According to press reports, recent numbers from the Washington Department of Health show the state’s hepatitis A outbreak continues to grow. The statewide total, as of Thursday, showed 72 confirmed cases since January 1. Of those cases, almost three dozen have led to hospitalization. On Monday, King County Public Health confirmed six new cases since an outbreak was declared in late July, bringing the county’s total to 24 for the year.

Hepatitis A is a contagious liver infection caused by a virus. Symptoms can range from none at all to liver failure and even death. Doctors say it most often gets into the body after someone touches an infected surface or does not wash their hands after using the bathroom. Washington’s cases align with a national trend tracked by the CDC.

Back in July, health officials announced cases in four counties: King, Snohomish, Spokane and Pend Oreille. At last update, Spokane County had 33 confirmed cases for the year.

Public Health says many cases are found among people experiencing homelessness, without steady access to sanitation or hygienic facilities, and among frequent drug users. The county has allotted close to $400,000 to provide hepatitis A vaccines to those living on the street, with clinics scheduled for most days until December.

“Hepatitis A can be serious and is very contagious from person to son,” said Dr. Jeff Duchin, Health Officer for King County Public Health.

“Vaccination is the best way to protect yourself and prevent the spread of hepatitis A to others.”

Public Health says other major cities have spent millions responding to larger outbreaks and the goal here is to be proactive.

Listen while reading.

Salmonella: The Public Health Agency of Canada issued a news release this week announcing that 110 Canadians have been sickened by the Reading strain of salmonella.

There have, however, been no product recalls issued by the Canadian Food Inspection Agency.

“Based on the investigation findings to date, exposure to raw turkey and raw chicken products has been identified as the likely source of the outbreak,” the Public Health Agency said, adding that outbreaks are continuing.

“Many of the individuals who became sick reported eating different types of turkey and chicken products before they fell ill,” the agency said.

There have been 26 people sickened in British Columbia, 36 in Alberta, 24 in Manitoba and seven in Ontario and one each in Quebec, the Northwest Territories and New Brunswick plus six in Nunavit.

Whole-genome sequencing linked all of these cases, which showed up between Apr. 2017 and Aug. 2019.

Thirty-two people were treated in hospitals and one died.

E.coli bacteria

E. coli: The Department of Health and Community Services says there is an E. coli outbreak in the province after confirming 22 cases of it within one week.

Public health officials within the department, as well as the regional health authorities are working with Service NL to investigate, according to a news release issued Friday afternoon.

Dr. Janice Fitzgerald, the province’s Chief Medical Officer of Health, said the first known cases were reported in eastern Newfoundland — and some were students at Memorial University in St. John’s — though she said it’s not clear if that’s where the outbreak began.

“The majority are concentrated in eastern [Newfoundland]. We do have cases in central and western,” Fitzgerald said Friday afternoon.

Virginia: According to the Peninsula Health District, people who consumed food from Mr. C’s Pizza & Subs, located at 493 Wythe Creek Road, between September 12 through 21, September 30 and October 1 may have been exposed to the disease.

The PHD said risk to the public from this exposure is low, and there is no indication of any food products at this restaurant being the source of the infection.

If you have not been previously vaccinated and have never had hepatitis A, you are susceptible to the disease, and may be at risk if you ate anything from Mr. C’s Pizza & Subs on the dates mentioned above. Hepatitis A vaccines are available at various urgent care clinics and pharmacies and can be received at the PHD for free or at a reduced cost.

Indiana: The Greene County Health Department investigated the incident at the Papa John’s located at 1810 E. State Road 54 in Linton and determined the risk of infection is very low.

All employees at the restaurant are being vaccinated. 

Georgia: A case of hepatitis A has been diagnosed in a food handler at Vittles restaurant located in Smyrna, Georgia. An investigation found that this employee worked while infectious Wednesday, October 2, 2019. It is rare for restaurant patrons to become infected with hepatitis A virus due to an infected food handler, but anyone who consumed food or drink at Vittles on the above date should contact their healthcare provider to determine if a hepatitis A immunization is needed to prevent the disease. Most healthcare facilities and pharmacies carry the hepatitis A vaccine, but call ahead to ensure availability.

Hepatitis A vaccination is also available at Cobb & Douglas Public Health clinics Monday – Friday, 8:00 a.m. to 5:00 p.m. with no out-of-pocket cost, regardless of insurance status (Please bring insurance card if available.)

A case of hepatitis A was diagnosed on September 11. The person who tested positive for Hep A is an employee at a KFC restaurant in Pike County.

The KFC store is located at 151 Appalachian Plaza South Williamson, Kentucky.

The Pike County Health Department said an investigation found that the risk of restaurant patrons becoming infected is very low.

KFC is working with the Health Department to prevent any new cases from arising in the community.

The health department says hepatitis A is a viral infection that could take up to seven weeks for someone to become ill after being exposed to the virus

Health officials said careful hand washing, along with vaccination of anyone at risk of infection, will prevent the spread of the disease.

I.M. Healthy – goodness the irony.

For a bit(e) of history: In the Spring of 2017, the CDC reported that thirty-two people infected with the outbreak strains of E. coli O157:H7 were reported from 12 states – Arizona 4, California 5, Florida 2, Illinois 1, Massachusetts 1, Maryland 1, Missouri 1, New Jersey 1, Oregon 11, Virginia 2, Washington 2 and Wisconsin 1.  There were also others sickened but because stool cultures were not completed, those two people were not “officially” counted by the CDC.  One of those was the likely first illness.  had “genetic fingerprinting” been done on the E. coli O157:H7 culture, it is certainly possible that this outbreak would have been identified sooner.

Twelve people were hospitalized – some for as many as four months. Nine people developed hemolytic uremic syndrome – some will require kidney transplants. Fortunately, no deaths were reported.

Twenty-six (81%) of the 32-ill people in this outbreak were younger than 18 years.

Epidemiologic, laboratory, and traceback evidence indicated that I.M. Healthy brand SoyNut Butter manufactured by Dixie Dew was the likely source of this outbreak.

Of the 32 sick, I have had the honor of representing 21 of the sickened through the bankruptcies of I.M. Healthy and its manufacturer Dixie Dew.  All but three cases have been resolved.  One failed at mediation in the last month and is now in litigation.  A month from now we will attempt to resolve two more, and if not resolved, those too will be put into litigation.  It has been a long process for the ill, both in medical recovery, but in seeking fairness from the insurance companies and lawyers that represent the retailers and supply chain that supplied the tainted product.

The Journal of Pediatrics weighed in on the outbreak and it is worth a read.  J. Pediatrics Article (02178215xAD20B) – I am most impressed by the authors* conclusions and recommendations:

  • This investigation identified soy nut butter as the source of a multistate outbreak of STEC infections affecting mainly children.
  • The ensuing recall of all soy nut butter products the facility manufactured, totaling .1.2 million lbs, likely prevented additional illnesses.
  • Prompt diagnosis of STEC infections and appropriate specimen collection aids in outbreak detection.
  • Child care providers should follow appropriate hygiene practices to prevent secondary spread of enteric illness in child care settings.
  • Firms should manufacture ready-to- eat foods in a manner that minimizes the risk of contamination.

*Rashida Hassan, MSPH, Sharon Seelman, MS, MBA, Vi Peralta, MPH, Hillary Booth, MPH, Mackenzie Tewell, MA, MPH, CPH, Beth Melius, RN, MN, MPH, Brooke Whitney, PhD, Rosemary Sexton, BS, Asha Dwarka, BS, Duc Vugia, MD, MPH, Jeff Vidanes, BS, David Kiang, PhD, Elysia Gonzales, RN, MPH, Natasha Dowell, MPH, Samantha M. Olson, MPH, Lori M. Gladney, MS, Michael A. Jhung, MD, Karen P. Neil, MD, MSPH.

The Mississippi State Department of Health (MSDH) is investigating a case of hepatitis A in a food service worker that could have led to possible exposure for restaurant customers.

An employee of Dixie Depot Courtyard Lane deli, 6241 Highway 613 in Lucedale (Agricola area), who handles food has been diagnosed with hepatitis A infection, and patrons who ate food from this facility during the following dates and times may have been exposed to hepatitis A:

  • August 19-21 from 2 p.m. to 10 p.m.
  • August 23-24 from 2 p.m. to 10 p.m.
  • August 26-31 from 2 p.m. to 10 p.m.

“While the risk of transmission is likely low, the management and staff of Dixie Depot are cooperating with us to prevent new illnesses as a result of this exposure,” said MSDH State Epidemiologist Dr. Paul Byers. “We recommend that anyone who ate at this restaurant during these times should consider getting a hepatitis A vaccination if they have not been previously immunized.”

Those who think they may have been exposed to this case can receive a hepatitis A vaccination free of charge Wednesday, Thursday and Friday this week (September 11-13) at the George County Health Department, 166 West Ratliff Street in Lucedale.

Hepatitis A is a contagious liver disease that causes fever, nausea, diarrhea, vomiting, jaundice (yellowing of the skin or eyes) and abdominal pain and dark colored urine. Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool (feces) from an infected person. If you think you have symptoms of hepatitis A, you should contact your healthcare provider.

Everyone can prevent the spread of hepatitis A by carefully washing hands with soap and water, including under the fingernails, after using the bathroom or changing diapers and before preparing or eating food.

As a reminder, there is an ongoing hepatitis A outbreak in Mississippi and surrounding states affecting those who use drugs, those who are in jail or were recently in jail, those with unstable housing or who are homeless, and men who have sex with men. The MSDH continues to recommend hepatitis A vaccination for those specific groups as well.

Presently, there has been outbreaks of hepatitis A that were first identified in 2016.  I started noticing the outbreak in San Diego in 2016, spreading to Utah, Kentucky and beyond. Now 30 states have publicly reported the following as of August 30, 2019

  • Cases: 24,952
  • Hospitalizations: 14,984 (60%)
  • Deaths: 244

Although many of the illnesses have been linked to homelessness and drug use, other illnesses are simply from an unknown cause. To help stop the outbreaks, the CDC recommends the hepatitis A vaccine for people who use drugs (including drugs that are not injected), people experiencing homelessness, men who have sex with men, people with liver disease, and people who are or were recently in jail or prison.

With food service being one of the lower paying positions, an interesting question to ask is how many food service workers fit into one or more of the above categories?

However, according to the CDC, the Advisory Committee on Immunization Practices continues to recommend only that the following persons be vaccinated against hepatitis A:

  • All children at age 1 year,
  • People with unstable housing or experiencing homelessness
  • Persons who are at increased risk for infection,
  • Persons who are at increased risk for complications from hepatitis A, and
  • Any person wishing to obtain immunity.

Which groups do NOT need routine vaccination against hepatitis A?

  • Food service workers. Foodborne hepatitis A outbreaks are relatively uncommon in the United States; however, when they occur, intensive public health efforts are required for their control.
  • Although persons who work as food handlers have a critical role in common-source foodborne outbreaks, they are not at increased risk for hepatitis A because of their occupation. Consideration may be given to vaccination of employees who work in areas where community-wide outbreaks are occurring and where state and local health authorities or private employers determine that such vaccination is cost-effective.

Although the CDC feels the risks to restaurant patrons from a hepatitis A ill food service worker is “relatively uncommon,” it certainly can be with tragic consequences.  Next week I will be in Court in upstate New York on behalf of the family of a 58-year-old mother and grandmother who died of acute hepatitis A induced liver failure in 2015.  She, and her family, suffered horribly.  She spent months hospitalized hovering between life and death.  Her medical expenses were several hundreds of thousands of dollars. The loss to her family is incalculable.

The unvaccinated food service worker who transmitted hepatitis A to this grandma worked while infectious before she showed any signs of symptoms of the infection.  Had she been vaccinated against hepatitis A this mother would not be dead and I would not be in Court against one of the largest restaurant chains in the world (let’s call it “fast food restaurant A” – the CDC will get my humor).

And, it is not like this chain has avoided hepatitis A in the past.  I have sued them several times because unvaccinated hepatitis A positive employees sickened customers.  I have also sued them multiple times for exposing thousands of customers and requiring them to seek hepatitis A vaccination to protect themselves – and the restaurant chain – from the ravages of a hepatitis A infection.

I recently challenged members of the food service industry – including “fast food restaurant A” – to voluntarily vaccinate employees against hepatitis A, and I would never sue them for anything ever in the future.  My phone still has not rung.

Yes, I have other examples – hundreds of customers sickened, with some dying, after been exposed to a hepatitis A infectious food service worker – just recently over 20 were sickened and 1 died after being exposed to a food service worker at a New Jersey golf and country club.  I have also seen tens of thousands of exposed customers standing in long lines to be vaccinated, with those vaccinated primarily being paid by taxpayers.  The news is replete with daily warnings of yet another hepatitis A positive employee exposing customers.

In the last week, in a community seeing a current spike in hepatitis A illnesses that had previously required hepatitis A vaccinations for food service workers, was asked why they would no longer require it.  The response – or excuse – put the onus on the CDC – “we will not do it because the CDC does not recommend it.”  As the Church Lady says:  “How convenient.”

CDC, it is time for a change.

In 2000, I wrote this:

In light of the recent, large-scale Hepatitis A exposure in the San Francisco Bay Area, food safety attorneys of the Seattle-based law firm of Marler Clark, are asking restaurants and food manufacturers to voluntarily vaccinate all workers against Hepatitis A. “In the last six months Hepatitis A exposures have been linked to two Seattle-area Subways, a Carl’s Jr. in Spokane, WA, Hoggsbreath, a Minnesota restaurant, and three restaurants in Northwest Arkansas, IHOP, U.S. Pizza, and Belvedeers. Now more than seven- hundred children are being vaccinated against this potentially deadly virus in California after possible consumption of contaminated strawberries. Furthermore, this isn’t the first time that strawberries have been implicated in the outbreak of a foodborne disease.” Marler continued, “Restaurants and food manufacturers must take action and voluntarily vaccinate all of their employees.”

Sound familiar?

Sorry, Mr. “Verde” – Green, I really could use my Spanish in a Listeria outbreak that has sickened well over 200 and killed 3 – and, that number is likely to rise.

According to Google Translate, and therefore the Spanish Health Authorities:

On Friday, August 16, Public Health of the Autonomous Community of Andalusia notified the Center for Coordination of Health Alerts and Emergencies of the Ministry of Health, Consumption and Social Welfare an outbreak of food poisoning by listeriosis in its Autonomous Community associated with the consumption of industrial meatloaf of the La Mechá brand prepared by a company located in the municipality of Seville.

The association between the product involved and the outbreak occurred on August 14 after the positive results for listeria in the analyzes carried out in the Autonomous Community in several processed meat products corresponding to different batches and that had consumed most of the cases identified.

The total number in the community is 196 cases related to the outbreak. Most of the cases have been registered in Seville (161), but they have been found in almost all the provinces of the Community: Cádiz (10), Granada (4), Huelva (17) and Málaga (4). 58% of cases are women, 31 of them in a state of gestation. 25% of cases are 65 years of age or older, with hardly any gender disparity (24 men and 25 women).

The clinic developed by the confirmed cases in Andalusia was distributed as follows: 58% presented symptoms compatible with acute gastroenteritis, 47% presented fever, 10% (19) developed meningeal forms and four patients presented septicemia. The average incubation period has been 3 days, shorter than usual. During the outbreak there have been three deaths, two people over 70 with serious co-morbidities and a person over 90 years. The investigation of the cause of death has not yet been closed.

Other communities are investigating cases associated with this outbreak. These cases may vary between different reports as possible duplicate cases are cleared that are reported in more than one community (e.g, diagnostic community and community of residence). In the rest of the Autonomous Communities, 4 laboratory confirmed cases (1 in Aragón, 1 in Castilla y León, 1 in Extremadura and 1 in Madrid) and 3 cases confirmed by epidemiological link (1 in Extremadura and 2 in Aragón) have been registered. In addition, 56 probable cases and 41 suspects have been reported in Aragón, Asturias, Canarias, Castilla y León, Castilla La Mancha, Cataluña, Comunidad Valenciana, Extremadura, Madrid and Melilla, many of them continue in research pending results.

The French authorities notified on August 23 through the EU Early Warning and Response System (EWRS), a confirmed case of listeriosis in an English citizen, diagnosed in France on August 16 and prior of consumption of a cold pork meat in Seville on August 13. The product was consumed by 4 more people during a meal in Seville and they all got sick. Although most of the product has been distributed in Andalusia, the Spanish Agency for Food Safety and Nutrition (AESAN) has reported that a small part of the product was sold to distributors in other communities, but according to the latest information available, most of the product did not leave Andalusia or was returned to origin.

All the autonomous communities involved have reported that the products have already been immobilized and are pending destruction, and therefore are no longer for sale.According to the information received from AESAN, given the isolation of Listeria in the product involved on August 14, the food safety authorities of Andalusia made an inspection visit to the company’s facilities and agreed voluntary withdrawal by the company of all food produced since May 1 and the suspension of production.

On August 20, the food alert was extended to other baked meat products of the inspected company and on August 23 to all products produced by it. On August 24, AESAN informs that the shredded meat manufactured by Magrudis, S.L. It had also been marketed by the Martínez León Commercial Company, with poor labeling. All clients of the latter company are located in various municipalities of the province of Seville and both the Official Control Services of the Junta de Andalucía and the City of Seville have verified that the clients have been contacted and informed of the problem, and indeed not they commercialize the mentioned product.

Since the incubation period of the disease is long and the wide distribution of the product cannot rule out the occurrence of new cases in the coming days, even in people residing in other regions or countries, who have been able to consume the roasted meat during their Stay in the distribution areas. Nor can we rule out the appearance of new cases due to the consumption of products that may have final consumers in their homes, since the expiration date is approximately 3 months.

However, according to the information available, since Friday, August 23, there is a reduction in the number of confirmed cases since the beginning of the outbreak, a trend that remains until today. As a precautionary measure, it is recommended that people who have in their homes some meat products of the brand “La Mechá” refrain from consuming it and return it to the point of purchase.

If you have consumed it, if you have any symptoms, go to a health center. To avoid risks of cross contamination from contaminated products to others, it is important to ensure proper hygiene on surfaces and utensils that may come into contact with food. The Ministry of Health, Consumption and Social Welfare, given the possibility of identifying cases of listeriosis in other countries, has made the necessary communications both to the Early Warning and Response System of the European Union and to the World Health Organization in the framework of the International Health Regulations. It is recalled that pregnant women and people with immune deficiencies, higher risk groups, should consume only perfectly cooked meats and pasteurized dairy products and heat leftovers. They should also avoid ready-to-eat prepared foods.

Listeria:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Listeria outbreaks. The Listeria lawyers of Marler Clark have represented thousands of victims of Listeria and other foodborne illness outbreaks and have recovered over $650 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Listeria lawyers have litigated Listeria cases stemming from outbreaks traced to a variety of foods, such as deli meat, cantaloupe, cheese, celery and milk.

If you or a family member became ill with a Listeria infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Listeria attorneys for a free case evaluation.

The Southern Nevada Health District has identified a person with hepatitis A that worked at a 7-Eleven convenience store located at 2910 S. Maryland Parkway, Las Vegas, NV 89109 (Maryland Parkway and Vegas Valley Drive) while they were potentially infectious to others. Although transmission of hepatitis A from food handlers to patrons is rare, the Health District is informing customers who purchased non-prepackaged foods such as hot dogs or hot deli items between Friday, July 26 and Friday, Aug. 7, 2019, at this 7-Eleven location that they may have been exposed to the virus.

Customers who purchased food at this location should contact their health care providers about getting a hepatitis A immunization or receiving post-exposure treatment. Packaged items, including bottled beverages and microwaved foods, are not implicated in this potential exposure. Customers who are fully vaccinated (two doses) against hepatitis A or who consumed only packaged or bottled items are not at increased risk.

This person is considered linked to the ongoing outbreak in Clark County. Currently, there are 86 reported cases, and one person has died. Updated outbreak reports are available on the Health District website at www.SNHD.info/hep-a-control.

Hepatitis A is commonly spread from person-to-person through the fecal-oral route. Symptoms include jaundice (yellowing of the skin and eyes), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and light-colored stools. Vaccination is the best prevention against hepatitis A. Practicing good hygiene can also help prevent the transmission of hepatitis A. Wash hands thoroughly after using the bathroom, changing diapers, and before preparing or eating food.

Food handlers are not at increased risk for hepatitis A virus because of their occupation. Most food handlers with hepatitis A virus infection do not transmit it to exposed consumers or patrons. During ongoing outbreaks, transmission from food handlers to restaurant patrons has been extremely rare due to sanitation standards and food safety practices that help prevent the spread of the virus. The Centers for Disease Control and Prevention (CDC) does not recommend vaccinating all food handlers because it would not be an effective method of stopping an outbreak. Hepatitis A outbreaks primarily affect individuals who report using injection or non-injection drugs and people experiencing homelessness.

For information about the Health District’s immunization clinics, call (702) 759-0850. Immunizations are available at the following locations. Please arrive by 4 p.m. to allow time for processing:

  • Main Public Health Center, 280 S. Decatur Blvd., Las Vegas
    Monday – Friday, 8 a.m. – 4:30 p.m.
  • East Las Vegas Public Health Center, 570 N. Nellis Blvd., Suite D1, Las Vegas
    Monday – Friday, 8 a.m. – 4:30 p.m.
  • Southern Nevada Health District Henderson Clinic, 874 American Pacific Dr., Henderson
    Monday – Thursday, 8 a.m. – 4:30 p.m., Friday 8 a.m. – 1 p.m.
    Closed daily 1 p.m. – 2 p.m.
    By appointment only. Call (702) 759-0960.
  • Mesquite Public Health Center, 830 Hafen Lane, Mesquite
    Tuesday and Thursday, 8 a.m. – 4:30 p.m. Closed noon – 1 p.m.
    By appointment only. Call (702) 759-1682.