No other cases reported, but officials wary
By Michael Schroeder
The Journal Gazette

Since a server at the Coventry Pizza Hut was diagnosed with hepatitis A nearly two weeks ago, no related cases have been reported.

But health officials – fully aware of the virus’ average monthlong incubation period during which infected persons exhibit no outward symptoms – are keeping close watch.

In all, 3,858 people received shots at eight immunization clinics set up in the wake of the hepatitis A diagnosis Aug. 24, Dr. Deborah McMahan, Allen County health commissioner, said Tuesday.

A total of 219 doses were sent out of the area (though not all were used) to Purdue University, Indiana University, Notre Dame and even Canada, among other locations. The shots are intended mostly for students and some others who ate food from the Coventry Pizza Hut.

Working with the restaurant, the health department estimated that 5,000 to 10,000 people may have been exposed to hepatitis A between Aug. 3 and Aug. 19, when the infected server was working and contagious. A total of 5,100 meals were served during that time.

So health officials are reminding all those who dined in, carried out or ordered from Coventry Pizza Hut between Aug. 3 and Aug. 19 not to become complacent.

“People should still watch for signs and symptoms,” said Pam Pontones, an epidemiologist and director of surveillance and investigation for the Indiana State Department of Health.

Symptoms usually appear two to seven weeks after exposure and can include mild fever, nausea, diarrhea, fatigue, abdominal pain and loss of appetite, yellowing of the skin or eyes (jaundice), dark urine or pale-colored stool.

Children usually experience a mild case of the virus. Hepatitis A may be more serious in adults, but it is rarely fatal. Temporary liver inflammation is common, though lasting liver damage is highly unlikely, Pontones said.

“Generally, your body will clear the infection” in a couple of weeks, she said. “You will recover from it and have lifelong immunity to it.” That differs from hepatitis B and hepatitis C, which victims carry throughout their lives, she said.

Although recovery from hepatitis A is likely, health officials are most interested in controlling the virus’ spread and stopping contraction.

Because Coventry Pizza Hut is near Interstate 69 and U.S. 24, there has been some concern about travelers unknowingly carrying the virus into other areas.

In addition to getting word out to media, the Fort Wayne-Allen County Department of Health and the state health department have been communicating with health care providers and other health departments throughout the state and country to monitor the issue.

“It is possible certainly we may not catch everybody, but we have cast the net as wide as we can,” Pontones said.

For now, it’s a wait-and-see game.

Bill Marler, a Seattle-based attorney who has handled a number of class action suits related to hepatitis A cases at restaurants, said it didn’t have to be that way.

Marler commended Pizza Hut on its handling of the case – including paying for shots, supplies and associated medical costs, something he said restaurants rarely do. But he said that restaurants in general should require that employees be vaccinated for hepatitis A so there is no chance the problem will arise in the first place.

“It’s relatively cheap insurance,” Marler said.

Currently, there are no federal, state or Allen County laws that compel restaurants to have food handlers vaccinated for hepatitis A.

“Disease-control provisions in food code don’t include vaccines,” said Scott Gilliam, director of the state health department’s food protection program.

Because cases are few and far between – the state confirmed 23 hepatitis A cases overall in 2005, 17 so far this year – Gilliam said it doesn’t make sense to allocate tax payer dollars to vaccinate hundreds of thousands of people. Requiring restaurants to pay for vaccines doesn’t seem fair either, given the high turnover rate, he said.

McMahan felt similarly.

“I don’t know if you need to vaccinate against every problem,” the health commissioner said. Still, it’s a discussion worth having, she said.

Coventry Pizza Hut employees were required to get shots of immune globulin after the server there was diagnosed with hepatitis A last month. But, like most restaurants, the nation’s largest pizza chain doesn’t have a policy requiring a preventive long-term vaccine.

Pizza Hut officials couldn’t be reached Tuesday to comment on the matter The company did release an e-mail statement about the server who contracted hepatitis A.

The employee has recovered fully, said Dave Bobilya, executive vice president of Pizza Hut of Fort Wayne Inc. in the statement. When that person receives with open … clearance from a doctor, the server “will be welcomed back arms.”

“Since we first learned of this isolated incident at the Coventry Lane restaurant, we have been focused on working with the Health Department and taking care of our employees and customers,” Bobilya continued. “We now will begin to turn our attention to rebuilding our business momentum and earning back the loyalty of our Coventry Lane customers day by day.”

mschroeder@jg.net

Hepatitis A at a glance
What: Liver infection

Cause: Hepatitis A virus

Effects: Usually temporary liver inflammation

Outlook: More than 99 percent of people recover. A very rare, severe liver infection, fulminant hepatitis, can occur.

Spread: Mainly by oral contact with feces containing the virus, which may get into food or water supply.

Incubation period: Two to seven weeks; average 30 days. Symptoms are not present until incubation period is over; virus can be spread to others for at least two weeks before symptoms develop.

Symptoms: May include fatigue, fever, sore muscles, headache, pain on right side of abdomen, nausea, loss of appetite, yellowing of the skin. Sometimes may include dark urine and clay-colored stools.

How long: Symptoms usually last less than two months.

Treatment: Infection usually goes away on its own; eat balanced meals and drink plenty of water.

Vaccine: Available in two shots six months apart; recommended for children beginning at age 1. Not effective for those already exposed.

Dealing with outbreak: People who have not been vaccinated and are exposed should receive a shot of immune globulin. You probably will not develop symptoms if you receive the shot within two weeks of exposure.

Limits: You can be infected with the virus only once.

Source: WebMD.com