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Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

19 Hepatitis A cases linked to a Milan, Illinois McDonalds – 13 are in Rock Island County, and 6 more are being reported in Henry, Mercer, Warren and Woodford Counties

As of Thursday afternoon, there are 19 confirmed Hepatitis A cases. 13 are in Rock Island County, and six more are being reported in Henry, Mercer, Warren and Woodford Counties.

John David at WQAD has reported: that “Lunch customers coming to the Milan McDonalds on Thursday found the doors locked. Drive-up customers were being turned away. According to investigators, an outbreak of Hepatitis-A may be linked to employees or someone who ate there.”

I guess lightening does strike at least twice. In March of 1998, the Skagit County Health Department (SCHD ) in Washington State received a number of reports that residents had been diagnosed with hepatitis A and began an investigation into what appeared to be a hepatitis A outbreak. During its investigation into the outbreak’s source, SCHD determined that the outbreak had occurred among patrons of the McDonald’s restaurant located on Riverside Drive in Mt. Vernon, Washington, who had eaten at the restaurant in mid-February, 1998. Through its investigation, SCHD learned that an assistant manager at the McDonald’s had worked while infected with hepatitis A and had contaminated food.

Hepatitis A is one of five human hepatitis viruses (hepatitis A, B, C, D, and E) that primarily infect the liver and cause illness. An estimated 80,000 cases occur each year in the U.S., although much higher estimates have been proposed based on mathematical modeling of the past incidence of infection. Each year, an estimated 100 persons die as a result of acute liver failure in the U.S. due to hepatitis A, but the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Hepatitis A is a communicable (or contagious) disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. 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, although he or she is generally not ill at the time of food preparation. The peak time of infectivity, when the most viruses are present in the stool of an infectious individual, is during the two weeks before illness begins. Although only a small percentage of hepatitis A infections are associated with foodborne transmission, foodborne outbreaks have been increasingly implicated as a significant source of hepatitis A infection.

In the last ten years we have been involved in a dozen Hepatitis A cases around the country. Most, if not all could have been prevented if restaurant or field workers had received a Hepatitis A shot BEFORE serving the customer.

Carl’s Jr. Hepatitis A Outbreak – Washington
Chi-Chi’s Hepatitis A Outbreak – Pennsylvania
Chipotle Grill Hepatitis A – San Diego, California
D’Angelo’s Deli Hepatitis A Outbreak – Massachusetts
Friendly’s Hepatitis A Exposure – Massachusetts
Houlihan’s Hepatitis A Exposure – Illinois
Maple Lawn Dairy Hepatitis A Outbreak – New York
McDonald’s Hepatitis A Outbreak – Washington
Quizno’s Hepatitis A Exposure – Massachusetts
Soleil Produce Hepatitis A Outbreak – California
Subway Hepatitis A Outbreak – Washington
Taco Bell Hepatitis A Outbreak – Florida

Hepatitis A can be severe.  In one case, in late October 2003, Beaver County ER doctors reported an alarming number of Hepatitis A cases. Investigators from the Pennsylvania Department of Health initiated an investigation immediately and discovered that many, if not all, cases had eaten at Chi Chi’s restaurant in Monaca, Pennsylvania’s Beaver Valley Mall. Along with the health department, the federal Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) conducted further studies of the outbreak. Preliminary analysis of a case-control study suggested that green onions were the probable source of the outbreak. The onions had been shipped to the restaurant in boxes and were stored and refrigerated in buckets of ice. They were eventually chopped up and served in various dishes at the restaurant, often uncooked, as in the preparation of mild salsa. “Preliminary trace-back information indicated that the green onions supplied to Chi Chi’s had been grown in Mexico.” Ultimately, over 650 people were sickened in the outbreak. The victims included at least thirteen Chi Chi’s employees and numerous residents of six other states. Four people died from their injuries, and more than 9,000 people obtained immune globulin shots as protection against the virus. This is the story of one of those cases.

  • cheryl berenson RN, MS-MPH student OHSU

    The Hepatitis A vaccine is a 2 dose series with the 2 doses given at least 6 months apart for lasting protection against infection by the Hepatitis A virus. The CDC site has good information about the disease and the vaccine: http://www.cdc.gov/hepatitis

  • Marymary

    A chain restaurant of McDonald’s size could certainly afford the cost of getting its workers vaccinated against Hepatitis A. It would be worth it, since employee health rules, even when strictly enforced, may not be effective while the employee is spreading Hep A to coworkers and customers. Employee health sections of state food codes require symptoms or diagnosis in order to isolate or restrict the employee(s). Symptoms are not likely to be present, and diagnosis is also not likely at the time when Hep A is at its most infectious.