Since January 2019, Southwestern Idaho has seen an increase in Hepatitis A cases. Though a common link among cases has not been identified, public health encourages you to protect yourself by getting vaccinated for hepatitis A and using proper hand hygiene.

7/17/2019: Hepatitis A case confirmed in food service worker employed at Saint Lawrence Gridiron, located at 705 W. Bannock Street in Boise

The food service employee worked various days and shifts during the period they were contagious. Based on the infectious period of hepatitis A, anyone who ate at Saint Lawrence Gridiron on the following dates should check their immunization records to see if they have received a hepatitis A vaccine:

June 21, 22, 23, 24 (2019)
June 27, 28, 29, 30 (2019)
July 1 (2019)
July 5, 6, 7, 8 (2019)
July 11, 12, 13, 14, (2019)

The risk of becoming infected with hepatitis A through an infected food service worker is low but CDHD encourages anyone who ate on any of the dates identified, and has not received a hepatitis A vaccine, or is unsure about their vaccine status, to consider getting vaccinated. CDHD is offering free hepatitis A vaccine to anyone who ate at this restaurant on an identified date listed above. Call 208-321-2222 to make an appointment at CDHD.

In order for the hepatitis A vaccine to help prevent possible transmission, patrons must get the vaccine within two weeks of the date they may have been exposed.

Those with questions about their immunization record, who wish to make a vaccine appointment or have questions related to hepatitis A and potential exposure at this restaurant may call 208-321-2222.

Potentially exposed patrons should also watch for symptoms of hepatitis A which may include abdominal pain, dark urine, fatigue, fever, jaundice (yellowing of the skin and eyes), light-colored stools, loss of appetite, nausea and vomiting. Hepatitis A symptoms typically develop around 4 weeks after exposure if you have been infected. If symptoms occur, seek medical attention.

Westchester County Health Department was notified of the first case in what would be identified as the Bartaco hepatitis A outbreak on October 10, 2017. Bartaco is a Mexican restaurant located at 1 Willett Ave, Port Chester, New York.

After learning of a second hepatitis A case with exposure to Bartaco, environmental health investigators conducted facility inspections of the restaurant on October 17 and 19. The Health Departments also provided preventative treatment and timely information to more than 3,000 people who were exposed to the confirmed HAV-infected Bartaco employee.  The inspections found several violations that could have contributed to the spread of hepatitis A to patrons. The Health Departments’ observations included inadequate employee hand washing facilities, and employees handling cooked and prepared foods with bare hands. Additionally, investigators observed that food items were not properly protected during storage and preparation from potential sources of contamination.

The Centers for Disease Control (CDC) performed  genetic analysis of the Hepatitis A strains from the 3 original Westchester residents who ate at Bartaco as well as the HAV-infected employee. The results demonstrated that all the individuals were infected with the same strain of Hepatitis A which was not being seen elsewhere in the United States. Id.

Ultimately, the investigation conducted by the Westchester County Health Department determined that the six laboratory confirmed cases of hepatitis A were associated with the Bartaco hepatitis A outbreak. All six cases had eaten at Bartaco Restaurant between October 12 and 23. It was concluded that the source of the outbreak was an ill employee who worked at the restaurant while infectious. This conclusion was based on (1) one of the initial four primary cases was also a Bartaco employee; (2) none of the primary cases knew each other or ate at the same time; the only commonality among the confirmed cases was their consumption of food and drink from Bartaco from September 7—12, 2017; (3) observations by WCDOH environmental inspectors indicated violations related to bare-hand contact with foods, utensils, and inadequate handwashing facilities for Bartaco staff; (4) subsequent investigation of food sources for the Bartaco brand indicated that all locations are serviced by the same supplier, and no other Bartaco restaurant experienced similar illness; and (5) while no ill employee was ultimately identified from September 2017, 22 employees who worked during that time were unable to be interviewed and investigated as a possible index case.

The conclusions made by the Westchester County Health Department are supported by the plaintiff’s expert witness Kristin Sweet, PhD, MPH. Ms. Sweet has an extensive background in public health, epidemiology, foodborne illness investigations, and viral infections, working specifically as an infectious-disease epidemiologist for viral hepatitis for 13 years.

Specifically, Kristin Sweet, PhD, MPH, concluded:

The only common exposure among the five primary cases of hepatitis A in this outbreak was having eaten at Bartaco in Port Chester, NY. During an inspection of the restaurant, gaps in sanitation practices were identified including bare‑hand contact with ready‑to‑eat foods and lack of handwashing supplies at sinks. Although the epidemiological investigation did not implicate a specific food item or food handler as the source of the infections, the environmental health assessment at the restaurant found food‑handling practices that could have led to contamination.

According to the NEARS Form, the restaurant did not have a salad bar or buffet where customers could more easily contaminate food consumed by other patrons. Employees and customers used separate restrooms and cases occurred both in customers and one employee. While hepatitis A can survive on environmental surfaces for a month or more, the likelihood that a customer contaminated a surface that was touched by multiple patrons on multiple days resulting in infection is low. Despite the fact that the NYDOH reported that no source was identified through their investigations, an ill food handler is still a possible source. These interviews depend on the availability of all employees completing an interview or survey. Even if all employees were interviewed, employees may not be honest or be able to report thoroughly on their symptom history from one or more months prior to interview. In the absence of complete documentation on the employee interviews, either of these scenarios is possible in this instance.

Based on the information provided to me, it is more likely than not that the hepatitis A outbreak at Bartaco was foodborne.

A second expert, Roy E. Costa, RS, MS (MBA), a Public Health Sanitarian and Consultant with over twenty years’ experience reached a similar conclusion, providing the following opinions of the case:

1.     Bartaco was the source of 5 primary HEP A outbreak cases.

2.     There were 2 secondary outbreak cases related to the primary cases.

3.     A HEP A infected Bartaco co-worker was the most likely source of the HEP A virus.

4.     The HEP A Positive employee and 4 other primary cases in October were exposed to an unidentified infected co-worker in September of 2017.

5.     A contaminated food and beverage were the most likely modes of HEP A virus transmission.

6.     The most likely contributing outbreak factors were poor maintenance of hand washing facilities, poor personal hygiene practices, lack of hand washing, bare-hand contact of RTE foods, and poor management surveillance.

Hepatitis A case confirmed in food service worker employed at Saint Lawrence Gridiron, located at 705 W. Bannock Street in Boise

The food service employee worked various days and shifts during the period they were contagious. Based on the infectious period of hepatitis A, anyone who ate at Saint Lawrence Gridiron on the following dates should check their immunization records to see if they have received a hepatitis A vaccine:

June 21, 22, 23, 24 (2019)
June 27, 28, 29, 30 (2019)
July 1 (2019)
July 5, 6, 7, 8 (2019)
July 11, 12, 13, 14, (2019)

The risk of becoming infected with hepatitis A through an infected food service worker is low but CDHD encourages anyone who ate on any of the dates identified, and has not received a hepatitis A vaccine, or is unsure about their vaccine status, to consider getting vaccinated. CDHD is offering free hepatitis A vaccine to anyone who ate at this restaurant on an identified date listed above. Call 208-321-2222 to make an appointment at CDHD.

In order for the hepatitis A vaccine to help prevent possible transmission, patrons must get the vaccine within two weeks of the date they may have been exposed.

Those with questions about their immunization record, who wish to make a vaccine appointment or have questions related to hepatitis A and potential exposure at this restaurant may call 208-321-2222.

Potentially exposed patrons should also watch for symptoms of hepatitis A which may include abdominal pain, dark urine, fatigue, fever, jaundice (yellowing of the skin and eyes), light-colored stools, loss of appetite, nausea and vomiting. Hepatitis A symptoms typically develop around 4 weeks after exposure if you have been infected. If symptoms occur, seek medical attention.

The Genesee County Health Department has recently been awarded a grant to provide the hepatitis A vaccine to food-service workers at NO COST to them or the employer.

In Western New York and across the United States, foodborne outbreaks of hepatitis A have occurred as a result of infected food-service workers.

Brenden Bedard, director of Community Health Services for Genesee and Orleans counties, understands the severity of hepatitis A and the effect it can have on a business and community.

“Hepatitis A is a serious issue because most food-service workers will spread the infection before even knowing they have the disease,” Bedard said. “A food-service worker can spread the virus to customers or other staff by contaminating surfaces, utensils and/or food, which can make unvaccinated individuals very sick.

“By offering the vaccine to food-service workers, we can prevent unnecessary illness from spreading in the community.”

Hepatitis A is a contagious (spreadable) liver infection that is caused by the hepatitis A Virus (HAV). It is typically spread through the feces (poop) of infected individuals.

Someone can become infected by consuming food or drink that has been contaminated by feces as well as having close personal contact with a person who is infected, or use of injection and non-injection drugs.

The symptoms of HAV may include sudden onset of fever, loss of appetite, nausea / vomiting, stomach pain, dark-colored urine and jaundice (a yellowing of the skin and whites of the eyes). HAV usually does not have signs or symptoms until the second week of infection and is the most infectious during this time.

The good news is that hepatitis A can be prevented through vaccination!

According to the Centers for Disease Control and Prevention (CDC), the vaccine has a 94- to 100-percent efficacy rate.

The hepatitis A vaccine is a two-dose series that is administered six months apart. As the vaccine is not required to attend school or daycare, many people have not received it.

Currently three local restaurants have taken advantage of this opportunity for themselves and their employees who chose to receive the vaccine. The restaurants who have participated thus far have all expressed gratitude knowing their employees can protect themselves and their customers from the hepatitis A virus.

Any food-service worker employed in Genesee County can receive the vaccine.

By receiving the vaccine, you are also protecting yourself from getting the virus if you come in contact with dishes and/or utensils that may have been contaminated by a customer or coworker.

Restaurants that participate in this opportunity will receive a certificate honoring their commitment to protecting the health and safety of their workers and customers.

An employee at Steak ’n Shake in Columbia County reportedly tested positive for hepatitis A.

According to the Georgia Department of Public Health and East Central Health District, the employee is not currently working at the restaurant on Belair Frontage Road and coworkers have been offered the vaccination.

The department said the public has a low risk of being exposed to the virus from food service employees due to standard sanitation practices. Symptoms of hepatitis A include fever, fatigue, nausea, vomiting, diarrhea and abdominal pain and usually appear four weeks after exposure.

Environmental health staff are inspecting the restaurant to ensure safe food handling and preparation protocols are being followed, according to the department.

People who ate at the restaurant recently can talk to their health professional about receiving a vaccination.

The Franklin County Health Department is planning mass vaccinations after learning an employee who works at the Jack in the Box located at the Bourbeuse River Access in Union, Missouri had Hepatitis A while serving customers.

The Missouri Department of Health and Senior Services said the employee handled food on June 9 and June 10.

Hepatitis A  is a viral infection of the liver that can cause loss of appetite, nausea, tiredness, fever, and stomach pain. It’s usually spread when a person unknowingly ingests the virus from objects, food, or drinks that have been contaminated. Franklin County health officials have conducted several inspections of the Jack in the Box since the problem was discovered.

Health officials said it is uncommon for restaurant customers to become infected with Hepatitis A due to an infected food handler. However, anyone who consumed food or drinks at the restaurant on June 9 or June 10 is recommended to receive vaccination by June 23 as further protection from becoming ill.

Free vaccinations will be given out at the Franklin County Health Department headquarters at 414 East Main Street in Union on June 21 from 8 a.m. to 7 p.m. and June 22 from 8 a.m. to 1 p.m.

Customers who ate at Popeyes on York Street in Aiken may have been exposed to hepatitis A, according to the Department of Health and Environmental Control. DHEC was notified on June 17 that an employee in the restaurant tested positive for hepatitis A, according to a press release. Customers who ate at Popeyes, located at 954 York Street, between May 29 and June 12 may have been exposed to the virus.

In addition, diners at Harbour Town Yacht Club, located in Sea Pines, could have been exposed to the hepatitis A virus in the past month, a S.C. Department of Health and Environmental Control news release says. DHEC was notified June 17 about an employee at the event venue who tested positive for the virus, a release says. Hepatitis A is a contagious liver virus. The employee worked at a social on June 8, a dinner on June 13 and a wedding party on June 14, the release says.

A food service worker at Village Pizza Restaurant in Spring Hill Florida has been diagnosed with hepatitis A, according to the Florida Department of Health in Hernando County (DOH-Hernando). Anyone who ate at the restaurant between May 29 and June 5 may have been exposed, according to DOH-Hernando officials. The restaurant is located at 4070 Deltona Boulevard in Spring Hill.

Health officials said the employee may have been infectious during those dates. Anyone who consumed food or drinks at the restaurant and has not been vaccinated for hepatitis A should consider getting vaccinated, they said. Those who have previously received the hepatitis A vaccine “does not need to take additional action,” according to a press release.

Maine Center for Disease Control and Prevention (Maine CDC) identified additional cases of acute hepatitis A virus infection in Aroostook County. Close contacts at risk are already being notified. The only risk to the public identified by Maine CDC at this time involves a Presque Isle food service worker.

The Presque Isle case served food and drink while infectious on May 26, 2019 and June 2, 2019.

Maine CDC recommends the hepatitis A vaccine as post-exposure prophylaxis to anyone who ate or worked at the Mai Tai Restaurant in Presque Isle, Maine between 11:00am and 4:30pm on June 2, 2019. Exposed persons can receive post-exposure prophylaxis up to 14 days from exposure, after which the treatment is no longer effective. Anyone who visited the restaurant between 11:00am and 4:30pm on May 26, 2019 is outside the window for which prophylaxis is recommended, but they should watch for symptoms and seek medical attention should they develop symptoms.

Health care providers are encouraged to remain vigilant for hepatitis A infection in persons with consistent symptoms. All cases of hepatitis are reportable in Maine. Providers with suspected cases should report them to Maine CDC at 1-800-821-5821.

People who ate at a local Taco Bell in mid-April may have been exposed to hepatitis A.

An employee at Taco Bell on 40976 U.S. Highway 19 North in Tarpon Springs tested positive for Hepatitis A, according to an email sent by the Pinellas County Health Department to the state.

The county also reported the employee worked at that Tarpon Spring’s Taco Bell during his infectious period from April 12 to April 14.

On April 17, the agency reached out to the Division of Hotels and Restaurants to conduct a joint investigation and food safety inspection.

When inspectors showed up on that day, the state found employees were not washing their hands.

According to the inspection report, the state also discovered there was no hot water in the hand wash sink in the men’s and women’s rooms and the soap dispenser was not working in the men’s room.

As health officials have warned, hepatitis A is spread when infected individuals do not wash their hands properly and contaminate food or surfaces they touch.

If you think you’ve been exposed to hepatitis A, medical experts recommend you get vaccinated as soon as possible.

The Pinellas County Health Department is offering free vaccines to anyone who wants one but the agency never told the public about the infected worker at Taco Bell.

A worker at a country club in Spring Hill may have exposed people, including high school students, to hepatitis A.

The Department of Health in Hernando County says someone working in food service at the Silverthorn Country Club Restaurant has tested positive for the disease.

Both Central and Springstead High Schools may have had their proms at Silverthorn during the dates in question, according to the school’s Facebook pages.

A vaccine can help protect you if you get it within two weeks and the health department is recommending anyone who ate or drank there during those dates should get one.

DOH-Hernando is also offering the hepatitis A vaccine for free at the Spring Hill location of the Health Department with extended hours May 1-3 and May 6-8 until 7 p.m.

From 2018 through May 1, 2019, there have been 41 confirmed cases of hepatitis A. In Hillsborough, there have been 165 cases. Pasco has reported 267 cases and Pinellas County has seen 319 cases.

Officials in Hernando County said 128 people came to get vaccinated at the health department after the Silverthorn case was announced.

Doctors suggest getting the vaccine if people exhibit the following symptoms: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice, reports the Centers for Disease Control and Prevention.