools
• Joint pain
• Jaundice (yellowing of the skin and eyes)

• Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. It can range from no symptoms at all, to a mild illness lasting a few weeks, to a severe illness lasting several months. Although rare, hepatitis A can cause death in some people.
• Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. This can happen from eating at a restaurant, sharing food or drink, or eating when traveling in one of the many countries outside the United States with a high Hepatitis A infection rate.
• People who are most at risk of Hepatitis A include:

– People with direct contact with someone who has a hepatitis A infection. This can occur up to 2 weeks before the infected person develops any symptoms, so you may not be aware of your exposure at the time.
– Travelers to countries where hepatitis A is common, which include most countries outside the United States. More information is available on the Centers for Disease Control and Prevention’s web site.
– Men who have sexual contact with men,
– People who use drugs, both injection and non-injection drugs, and
– Homeless individuals

People who are considered high risk for exposure to the Hepatitis A virus should get vaccinated as soon as possible to avoid contracting the virus and lessen the spread of the disease. High risk groups include individuals who use illicit drugs, close contacts of illicit drug users, and homeless people.

The Department for Public Health (DPH) is making this recommendation as part of its efforts to respond to the ongoing outbreak of Hepatitis A. Since the outbreak began in August 2017, reported cases continue to rise and have now been recorded in 103 of Kentucky’s 120 counties.

“If you are at-risk of exposure to the Hepatitis A virus, we urge to get vaccinated immediately. Immunizations can be obtained from a healthcare provider, pharmacies, and clinics throughout the state. Local health departments have limited vaccine supply for at-risk individuals who are uninsured,” said DPH Commissioner Dr. Jeff Howard. “In addition, if you live in a county currently experiencing an outbreak, we also urge you to be vaccinated for Hepatitis A as well as continue to practice regular and thorough hand washing, particularly if you are engaging with any of the high risk groups.”

About 80 percent of cases in the current outbreak are people in the high risk groups. Other priority populations include;

People with direct contact with someone who has Hepatitis A (particularly during their infectious period);
Men who have sexual contact with men; and
People who are at increased risk of complications from Hepatitis A (e.g., people with chronic liver disease).
As of Jan. 26, 3,819 cases have been reported in Kentucky due to the outbreak. A recent year-end review of Kentucky mortality records revealed additional deaths, increasing the total known deaths to 40 associated with the current Hepatitis A outbreak. Counties have reported 1,862 hospitalizations due to Hepatitis A.

To date, 80 counties have reported five or more cases, meaning they meet the threshold for what is considered an outbreak of Hepatitis A virus. Boyd, Carter, Fayette, Floyd, Jefferson, Kenton, Laurel, Madison, and Whitley counties report 100 or more cases associated with the outbreak.

Hepatitis A is a highly contagious, vaccine-preventable disease of the liver, which causes inflammation of the liver and affects the organ’s ability to function. Signs and symptoms of Hepatitis A include nausea, diarrhea, and loss of appetite, fever, fatigue, jaundice (yellowing of the skin or eyes), clay-colored bowel movements, dark-colored urine, and abdominal discomfort. Signs and symptoms usually appear 2-4 weeks after exposure, but may occur up to 7 weeks after exposure. Children under 6 years of age with Hepatitis A often show few signs and symptoms.

Hepatitis A virus is found in the stool of infected people, and is usually spread person-to-person when infected people do not properly wash their hands or do not have access to proper sanitation. Transmission typically occurs when a person ingests infected fecal matter, even in microscopic amounts, from contact with contaminated objects, food, or drinks. DPH recommends frequent hand washing, particularly after using the restroom, or before eating, to prevent transmission of hepatitis A and many other common diseases.

To prevent new cases from occurring, DPH has partnered with local public health staff, health care providers, correctional facilities, faith-based organizations, homeless shelters, and substance abuse treatment centers to vaccinate people who are at the highest risk of getting Hepatitis A. People who have had Hepatitis A disease or previously received 2 doses of the Hepatitis A vaccine do not need to be immunized.

“Vaccination of high risk groups is crucial to stopping the outbreak in Kentucky,” added Dr. Howard. “If you or someone you know might be at risk for Hepatitis A, please get vaccinated as soon as possible at your local health department, primary care physician’s office, or local pharmacy. If you suspect you might have Hepatitis A infection or are experiencing symptoms (including, vomiting, diarrhea, jaundice/yellowing of the skin and eyes), you should seek medical care immediately.”

Individuals also are advised to contact their local health department or the Reportable Disease program at DPH at (502) 564-3261.

Since 2006, the Centers for Disease Control and Prevention (CDC) has recommended that all children receive the Hepatitis A vaccine series. DPH recommends children aged 1 to 18 years receive the two-dose Hepatitis A vaccine, as well as at-risk adults. Kentucky now requires all students in kindergarten through 12th grade to have two doses of the Hepatitis A vaccine in order to attend school or receive a provisional certificate of immunization.

The Cumberland Valley District Health confirmed on Friday that a McDonald’s employee tested positive for hepatitis A.

The McDonald’s is located on Muddy Gap Road. In a release, health officials said that the employee did not handle food directly and was in a customer service position.

Health officials said the transmission risk to employees and customers at the store is low. However, anyone who ate at the McDonald’s in Manchester between October 30th and November 16th can seek further protection from becoming ill by getting a Hepatitis A vaccination. All employees have been offered the hepatitis A vaccine. The vaccine should be taken within two weeks of possible exposure.

Management voluntarily closed the restaurant on Friday for a thorough cleaning and sanitation. Our reporter on the scene said people were already cleaning inside the building and there is yellow tape surrounding the entire location.

Anyone who consumed food or drinks at McDonald’s in Manchester from October 30th through November 16th is also asked to:

1. Monitor their health for symptoms of hepatitis A infection up to 50 days after exposure.

2. Wash their hands with soap and warm water frequently and thoroughly, especially after using the bathroom and before preparing food.

3. Stay at home and contact their healthcare provider immediately if symptoms of hepatitis A infection develop.

Hepatitis A is a viral infection of the liver that can cause loss of appetite, nausea, tiredness, fever, stomach pain, brown colored urine, and light-colored stools. Yellowing of the skin or eyes may also appear. People can become ill up to 7 weeks after being exposed to the virus.

Florida: The Florida Department of Health in Pinellas County announced Nov. 5 that a positive case of hepatitis A has been identified in a food service worker in St. Pete Beach.

Following lab confirmation on Nov. 1, DOH-Pinellas immediately began conducting an epidemiological investigation and determined the individual worked at Toasted Monkey, 6110 Gulf Blvd., from Oct. 17-28.

DOH says persons who frequented the restaurant on Oct. 17-28, and have not previously been vaccinated for hepatitis A, should be vaccinated. If you have previously received the hepatitis A vaccine you do not need to take additional action. DOH-Pinellas is offering the vaccine at the following locations:

• St. Petersburg, 205 Dr. Martin Luther King Jr. St. N.

• Pinellas Park, 6350 76th Ave. N.

• Mid-County, 8751 Ulmerton Road, Largo.

• Clearwater, 310 N. Myrtle Ave.

• Tarpon Springs, 301 S. Disston Ave.

DOH-Pinellas is encouraging all healthcare providers, including hospital emergency departments to stay on high alert and immediately report cases to the Florida Department of Health.

Ohio: Taco Bell Corporation has confirmed  that an employee at the Elm Road location in Warren has tested positive for hepatitis A. So far there’s only been one confirmed case — but a handful of other employees were showing symptoms.

Taco Bell Corporation issued the following statement:

As soon as the operator of this Warren, Ohio location learned that a team member tested positive for the hepatitis A virus, the franchisee began working immediately with Taco Bell and local health officials. All team members currently working at this restaurant have been offered vaccinations, and the restaurant was thoroughly sanitized.”

Deputy Health Commissioner of the Warren Health District Robert Pinti says he was informed Saturday about an employee testing positive for Hepatitis A.

“Our understanding is eight people were symptomatic having symptoms of Hepatitis A. They’ve received the vaccine also,” Pinti said.

The team member exposed to the virus is on leave and will not return until they are cleared by medical professionals, according to a spokesperson from Taco Bell.

“In this particular case in a restaurant setting, if that food prep handler is doing the right thing and keeping their hands clean, using their gloves, changing their gloves, washing their hands it would be very difficult to pass,” Pinti said.

Taco Bell says all employees working at this location have been offered vaccinations and the restaurant was thoroughly sanitized.

Ohio: People who ate at Cracker Barrel between Oct. 15-21 are being advised to consider getting the hepatitis A vaccine after a food service worker there tested positive for the viral infection.

The Mid-Ohio Valley Health Department made the announcement Monday morning in a joint press release with Cracker Barrel Old Country Store. An assessment by the health department determined the risk of infection was low, the release says.

The Mineral Wells restaurant voluntarily closed late Friday afternoon once test results confirming the employee had tested positive for hepatitis A were received, said Carrie Brainard, public information specialist for the health department. The facility was cleaned and sanitized overnight and reopened early Saturday morning following a health department inspection, she said.

“At Cracker Barrel, nothing is more important to us than the health and well-being of our guests and employees,” Cracker Barrel Old Country Store spokeswoman Heidi Pearce said in the release. “We are also working in collaboration with the Health Department to arrange for a clinic to vaccinate all employees.”

The investigation is related to the multistate outbreak of hepatitis A. An infected worker was reported at the Taco Bell in Belpre this spring.

Brainard said the Cracker Barrel employee is the first case involving a food worker reported in the Mid-Ohio Valley Health Department’s eight-county service area.

“There have been no known cases of hepatitis A being passed from a food worker to a patron” in West Virginia, she said.

Still, the health department recommends people who have not been vaccinated against hepatitis A and ate at the restaurant during the period in question consider getting the vaccine. The release emphasizes this should be done “not more than two weeks from the potential exposure to help prevent infection.”

A new case of hepatitis A has been diagnosed in a Frankfort food worker, the Franklin County Health Department reports.

The infected individual worked at the KFC located on at 1229 US 127 between Oct. 22 and Oct. 25.

The health department wants to remind the public that it’s rare for restaurant patrons to become infected with hepatitis A virus due to an infected food handler. However, for anyone who consumed food or drink at that KFC location during that time should receive a vaccination by Nov. 8.

Vaccinations are being administered at the Franklin County Health Department located at 100 Glenns Creek Road on the following dates and times:

Monday-Tuesday: 8 a.m. to 11 a.m., 1:30 p.m. to 3:15 p.m.
Wednesday: 8 a.m. to 11 a.m., 1:30 p.m. to 5:15 p.m.
Thursday-Friday: 8 a.m. to 11 a.m.

Anyone who ate there during that time frame should monitor their health for symptoms up to 50 days after exposure.

Careful hand washing, including under the fingernails, with soap and water, along with vaccination of anyone at risk of infection, will prevent the spread of this disease.