Alison Graham and the Roanoke Times told a story of an unnecessary hepatitis A outbreak.  Thanks for doing the story.

The Vests spent the last few weeks of their 40-year marriage in and out of the hospital.

At first, Larry Vest, 77, ran a low fever and felt tired. After a few tests at his doctor, he went to the emergency room and was diagnosed with hepatitis A. He stayed at Carilion Roanoke Memorial Hospital for 19 days while his wife Dianne, 78, visited him and cared for their home.

When Larry left the hospital, he spent one day with his wife before she started to experience the same symptoms and left for the hospital in an ambulance.

She went into a coma-like state within a few days and died Oct. 26.

“The family survived the pandemic with no major issues only to be devastated by a public health issue that could have just been avoided,” Dianne’s son Tim O’Leary said.

The Vests are just one local family affected by the recent hepatitis A outbreak in the Roanoke Valley, which has been linked to three Famous Anthony’s restaurants — on Grandin Road Extension, Williamson Road and Crystal Spring Avenue.

An employee who worked at all three locations tested positive for the virus. So far, there have been 52 confirmed cases, 31 hospitalizations and three deaths. James Hamlin, a Roanoke County man, died Oct. 8 from hepatitis A complications.

Like the Hamlins, Larry and Dianne Vest ate at Famous Anthony’s frequently. They visited the Williamson Road location, across the street from their church, two times during the period the employee was contagious.

Larry is currently recovering and doing well, but O’Leary said the family will be forever changed.

“What we had, two months ago, were two healthy parents enjoying their life together and doing the things they like to do,” he said. “And that all came to a screeching halt because someone did not want to practice basic hygiene.”

Disease spreads

Hepatitis A is a virus that causes liver inflammation, which can prevent the organ from functioning normally.

The liver is responsible for turning food and drink into energy and nutrients. It also removes harmful substances from the blood and helps fight off infections.

According to the American Liver Foundation, hepatitis A is most commonly spread by not washing hands before preparing or eating food or not washing hands after using the bathroom or changing a diaper.

The virus is spread through fecal to oral transmission, which means a person ingests fecal matter, usually in microscopic amounts invisible to the eye. People can also contract the virus from using drugs with others, certain types of sexual contact or caring for someone who has the virus.

When someone contracts hepatitis A, they can experience fatigue, nausea, vomiting, abdominal pain, clay-colored bowel movements, loss of appetite, low grade fever, dark urine, joint pain, intense itching and jaundice, or yellowing of the skin and eyes.

Symptoms can take weeks to develop after the initial exposure, which means people sometimes don’t know they are contagious or have the virus before spreading it. Roanoke City and Alleghany Health Districts director Cynthia Morrow said because of how long it takes for patients to show symptoms, the infectious period is often over before the health department is aware that someone is infected.

That happened in the case of Famous Anthony’s. Morrow said it’s hard to know for certain where any one individual was infected outside of an outbreak, but the department had no reason to believe that wherever the employee was initially exposed is a public threat.

She said once the department suspected the restaurant could be implicated in the transmission of the virus, officials completed an inspection. She said there was nothing that raised any alarms or would require a closure or cleaning.

Attorney Sean Workowski issued the following statement on behalf of Famous Anthony’s: “The Famous Anthony’s staff and employees wish to express their most heartfelt concern and sympathy to all the families and individuals in our community that have been affected by this unforeseen, lamentable event. Upon notification by the Roanoke and Alleghany Health District officials of a possible hepatitis A exposure … we have cooperated fully with the health department’s investigation and adhered to all recommendations to ensure the continued safe and healthy operation of all locations for our many loyal customers.”

Famous Anthony’s attorneys declined a request to interview the restaurant’s owner or answer any further questions due to pending litigation.

Hepatitis A is vaccine preventable. The U.S. Food and Drug Administration has licensed two hepatitis A vaccines and one combination vaccine that protects against both Hepatitis A and B. The first vaccine was licensed in 1995, and since then, rates of hepatitis A have declined dramatically in the U.S. Since 2006, the hepatitis A vaccine has been recommended for all children at age one and is sometimes required by schools. But this means many adults have not been vaccinated.

The Centers for Disease Control and Prevention identified unprecedented widespread outbreaks of hepatitis A in the U.S. in 2016. Since then, more than 40,000 cases have been reported and at least 400 deaths. Many of the cases have been among people who are the most at risk, including those who use drugs or people who are experiencing homelessness.

Morrow said the district has seen an uptick in vaccines since the local outbreak and vaccinated as many as 45 people in one day.

O’Leary said when his stepfather Larry Vest went to the hospital with symptoms, no one told his mother she should get vaccinated or asked if she was potentially exposed. He said he wished someone had asked her questions or told her to see a doctor. But soon enough, it was too late.

“This family has been wrecked,” he said. “It’s simple handwashing that has caused devastation to at least 50 families.”

Outbreaks across Virginia

Mindy Perdue, 40, made many memories at Famous Anthony’s. She and her parents used to eat at the Williamson Road location every Saturday before she went bowling. Occasionally, they hosted family gatherings there and on other days, she visited the restaurant with her husband of 13 years.

In August, she ordered a gravy biscuit combo from the Famous Anthony’s on Grandin Road Extension. Within a few weeks, a migraine and fever set in. She started to throw up and went to the emergency room. They suspected it might be COVID-19, gave her fluids and sent her home.

Eventually, she threw up again and saw blood. She went to work and her temperature hit 100 degrees. She went home and spent a few days resting, but when she returned, her coworkers said she looked yellow. She drove herself straight to the emergency room and spent four days in the hospital.

Perdue became the first person to file a lawsuit with Seattle attorney Bill Marler, who is now representing 25 families, including the Vests and the Hamlins.

Perdue said she was out of work for weeks and has hospital and lab bills stacking up that she needs to pay. She has since returned to work, but still experiences residual pain and is waiting for her body to return to normal.

“I didn’t have to get sick,” Perdue said. “I almost died because of it. It changed my life and it still has.”

Marler has represented hundreds of people across the country in hepatitis A outbreaks. He represented about 50 people, some from Virginia, in an outbreak linked to strawberries at a Tropical Smoothie Café in 2016. The frozen strawberries, imported from Egypt, infected 143 people in nine states. More than 50 were hospitalized, but there were no deaths, according to the Centers for Disease Control and Prevention. Virginia accounted for the majority of cases with 109 people infected.

The Mount Rogers Health District, which includes Galax and Carroll, Grayson, Bland and Wythe counties in southwestern Virginia, has reported the most hepatitis A cases in the state — more than 150 cases since January 2019.

In 2019, an employee at Cheddar’s Scratch Kitchen in Bristol was diagnosed with hepatitis A. And in 2020, an employee at Taco Bell in Chilhowie was also diagnosed with the virus.

Breanne Forbes Hubbard, population health manager at the health district, said those two restaurant-related outbreaks caused many cases in her district, but there have also been increases among the substance use community. The area has been hit hard by the opioid epidemic and the department has worked to do contact tracing in that population.

The health district offered vaccine clinics and worked with local restaurants on proper protocols to stop the spread.

She said food service workers are not at a greater risk of contracting the virus, but they are at a higher risk of spreading it. She said handwashing is the best way to stop the spread beyond vaccination.

“We were telling people you shouldn’t eat at a restaurant if you’re not vaccinated against hepatitis A,” she said. “All it takes is one time of someone not washing their hands well.”

Slow recovery

LouAnn and Harvey Howell set out on a mission to get healthier. They joined Weight Watchers and started going to Famous Anthony’s every week to order salads.

They ate at the restaurant seven Fridays in a row — three times during the period when the employee was contagious. LouAnn ordered a taco salad and Harvey ordered a chef salad.

In mid-September, Harvey ran a high fever and felt incredibly sick. He went to an urgent care clinic and they gave him a COVID-19 test, which came back negative. A few days later, his fever still raged on and he started dry heaving. He called his wife to come home from work and they went to the hospital.

By then, Harvey’s eyes and skin had turned yellow and the hospital staff issued a sepsis alert and rushed him into the emergency room, he said. Within a few hours, they had diagnosed him with hepatitis A and made plans to transfer him to another hospital where he could get a liver transplant.

“There’s not much I could focus on, but when I heard that it scared me,” he said. “That’s when I realized this is really serious.”

For days, Harvey hallucinated. He insisted to the doctors that he had previously had a lung transplant, which is not true. And in one case, he thought he saw a bug on the wall that wasn’t there and was adamant when his wife and the nurses told him he was wrong.

His wife LouAnn packed a bag and kept it in her car in case he was transferred to a different hospital for an organ transplant. But eventually, he started to stabilize and a transplant was no longer necessary. He spent a week in the hospital before he returned home.

Since then, his recovery has been slow. Even small tasks take all of his energy and he can hardly eat anything. He’s on short term disability while he waits out the symptoms and for his liver to fully recover. He lost almost 40 pounds in a matter of weeks.

“I feel like I’ve been sick for seven months, not seven weeks,” he said. “It’s incredibly depressing and weighs heavy on you. You think about all the stuff you’re supposed to be doing, need to be doing, but you can’t do any of it.”

His doctor said he might have long-term scarring or damage to his liver, but he will eventually be able to carry on a normal life. LouAnn said she spends most of her days making sure he continues to eat, stay hydrated and gets to his doctor appointments.

Every two weeks, he goes to get blood drawn and they hold their breath waiting for the results. They’ve been told that a full recovery could take six to nine months.

“I’m nothing like I was before this,” Harvey said. “It’s just gonna be different from now on. Lord willing I will recover and get back to some semblance of life someday.”