KnoxNews
Clinton Waffle House employee tests positive for hepatitis A
By KRISTI L. NELSON, nelsonk@knews.com
April 20, 2005
A Clinton restaurant worker has tested positive for the hepatitis A virus, prompting the East Tennessee Regional Health Office to offer shots for residents who might have been exposed while eating at the restaurant.
The infected Waffle House worker is a result of an earlier outbreak in Campbell County, not the cause of it, said Dr. Paul Erwin, ETHRO executive director.
The Anderson County Health Department and ETRHO have planned a mass clinic to give immune serum globulin to people who ate at Clinton’s Waffle House, 2255 N. Charles G. Seviers Blvd., between April 5-15. Immune serum globulin, or ISG, offers protection from the virus when given within 14 days of exposure; those exposed earlier than 14 days ago may still get sick but would not be helped by ISG shots.

ETHRO is prepared to give up to 5,000 shots if necessary – the maximum estimated number of people possibly served at the restaurant during that time period, said Sandy Halford, registered nurse in communicable disease control for ETHRO. The health office had some ISG on hand and got more from Knox County Health Department and the state.
“We have more than enough ISG,” Erwin said. “We will not run out.”
So far, the Waffle House employee is the only hepatitis A case in Anderson County. No cases have been linked to that worker, but there have been 16 other, earlier cases in the region: 13 in Campbell County and three in Scott County.
Symptoms generally take about a month to show up, Erwin said, so the health department is giving ISG to Waffle House staff and patrons as a precaution. By the end of the month, the health department may see more cases that could be linked with the Clinton Waffle House.
Erwin said the Anderson County food handler may have become infected during the Campbell County outbreak, which began with a case reported March 11 by St. Mary’s Campbell County Medical Center. In investigating that outbreak, ETHRO wasn’t able to find a single common exposure. Most of the people infected ate at a certain LaFollette restaurant; however, none of that restaurant’s employees has been positive for hepatitis A. Those exposures likely took place in early to mid-March, Erwin said, and he said he knows of no possibility of exposure in Campbell County in the past 15 days.
Erwin did say ETHRO suspects the virus was transmitted by a person, rather than by a contaminated food item, such as the green onions that caused a Knox County hepatitis outbreak in 2003. The health office has also decided it is unlikely the virus was transmitted through water or environmental factors; at a community event; or at day-care centers. Hepatitis A outbreaks can spread quickly in day-care centers because the virus that causes it is passed in fecal matter.
About 30 percent of people infected with hepatitis A, which causes liver inflammation, show no symptoms at all. Young children are less likely to have symptoms. Annually, around 143,000 Americans get the virus; 22 percent may need hospitalization, and fewer than 1 percent will die. However, those with mild or no symptoms can still spread the virus.
The virus is usually transmitted by person-to-person contact or by contaminated food. An infected food handler can contaminate food, especially if he or she doesn’t practice thorough hand washing between using the toilet and handling food, ice, water, utensils or plates.
Because the Clinton Waffle House is just off Interstate 75, Erwin said, he’s concerned travelers may have been infected. All regional health departments in Tennessee were apprised of the potential for infection Tuesday, and it will also be posted on a Centers for Disease Control and Prevention Web site, where it will be accessible to health departments in other states, he said.
ETHRO has also set up a toll-free hotline, 866-852-6710, and will refer out-of-town callers to sites where they can receive ISG if necessary.
Kristi L. Nelson may be reached at 865-342-6434. She is health writer for the News Sentinel.