Hepatitis A

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Not  to be confused with the Seven Deadly Sins: pride, greed, lust, envy, gluttony, wrath and sloth, although, perhaps some of these outbreaks were sinful.  I had the honor to represent many of the ill and the families of those who died.

Jack-in-the- Box E. coli Outbreak – 1992 – 1993

708 ill, 171 hospitalized and 4 dead

An outbreak of E. coli O157:H7 was linked to the consumption of hamburgers from the Jack-in-the-Box Restaurant chain. Cases were reported from the states of Washington (602 cases/144 hospitalizations/3 deaths), Idaho (14 cases/4 hospitalizations/no deaths), California (34 cases/14 hospitalizations/1 death), and Nevada (58 cases/9 hospitalizations/no deaths). A case control study implicated the chain’s hamburgers resulting in a multistate recall of the remaining hamburgers. Only 20 percent of the product remained at the time of the recall; this amounted to 272,672 hamburger patties. Subsequent testing of the hamburger patties showed the presence of E. coli O157:H7. The strain of E. coli O157:H7 found in ill people matched the strain isolated from uncooked hamburger patties. The outbreak illustrated the potential for large, foodborne illness outbreaks associated with restaurant chains receiving shipments of contaminated food. At the time, many clinical laboratories in the United States were not routinely culturing patients’ stool for E. coli O157:H7 by using the correct culture medium. Additionally, many local and state health departments were not actively tracking and investigating E. coli O157:H7 cases.

Chi Chi’s Green Onion Hepatitis A Outbreak – 2003

565 ill, 130 hospitalized and 3 dead

Pennsylvania State health officials first learned of a hepatitis A outbreak when unusually high numbers of hepatitis A cases were reported in late October 2003. All but one of the initial cases had eaten at the Chi Chi’s restaurant at the Beaver Valley Mall, in Monaca, PA. Ultimately, at least 565 cases were confirmed. The victims included at least 13 employees of the Chi Chi’s restaurant, and residents of six other states. Three people died as a consequence of their hepatitis A illnesses. More than 9,000 people who had eaten at the restaurant, or who had been exposed to ill people, were given a post-exposure injection as a prevention against developing hepatitis A. Preliminary analysis of a case-control study indicated fresh, green onions were the probable source of this outbreak. The investigation and tracebacks by the state health department, the CDC, and the FDA, confirmed that the green onions had been grown in Mexico.

Dole Baby Spinach E. coli Outbreak – 2006

238 ill, 103 hospitalized and 5 dead

On Sept. 13, 2006, public health officials in Wisconsin, Oregon and New Mexico noted E. coli O157:H7 infections with matching pulsed-field gel electrophoresis (PFGE) patterns. These illnesses were associated with eating fresh, bagged spinach produced by Dole Brand Natural Selection Foods. By Sept. 26 that year, infections involving the same strain of E. coli O157:H7 had been reported from 26 states with one case in Canada. A voluntary recall was issued by the company on Sept. 15. E. coli O157: H7 was isolated from 13 packages of spinach supplied by patients in 10 states. Eleven of the packages had lot codes consistent with a single manufacturing facility on a particular day. The PFGE pattern of all tested packages matched the PFGE pattern of the outbreak strain. The spinach had been grown in three California counties – Monterey, San Benito and Santa Clara. E. coli O157:H7 was found in environmental samples collected near each of the four fields that provided spinach for the product, as designated by the lot code. However, E. coli O157:H7 isolates associated with only one of the four fields, located on the Paicines Ranch in San Benito County, had a PFGE pattern indistinguishable from the outbreak strain. The PFGE pattern was identified in river water, cattle feces and wild pig feces on the Paicines Ranch, the closest of which was less than one mile from the spinach field.

Peanut Corporation of America Salmonella Outbreak – 2008 – 2009

714 ill, 171 hospitalized and 9 dead

Beginning in November 2008, CDC’s PulseNet staff noted a small and highly dispersed, multistate cluster of Salmonella Typhimurium isolates. The outbreak consisted of two pulsed-field gel electrophoresis (PFGE) defined clusters of illness. Illnesses continued to be revealed through April 2009, when the last CDC report on the outbreak was published. Peanut butter and products containing peanut butted produced at the Peanut Corporation of America plant in Blakely, GA, were implicated. King Nut brand peanut butter was sold to institutional settings. Peanut paste was sold to many food companies for use as an ingredient. Implicated peanut products were sold widely throughout the USA, 23 countries and non-U.S. territories. Criminal sanctions were brought against the owners of PCA.

Jensen Farms Cantaloupe Listeria Outbreak – 2011

147 ill, 143 hospitalized and 33 dead

A multistate outbreak of Listeria monocytogenes involving five distinct strains was associated with consumption of cantaloupe grown at Jensen Farms’ production fields near Granada, CO. A total of 147 ill people were reported to the CDC. Thirty-three people died, and one pregnant woman miscarried. Seven of the illnesses were related to pregnancy – three newborns and four pregnant women. Among 145 ill people with available information, 143 – 99 percent – were hospitalized. Source tracing of the cantaloupes indicated that they came from Jensen Farms, and were marketed as being from the Rocky Ford region. The cantaloupes were shipped from July 29 through Sept. 10, 2011, to at least 24 states, and possibly distributed elsewhere. Laboratory testing by the Colorado Department of Public Health and Environment identified Listeria monocytogenes bacteria on cantaloupes collected from grocery stores and from ill persons’ homes. Laboratory testing by FDA identified Listeria monocytogenes matching outbreak strains in samples from equipment and cantaloupe at the Jensen Farms’ packing facility in Granada, Colorado.  Criminal sanctions were brought against the two owners of Jensen Farms.

Bidart Caramel Apple Listeria Outbreak

35 ill, 34 hospitalized and 7 deaths

On December 19, 2014, the CDC announced a multistate outbreak of Listeria monocytogenes linked to commercially produced, prepackaged caramel apples. A total of 35 people infected with the outbreak strains of Listeria monocytogenes were reported from 12 states. Of these, 34 were hospitalized. Listeriosis contributed to at least 3 of the 7 deaths reported. Eleven illnesses were pregnancy-related with one illness resulting in a fetal loss. here invasive illnesses were among otherwise healthy children aged 5-15 years. Twenty-eight (905) of the 31 ill persons interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill. The Public Health Agency of Canada identified one case of listeriosis that was genetically related to the US outbreak. The investigation was assigned Cluster ID #1411MNGX6-1. On December 24, 2014, Happy Apples issued a voluntary recall of Happy Apple brand caramel apples with best use by date between August 25th and November 23rd, 2014 due to a connection between the apples and outbreak associated cases. California Snack Foods brand caramel apples issued a similar recall on December 27th. Both companies used apples supplied by Bidart Brothers. On December 29 Merb’s Candies recalled Bionic Apples and Double Dipped Apples. On January 6, 2105 Bidart Bros. of Bakersfield, California recalled Granny Smith and Gala apples because environmental testing revealed contamination with Listeria monocytogenes at the firm’s apple-packing facility. On January 8, 2015 FDA laboratory analyses using PFGE showed that environmental Listeria isolates from the Bidart Bros. facility were indistinguishable from the outbreak strains.

Andrew and Williamson Cucumber Salmonella Outbreak – 2015

907 ill, 204 hospitalized and 6 dead

On September 4, 2015 the CDC announced an outbreak of Salmonella Poona linked to consumption of cucumbers grown in Mexico and imported by Andrew & Williamson Fresh Produce. On March 18, 2016 the outbreak was declared to be over. A total of 907 people infected with the outbreak strains of Salmonella Poona were reported from 40 states. Among people for whom information was available, illnesses started on dates ranging from July 3, 2015 to February 29, 2016. Two hundred four ill people were hospitalized and six deaths were reported. Salmonella infection was not considered to be a contributing factor in two of the 6 deaths. Epidemiologic, laboratory, and traceback investigations identified imported cucumbers from Mexico and distributed by Andrew & Williamson Fresh Produce as the likely source of the infections in this outbreak.

According to the Kern Faculty Medical Group, they expect to have enough hepatitis A vaccine shots after supplies temporarily ran out Saturday. The medical group had given about 90 vaccine shots Saturday morning before supplies ran out, said Dr. Mansukh Ghadiya with the clinic.  Public health officials made arrangements with Kern Faculty Medical Group for people who needed the vaccine or other treatment after news a worker at Chuy’s Mesquite Broiler (not to be confused with the Chuy’s in Austin Texas which was famous for serving alcohol to one of the under-age Bush girls) was diagnosed with hepatitis A was released last week.  I bet Chuy’s wished they required Hepatitis A vaccines of all employees.

In that last several years we have represented health departments who pay for these shots, the people who stand in line waiting to get them and those unfortunate enough to not get the shots in time. Restaurants have included, Houlihan’s, Carl’s Jr., Chi-Chi’s, D’Angelo’s, Friendly’s, Maple Lawn Dairy, McDonald’s, Quizno’s, Silver Grill Location Catering, Subway and Taco Bell.

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 virus is 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.

When Taco Bell offered free tacos for every American during baseball’s World Series last month, all I could do was hold my head and mutter something like: "Hasta luego, Amigos!"

The very idea of doling out fast-food tacos to millions of baseball fans should ring like a casino jackpot jingle in the corridors of a personal injury law firm like mine – or all the "wannabees" that are beginning to light up the Internet with "google ads" and plagiarized blogs.  Recently tacos seem have a food-poisoning track record right up there with Chinese-manufactured pet food.  In the past few years alone, we’ve seen outbreaks of deadly E. coli O157:H7, Salmonella, Hepatitis A, Listeria, Shigella and Norovirus in at least 13 states, from Washington and California to New York and Texas – all traced to restaurant tacos.

Just this year there have been taco-related outbreaks in Alabama, Illinois and Oregon.  And those are just the outbreaks scientifically traced by public health officials.  We’ll never know how many more people have been sickened without identifying a source.  Tracing the source of disease outbreaks isn’t easy.  Health officials need to detect an outbreak early, thoroughly interview sick people and find the common denominator before memories fade and evidence disappears.

And even when tacos are suspect, the specific source of the poison varies from one outbreak to the next.  In the Alabama outbreak last summer, the culprit may have been lettuce laced with E. coli.  In Illinois, it was Salmonella in the cheese.  An outbreak at Taco Bell last year in East Coast states was blamed on tainted lettuce, or as my post below says – maybe not.  Others have been tracked back to green onions, cilantro or undercooked meat.  It seems that when restaurants layer tortillas, meat, cheese, tomatoes, onions, avocado and lettuce, there are multiple opportunities to contaminate, cross-contaminate and make people sick.

Take, for example, a major outbreak of Hepatitis A in Florida in December, 2000.  Officials at the Lake County Health Department learned that seven people were sick, and five were hospitalized with Hepatitis A, all in a two-week span.  State and local officials identified the toxin and questioned each of the patients, including family members and friends who were not so sick.  Eventually, officials identified 78 people sickened in five eastern states. In the Florida case, most of the sick people had eaten at a Taco Bell restaurant in Fruitland Park.  Further inquiry narrowed the possibilities down to six menu items and eight ingredients, and only two of those items had been eaten by a majority of the sick people. Eventually, they zeroed in on the green onions as the most likely cause.  But, given the fact that nearly every menu item in a Taco Bell has nearly the same ingredients, how do you really know what ingredient was contaminated?

My point: Tacos can be dangerous.  The ingredients – meat and lettuce and green onions – come from an array of sources, are handled by so many people and are all tossed into the same products, creating a very muddy trail of evidence.  A list of outbreaks below:

Date Location Vendor Microorganism Food type
Oct 98 WA Finley School E. coli O157:H7 Taco Meal
Aug 00 TN San Antonio Salmonella Unknown
Oct 00 CA Viva Mexico Shigella Salsa
Feb 02 IL Laredo Salmonella Employee
Aug 03 TX Cheese LIsteria Cheese
Aug 03 MO Habaneros E. coli O157:H7 Salsa
Nov 03 PA Chi-Chi’s Hepatitis A Onions
Sep 05 CA La Golondrina Hepatitis A Lettuce?
Jun 06 OH La Fiesta Norovirus Employee
Nov 06 Several Taco Bell E. coli O157:H7 Lettuce?
Nov 06 Several Taco Johns E. coli O157:H7 Lettuce
Jan 07 AU Mex Express Botulism Cheese
Jan 07 OR Sergio’s Dos Norovirus Unknown
Mar 07 IL El Paso Salmonella Cheese
Jul 07 AL Little Rosie’s E. coli O157:H7 Lettuce

And there have been more – In October 2007, Tortilla Flat was the scene of a Norovirus outbreak and just a few days ago, Carniceria Y Taqueria served Salmonella-Tainted Tacos in North Carolina.  Buenos Noches.  Thanks to my friends at K-State (who bring you BARFBLOG) for providing a "bite" of the history of the "terrible tacos."

Two East Tennessee counties, Campbell and Scott, have reported an increased incidence of hepatitis A cases for the second time this year. The East Tennessee Regional Health Department has confirmed eight cases of hepatitis A since June 25, and the Health Department is working to determine the source of a potential outbreak. In April, 2005, 23 cases were confirmed in Campbell, Scott, and Anderson counties, but health officials were unable to pinpoint the source of the earlier outbreak.
Hepatitis A is a virus that primarily infects the liver. Symptoms of infection may not appear for 15-50 days after exposure to the virus. They include muscle aches, headache, loss of appetite, abdominal discomfort, fever, and malaise. After a few days of initial symptoms, jaundice (yellowing of the skin and eyes) sets in. In rare cases, the hepatitis A virus causes liver failure and impairs the infected person’s cognitive functioning.
“Ideally, outbreaks would be prevented by vaccination against hepatitis A,” said William Marler, a Seattle attorney with a law practice dedicated to representing victims of foodborne illness. “I’ve represented hundreds of people in the last two years who either became ill with, or were exposed to, the hepatitis A virus. Some have had liver transplants, or even died after suffering from acute hepatitis A infection.” The CDC estimates that at least 100 people die each year after suffering from hepatitis A-induced liver failure.
“This is the second time since April that public health has been put at risk in East Tennessee. People need to know that outbreaks can be prevented through widespread vaccination against hepatitis A. It’s time to take this threat more seriously and do what we can to stop outbreaks before they start,” Marler concluded.
Marler has represented hundreds of victims of hepatitis A outbreaks, including over 75 victims of a 2003 hepatitis A outbreak in Pennsylvania that was traced to contaminated green onions, and 29 people who were infected with hepatitis A after being exposed at a Seattle Subway sandwich shop. Marler Clark has also represented thousands of people who were forced to receive Immune Globulin injections to prevent infection with hepatitis A after they were exposed to the virus by infected food handlers.

The Centers for Disease Control and Prevention (CDC) estimates that each year 76 million – or one out of every four – Americans are sickened as a result of consuming contaminated foods or beverages. Some become seriously ill; 325,000 require hospitalization and 5,000 die. Older adults, young children, and those who have weakened immune systems are particularly vulnerable.
More than 250 different foodborne diseases have been identified. Most of these diseases are infections caused by a variety of bacteria, viruses, and parasites.
Foods that are contaminated with poisonous chemicals or harmful substances can also cause illness. Symptoms of foodborne illness vary by disease but the most common are nausea, vomiting, abdominal cramps, and diarrhea.

Continue Reading Foodborne Illness

As the AP has reported, the bankrupt Chi-Chi’s Inc. and its subsidiaries have tentatively agreed to pay $800,000 to compensate nearly 9,500 people who got inoculated because of a hepatitis outbreak linked to a western Pennsylvania restaurant.
The Associated Press obtained a copy of the class action settlement agreement, which must still be filed in federal bankruptcy court in Delaware, from William Marler, a Seattle attorney who represents the plaintiffs’ class.
The victims will split $800,000, but how much each gets will be determined by how many of them eventually file claims with the court, Marler said. His firm will get a fee of $150,000, though Marler said that money would be donated to charity after his firm pays $50,000 in expenses spelled out in the deal.

“With class actions what’s bothered me in the past is that everybody (the plaintiffs) gets a coupon and the lawyers get a million dollars,” Marler said.

Four people died and more than 650 people were sickened by tainted green onions served at the restaurant at Beaver Valley Mall in western Pennsylvania.

In the last two weeks 1,200 High School and Elementary School students from Stockton, California, 5,000 patrons of a Clinton, Tennessee Waffle House, and thousands who ate a Norfolk, Virgina Soul Food Restaurant all have something in common – all are being urged to get Immune Globulin (Ig) shots to prevent the infection and further spread of hepatitis A after being exposed to a hepatitis A infected foodservice worker.
It seems that hardly a month passes without a warning from a health department somewhere that an infected food handler is the source of yet another potential hepatitis A outbreak. Absent vaccinations of food handlers, combined with an effective and rigorous hand washing policy, there will continue to be more hepatitis A outbreaks. It is time for health departments across the country to require vaccinations of foodservice workers, especially those that serve the very young and the elderly.

Continue Reading Call for Hepatitis A Vaccinations for all Foodservice Workers

Nearly 1,200 High School and Elementary School students are being urged to get Immune Globulin shots to prevent the spread of hepatitis A after being exposed to a hepatitis A positive cafeteria worker.

“It seems that a month hardly passes without a warning from a health department somewhere that an infected food handler is the source of a potential hepatitis A outbreak,” said attorney William Marler, managing partner of the Seattle law firm of Marler Clark. “Absent vaccinations of food handlers, combined with an effective and rigorous hand washing policy, there will be more hepatitis A outbreaks. It is time for health departments to require vaccinations of food handlers, especially those that serve the very young and the elderly” added Marler.

Continue Reading Attorney Again Calls for Mandatory Hepatitis A Vaccinations for all

It seems that a month hardly passes without a warning from a health department somewhere that an infected food handler is the source of a potential hepatitis A outbreak, which further proves that the restaurant industry should act now and require vaccination of its employees.
Now the Regional Health Department has confirmed that a foodservice worker who worked at the Waffle House restaurant located at off Highway 61 in Clinton tested positive for hepatitis A. People who ate at the restaurant between April 1 and April 15, during the time when the worker was infectious, are now at risk for developing hepatitis A infection. The infected Waffle House worker is suspected to be the victim of a larger outbreak of hepatitis A that is believed to have caused at least 17 acute hepatitis A infections. Health officials have traced the outbreak to a restaurant in LaFollette.
The Regional Health Department organized a clinic to inoculate patrons of the restaurant who ate there between April 5 and April 15. The average incubation period for hepatitis A infection is thirty days, but can be as long as fifty days. A person who is infected with hepatitis A is infectious for the two weeks pervious to symptom onset and for two weeks thereafter. Immune globulin shots prevent hepatitis A infection, but only if administered during the two weeks following exposure to the virus.