Hepatitis A Scare at California Restaurant

Customers who ate at Chuy's Mesquite Broiler on the Rosedale Highway in Bakersfield, California, between January 4 and January 10 are being warned that they may have been exposed to the hepatitis A virus.  The Kern County Health Department issued a press release stating that customers who ate at the restaurant between those dates should receive an inoculation to prevent against hepatitis A infection.  In it, the health department provided a chart with information on the timeline for receiving preventative treatment:

Hepatitis A Treatment Schedule

KGET.com reported that the health department had run out of vaccinations, but would be able to treat all individuals who were exposed at the restaurant.  According to KGET, the restaurant has been cleaned and re-inspected.  The worker will not resume responsibilities at the restaurant until proven healthy.

According to the Kern County Department of Health Press Release:

On average, symptoms of hepatitis A occur within 28 days following exposure and may include fever, fatigue, body ache, nausea, abdominal discomfort, dark colored urine and pale stools. Jaundice or yellowing of the skin or whites of the eyes may follow. The illness usually lasts 1-2 weeks, although in rare cases, symptoms can be severe and recovery can take several months. Many people infected with Hepatitis A may have no symptoms or may have mild symptoms without jaundice. For symptom related questions, please contact your medical provider.

Hepatitis A virus is spread by close physical contact and through fecal contamination of liquids or food that does not get cooked and is then consumed. Close contacts, including household and sexual partners, are at risk for acquiring Hepatitis A from an infected person. The incubation period is 2 to 7 weeks. Prompt diagnosis is a benefit in minimizing the spread of infection. Thorough handwashing with soap and warm water after using the toilet and before handling food is the most important factor in preventing the spread of the disease.

Hepatitis A exposure extends beyond Jamba Juice

A food worker at a Jamba Juice restaurant recently tested positive for hepatitis A, and KCBS out of San Jose, California, reported that the same worker prepared smoothies at the National Gymnastics Championships in August.  According to the report:

The female worker, who is now recovering from her infection, used good hygiene and food safety practices while preparing the smoothies so the chance of anyone who had a smoothie at the championships or the concurrent trade show is remote, Alexiou said.

Smoothies prepared by the infected worker were distributed at the JumpSport booth at the trade show on August 16th and 17th.

There have been no reports of additional Hepatitis A infections since the initial announcement about Jamba Juice last week.

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. Outbreaks associated with food have been increasingly implicated as a significant source of Hepatitis A infection. Such “outbreaks are usually associated with contamination of food during preparation by an HAV-infected food handler.” (Francis & Maynard, 1983; CDC, 2007)

Food contaminated with the virus is a common vehicle transmitting Hepatitis A. The food preparer or cook is the individual most often contaminating the food.  He or she is generally not ill: the peak time of infectivity (i.e., when the most virus is present in the stool of an infectious individual) is during the 2 weeks before illness begins. Indeed, “viral gastroenteritis was reported as the most common food-borne illness in Minnesota from 1984 to 1991, predominantly associated with poor personal hygiene of infected food handlers.” (Jaykus, 1997)

In addition to infected food workers, 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, 1999) 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, 2005)

Food worker diagnosed with hepatitis A

A worker at a Cheesecake Factory restaurant in east Phoenix was diagnosed with hepatitis A, and the Maricopa County Public Health Clinic is providing Immune Globulin (IG) shots for all patrons of the restaurant who may have been exposed to the hepatitis A virus after eating at Cheesecake Factory.  The clinic is located at 1645 E. Roosevelt St. in Phoenix. 

The Arizona Republic reported today that 150 people have received IG shots to prevent infection since the announcement that the worker had been diagnosed with hepatitis A.  From the article:

The sick person worked at the restaurant at 24th Street and Camelback Road. Some patrons may have been exposed, but the health department says the risk of exposure is low.

People who ate at the restaurant July 20 are being offered the shot. Information: (602) 747-7500.

Hepatitis A class action settlement agreement

A settlement agreement has been reached between Marler Clark and the attorneys representing Houlihans.  The class action settlement agreement, if approved by the Court, will award damages to any person who ate at Houlihan's during the time when an employee who was diagnosed with hepatitis A was working, and received an Immunoglobulin shot to prevent hepatitis A infection. 

Today's Daily Herald carried a story on the tentative settlement.

An estimated 3,000 dined at the restaurant during the January time period when an employee infected with hepatitis was working and was potentially contagious. The health department gave shots to more than 2,000 people to minimize the effects of the exposure. Most at risk are patrons who had drinks with contaminated ice.

Hepatitis can cause liver damage and is contracted by eating or drinking food contaminated with fecal matter from an infected person who has not properly washed his or her hands.

The full story from the Daily Herald, and more information on the settlement agreement, can be accessed on the Daily Herald website.

Hepatitis A in Kentucky - food worker diagnosed

The Lexington Herald-Leader reported that a hepatitis A outbreak is ongoing.  The Lexington-Fayette County Health Department is working to trace the source of the outbreak, and has discovered that a food worker was one of three people diagnosed with hepatitis A.

The food worker is among three confirmed cases of hepatitis A that the health department reported yesterday. A fourth likely case is being investigated. Kevin Hall, the health department's spokesman, said the four cases occurred in two households and that the infected people know one another.

"There was interaction between the households," Hall said.

At this point, health department investigators think the food service worker had a low likelihood of spreading the disease. The person was not at work when he or she was most infectious and did not work at the restaurant for long.

Hepatitis A is a communicable (or contagious) disease that spreads from person to person. It is transmitted by the “fecal – oral route.” This does not mean, or course, that Hepatitis A transmission requires that fecal material from an infectious individual must come in contact directly with the mouth of a susceptible individual. It is almost always true that the virus infects a susceptible individual when he or she ingests it, but it gets to the mouth by an indirect route.

Food contaminated with the virus is the most common vehicle transmitting Hepatitis A. The food preparer or cook is the individual most often contaminating the food. He or she is generally not ill: the peak time of infectivity (i.e., when the most virus is present in the stool of an infectious individual) is during the 2 weeks before illness begins. Hepatitis A is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Outbreaks associated with food have been increasingly implicated as a significant source of Hepatitis A infection. Such “outbreaks are usually associated with contamination of food during preparation by an HAV-infected food handler.”2 Indeed, “[v]iral gastroenteritis was reported as the most common food-borne illness in Minnesota from 1984 to 1991, predominantly associated with poor personal hygiene of infected food handlers.”

Hepatitis A exposure at Minnesota school

The parents of eleven children who attended a function at the Burnsville, Minnesota, high school have been asked to monitor their children for symptoms of hepatitis A.  According to a story in the Minneapolis Star-Tribune, a high school student in the day care center at the high school contracted hepatitis A on a recent trip to Mexico and handled food served to preschool children.

From the story:

The Burnsville Eagan Savage school district sent a letter to parents asking them to watch for symptoms in their children in the next few weeks. The 11 children will not be given preventive shots because too much time has passed since they were exposed, Schultz said.

But if they show symptoms, their family members may be given shots. The school district urged parents of the at-risk children to monitor their households through July.

Possible hepatitis A exposure at Minnesota pizza place

The Minnesota Health Department is warning that people who ate at Pizza Ranch in Slayton, Minnesota, may have been exposed to the hepatitis A virus.  Two food workers at the restaurant recently tested positive for hepatitis A infection.  The Argus-Leader reported:

Patrons could have been exposed between April 9 and Tuesday. Symptoms usually begin two to seven weeks after exposure between April 23 and June 19.

Lyon Lincoln Murray Pipestone County Public Health Services will have a clinic to provide immune globulin to those who ate at Pizza Ranch or at events it catered between April 20 and Tuesday, but a date has yet to be set. IG can be given within 14 days of exposure to the virus to protect against developing infection.

Those exposed before before April 20 won’t benefit from receiving IG, but could develop hepatitis A in the next few weeks.