Health officials now believe that contaminated food delivered to a Beaver County restaurant is a more likely cause of the ongoing hepatitis A outbreak than poor worker hygiene as originally suspected.
Investigators are also considering whether the problem at the Chi-Chi's restaurant at Beaver Valley Mall is related to recent hepatitis A outbreaks in Georgia and Tennessee, which are being blamed on contaminated green onions.
The number of cases, which rose to 340 yesterday, forced investigators to reconsider the worker-hygiene theory, said Richard McGarvey, spokesman for the state Department of Health. The new thinking also coincided with the arrival this past weekend of investigators from the Centers for Disease Control and Prevention, which investigated the outbreaks in the other states.
In Georgia, about 250 people came down with hepatitis A in September and October after eating at about 12 restaurants in the central and northern parts of the state, said Richard Quartarone, spokesman for the state's health department. In Knoxville, Tenn., 80 people became ill with hepatitis A in September after eating at one city restaurant, said Mark Jones, director of the Knox County Health Department.
Contaminated green onions are the prime suspects in both states.
"Because they're multi-layered, green onions are very difficult to clean," Quartarone said. "The only way to be 100 percent sure that you killed the hepatitis in green onions is to cook them. But they're often used as a garnish, so you don't cook them."
McGarvey cautioned that investigators have not concluded that green onions are the prime suspect here.
"We're focusing more on some product that came through here, some ingredient that was possibly contaminated before a food handler could have contaminated it," he said. "Can I say what product at this point? No."
A confounding factor in the Pennsylvania investigation is that one victim apparently was exposed to hepatitis A around Sept. 20, more than a week before most others were exposed, McGarvey said.
If that individual was a restaurant employee, it might suggest the worker caused the problem, but that's not the case, he said. All of the workers -- 11 as of yesterday -- with confirmed hepatitis cases were apparently exposed during the first week of October.
Dr. Bruce Dixon, director of the Allegheny County Health Department, said a food item such as green onions might be contaminated at one restaurant but not others in a community, because of the way restaurants buy perishables.
"It may be that there are different lots and only one lot was contaminated," said Dixon, who is not involved in the investigation. "That's the real concern with the whole scenario. You're going to have to say it was a different lot than what someone else got, or it was only a certain box or quantity that got contaminated."
Chi-Chi's Inc. announced yesterday that it would not open its Beaver Valley Mall restaurant for at least 60 days.
Meanwhile, hepatitis A patients kept cropping up at local hospitals.
Five patients ranging in age from 5 to 47 showed up yesterday at Allegheny General Hospital, which previously treated two outbreak patients. UPMC Presbyterian had five patients in fair condition and two in critical condition yesterday, one more than on Tuesday.
St. Clair Hospital also was treating an outbreak patient.
Central Blood Bank said yesterday it has pulled from its stocks the blood of 25 people who ate at the Beaver Valley Mall Chi-Chi's in September and October and then donated blood. The local branch of the American Red Cross Blood Services has pulled the blood of about 15 to 20 donors.
Lawsuits related to the outbreak also started pouring in yesterday, with at least two filed in Allegheny County and another two in Beaver County.