subwayindexToday the Arkansas Department of Health (ADH) warned of a possible Hepatitis A Virus (Hep A) exposure after a Subway employee in Morrilton tested positive for the virus. The Subway is located at 1812 State Highway 9 Business, just off of Exit 108 on Interstate 40 in Morrilton. The ADH announced that any individual, who has eaten food from the Morrilton Subway between March 25 and April 5 and is experiencing symptoms should contact their primary care provider immediately.

Hmm, this sounded familiar.

In mid-October of 1999, an unusually high number of hepatitis A cases were reported among individuals residing in Northeast Seattle and Snohomish County, Washington. The Snohomish Health District (SHD) noted that a number of the Hep A cases were reported among individuals who resided in Snohomish County, but who worked in the Northeast Seattle area.

Public health officials conducted an epidemiologic survey that included questions about whether case-patients had eaten at fast food restaurants and grocery stores prevalent in the North Seattle area.  By November 5, 1999, 18 of 21 persons confirmed positive with Hep A in King County after October 15, 1999 were found to have eaten at one of two Subway Sandwich outlets during the two to six week period prior to the onset of symptoms.  During this same time period, the SHD determined that at least six persons with Hep A had eaten at one of the two implicated Subway outlets.  Having confirmed that the Subway outlets were, in fact, the outbreak’s common source, health department officials issued a press release that stated, in part, that:

An ongoing investigation by Public Health suggests that many Hep A infections are associated with consuming food from one of two Subway Salads and Sandwiches outlets during the month of September. . . .“If you have eaten at these restaurants during September and are ill with symptoms of hepatitis, you should seek prompt medical evaluation,” said Dr. Alonzo Plough, Director of Public Health – Seattle & King County.

It is estimated that over 40 persons became ill as a result of eating contaminated food sold at the two Subway outlets implicated in the September 1999 Hep A outbreak.

We represented most of them.

Hep A is usually spread when a person ingests fecal matter – even in microscopic amounts – from contact with objects, food or drinks contaminated by the feces, or stool, of an infected person. Typical symptoms of Hep A include, but are not limited to: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain or jaundice (yellowing of the skin or eyes). Hep A is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. A person can transmit the virus to others up to 2 weeks before and one week after symptoms appear. There are no specific treatments once a person gets Hep A. However, it can be prevented through vaccination or through receipt of a medicine called immune globulin. This medicine contains antibodies from other people who are immune to Hep A. Many people, especially children, may have no symptoms. The older a person is when they get Hep A, typically the more severe symptoms they have. Almost all people who get Hep A recover completely and do not have any lasting liver damage, although they may feel sick for months. Hepatitis A is preventable through vaccination. Hepatitis A vaccine has been recommended for school children for many years and one dose of Hep A vaccine is required for entry into kindergarten and first grade as of 2014. Most adults are likely not vaccinated, but may have been if they received vaccinations prior to traveling internationally.