About Hepatitis

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What you need to know during a Hepatitis A outbreak

The Roanoke City and Alleghany Health Districts (RCAHD) in Virginia announced that RCAHD has identified a total of 50 confirmed primary cases and 2 secondary cases of hepatitis A. There have been at least 31 hospitalizations and unfortunately 3 deaths linked to Famous Anthony’s restaurants.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A and other foodborne illness outbreaks and have recovered over $800 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.

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What is Hepatitis A?

Hepatitis A is the only common vaccine-preventable foodborne disease in the United States. It is one of five human hepatitis viruses that primarily infect the human liver and cause human illness. Unlike hepatitis B and C, hepatitis A doesn’t develop into chronic hepatitis or cirrhosis, but in rare cases infection with hepatitis A virus can lead to a more rapid onset of liver failure and death.

How do you contract Hepatitis A?

Hepatitis A is a contagious disease that is transmitted by the “fecal – oral route,” either through person-to-person contact or contaminated food or water. Food-related outbreaks are usually traced to food that has been contaminated by an infected food handler. Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A.

What are the signs and symptoms of Hepatitis A?

Symptoms typically begin about 28 days after infection but can begin as early as 15 days or as late as 50 days after exposure. Symptoms may include headache, loss of appetite, nausea, vomiting, abdominal discomfort, fatigue, joint pain, dark urine, clay colored bowel movements, and fever. Jaundice, a yellowish discoloration of the skin and whites of the eyes, occurs in most cases. Hepatitis A may cause no symptoms at all when it is contracted, especially in children. Those infected usually recover fully within 2 to 6 months.

What to do if you become infected with Hepatitis A:

Infection is determined by a blood test. If you know you have been exposed to hepatitis A, immune globulin shots or a hepatitis A vaccine can reduce your chance of infection by up to 90%.

How to Prevent a Hepatitis A Infection:

Ask your health care provider about vaccination – there are many reasons to seriously consider it, including working with food or ill persons, travel, or an impaired immune system. Children who contract hepatitis A but have no symptoms can also pass the virus through ordinary play to their parents. Make sure your childcare providers are vaccinated and be aware of friends and relatives who may have traveled to countries with high rates of infection. Stay alert to notices of outbreaks to determine if your family has been exposed.

Hepatitis A positive food service worker at Josephs Market announced

The Maine Center for Disease Control and Prevention (CDC) and Maine Department of Agriculture, Conservation and Forestry (DACF) have identified a case of hepatitis A virus infection in a Waterville food service worker. The individual prepared food while infectious from December 27, 2019, through January 9, 2020. An assessment of the individual’s illness determined that patrons of Josephs Market in Waterville may be at risk for hepatitis A infection.

Individuals who purchased deli items, ready-to-eat food, or meat from Josephs Market in Waterville between those dates should watch for symptoms and contact a health care provider to be tested if they show any signs of infection. Deli and ready-to eat-food purchased between December 27, 2019, and January 9, 2020, should be discarded. Meat purchased between those dates should either be discarded or cooked thoroughly.

Individuals who ate deli items, ready-to-eat food, or meat purchased between these dates have up to 14 days after eating it to receive Hepatitis A immune globulin (IG) or the vaccine. Contact your medical provider to discuss options. Individuals with compromised immune systems or children under one year old who ate deli items, ready-to-eat food, or meat from Josephs Market during this time could gain added protection by receiving the hepatitis A IG, upon consultation with their health care providers.

Hepatitis A is a vaccine-preventable, contagious liver disease that is caused by the hepatitis A virus. Symptoms can range from mild illness to a severe sickness that requires hospitalization and can last several months. Most adults with hepatitis A have a sudden onset of symptoms such as tiredness, low appetite, stomach pain, nausea, dark urine and jaundice (yellowing of the skin and eyes). Most children younger than 6 years old do not have symptoms or have an unrecognized infection. The best way to prevent hepatitis A infection is to get vaccinated.

Hepatitis A can be spread through contaminated food or water, especially in food prepared by a person who is infected. Symptoms will begin to show 15-50 days after exposure to the virus. An infected person can spread the virus to others approximately two weeks before symptoms start until one week after symptoms end.

Maine DACF and CDC are working with the business owner and local health care providers to minimize risk of further exposures.

7-11 link in Vegas Hepatitis A worry

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.

Bartaco Hepatitis A Outbreak - Years Later

Westchester County Health Department was notified of the first case in what would be identified as the Bartaco hepatitis A outbreak on October 10, 2017. Bartaco is a Mexican restaurant located at 1 Willett Ave, Port Chester, New York.

After learning of a second hepatitis A case with exposure to Bartaco, environmental health investigators conducted facility inspections of the restaurant on October 17 and 19. The Health Departments also provided preventative treatment and timely information to more than 3,000 people who were exposed to the confirmed HAV-infected Bartaco employee.  The inspections found several violations that could have contributed to the spread of hepatitis A to patrons. The Health Departments’ observations included inadequate employee hand washing facilities, and employees handling cooked and prepared foods with bare hands. Additionally, investigators observed that food items were not properly protected during storage and preparation from potential sources of contamination.

The Centers for Disease Control (CDC) performed  genetic analysis of the Hepatitis A strains from the 3 original Westchester residents who ate at Bartaco as well as the HAV-infected employee. The results demonstrated that all the individuals were infected with the same strain of Hepatitis A which was not being seen elsewhere in the United States. Id.

Ultimately, the investigation conducted by the Westchester County Health Department determined that the six laboratory confirmed cases of hepatitis A were associated with the Bartaco hepatitis A outbreak. All six cases had eaten at Bartaco Restaurant between October 12 and 23. It was concluded that the source of the outbreak was an ill employee who worked at the restaurant while infectious. This conclusion was based on (1) one of the initial four primary cases was also a Bartaco employee; (2) none of the primary cases knew each other or ate at the same time; the only commonality among the confirmed cases was their consumption of food and drink from Bartaco from September 7—12, 2017; (3) observations by WCDOH environmental inspectors indicated violations related to bare-hand contact with foods, utensils, and inadequate handwashing facilities for Bartaco staff; (4) subsequent investigation of food sources for the Bartaco brand indicated that all locations are serviced by the same supplier, and no other Bartaco restaurant experienced similar illness; and (5) while no ill employee was ultimately identified from September 2017, 22 employees who worked during that time were unable to be interviewed and investigated as a possible index case.

The conclusions made by the Westchester County Health Department are supported by the plaintiff’s expert witness Kristin Sweet, PhD, MPH. Ms. Sweet has an extensive background in public health, epidemiology, foodborne illness investigations, and viral infections, working specifically as an infectious-disease epidemiologist for viral hepatitis for 13 years.

Specifically, Kristin Sweet, PhD, MPH, concluded:

The only common exposure among the five primary cases of hepatitis A in this outbreak was having eaten at Bartaco in Port Chester, NY. During an inspection of the restaurant, gaps in sanitation practices were identified including bare‑hand contact with ready‑to‑eat foods and lack of handwashing supplies at sinks. Although the epidemiological investigation did not implicate a specific food item or food handler as the source of the infections, the environmental health assessment at the restaurant found food‑handling practices that could have led to contamination.

According to the NEARS Form, the restaurant did not have a salad bar or buffet where customers could more easily contaminate food consumed by other patrons. Employees and customers used separate restrooms and cases occurred both in customers and one employee. While hepatitis A can survive on environmental surfaces for a month or more, the likelihood that a customer contaminated a surface that was touched by multiple patrons on multiple days resulting in infection is low. Despite the fact that the NYDOH reported that no source was identified through their investigations, an ill food handler is still a possible source. These interviews depend on the availability of all employees completing an interview or survey. Even if all employees were interviewed, employees may not be honest or be able to report thoroughly on their symptom history from one or more months prior to interview. In the absence of complete documentation on the employee interviews, either of these scenarios is possible in this instance.

Based on the information provided to me, it is more likely than not that the hepatitis A outbreak at Bartaco was foodborne.

A second expert, Roy E. Costa, RS, MS (MBA), a Public Health Sanitarian and Consultant with over twenty years’ experience reached a similar conclusion, providing the following opinions of the case:

1. Bartaco was the source of 5 primary HEP A outbreak cases.

2.     There were 2 secondary outbreak cases related to the primary cases.

3.     A HEP A infected Bartaco co-worker was the most likely source of the HEP A virus.

4.     The HEP A Positive employee and 4 other primary cases in October were exposed to an unidentified infected co-worker in September of 2017.

5.     A contaminated food and beverage were the most likely modes of HEP A virus transmission.

6.     The most likely contributing outbreak factors were poor maintenance of hand washing facilities, poor personal hygiene practices, lack of hand washing, bare-hand contact of RTE foods, and poor management surveillance.

Yet another restaurant with a hepatitis A issue

An employee at Steak ’n Shake in Columbia County reportedly tested positive for hepatitis A.

According to the Georgia Department of Public Health and East Central Health District, the employee is not currently working at the restaurant on Belair Frontage Road and coworkers have been offered the vaccination.

The department said the public has a low risk of being exposed to the virus from food service employees due to standard sanitation practices. Symptoms of hepatitis A include fever, fatigue, nausea, vomiting, diarrhea and abdominal pain and usually appear four weeks after exposure.

Environmental health staff are inspecting the restaurant to ensure safe food handling and preparation protocols are being followed, according to the department.

People who ate at the restaurant recently can talk to their health professional about receiving a vaccination.

California Hepatitis A Outbreak Over After 704 Sick, 461 Hospitalized and 21 Dead

Final update as of April 11, 2018.

With the slowdown in reported hepatitis A cases across California, CDPH has demobilized the outbreak response and continues to monitor reported hepatitis A cases statewide.  While CDPH might receive additional reports of outbreak-associated hepatitis A cases, CDPH has entered a new phase where monitoring of cases and prevention activities, such as vaccinating the at-risk population (people experiencing homelessness and/or using illicit drugs in settings of limited sanitation), have been shifted from emergency response to day-to-day operations. CDPH greatly appreciates the monumental efforts of federal, state, and local government partners, especially local public health departments and their community partners, as well as private partners, to control this large hepatitis A outbreak.  We encourage partners to continue providing hepatitis A vaccination for people experiencing homelessness, along with other high-risk groups, including people using illicit drugs and men who have sex with men.

Below is a summary of the outbreak and CDPH response as of April 11, 2018.  Any subsequent hepatitis A cases reported to CDPH will be included in our annual surveillance reports.

No future website updates of this page are planned.

The outbreak began in San Diego County in November 2016 and spread to Santa Cruz, Los Angeles, and Monterey counties.  To date, San Diego and Santa Cruz have reported the greatest number of cases, and in addition to cases in Los Angeles and Monterey counties, other counties have reported 17 outbreak-associated cases. The majority of people who have been infected with hepatitis A virus in this outbreak are people experiencing homelessness and/or using illicit drugs in settings of limited sanitation.  Other states are experiencing outbreaks in similar populations of at-risk people.  Following intensive efforts by local health departments and their clinical and community partners, including vaccination campaigns targeting the at-risk population, education, obtaining and managing vaccine, and many other interventions, the number of reported outbreak-associated cases has substantially decreased in California.

CDPH has helped to support the local health department response in the following ways:

  1. Coordinating and supporting hepatitis A outbreak response efforts across California and supporting the Governor’s declaration of a state of emergency to secure and purchase vaccine in a time of vaccine constraint.
  2. Monitoring the outbreak and providing epidemiologic support to the response by enhancing monitoring of cases, testing specimens to identify the outbreak strain, and providing staff and technical expertise, including developing and disseminating disease control, clinical, and vaccine prioritization guidance.
  3. Buying, distributing, and monitoring hepatitis A vaccine – to date, CDPH has distributed about 123,000 vaccine doses to local health departments during this outbreak.
  4. Communicating accurate information about the outbreak, control measures, and level of risk of hepatitis A infection for different populations with partners, the media, and the public.
​Jurisdiction ​Cases ​Hospitalizations ​Deaths
​San Diego ​587 402 20
​Santa Cruz 76 ​33 ​1
​Los Angeles ​12 8 ​0
​Monterey ​12 ​10 ​0
​Other 17 ​8 ​0
​Total 704 461 21

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