November 17, 2003
Community Is Reeling From Hepatitis Outbreak
By LYDIA POLGREEN

MONACA, Pa., Nov. 16 - It was her friend Eve's idea: a bunch of high
school girls and a bunch of Mexican food to celebrate her 15th
birthday. Jennifer Seevers, 14, said Mexican food was not her
favorite, but it was Eve's birthday and in Beaver County there are
only so many places for Mexican food. Therefore, Chi-Chi's it was.

So Jennifer and a dozen other girls from Ambridge High School all sat
down to plates of nachos, fajitas and tacos last month. Within a few
weeks, one of the girls was seriously ill with hepatitis A, a
potentially fatal virus that can lead to liver failure, and Jennifer
was lining up to get a vaccine to keep her from developing the disease
too.

"I feel really lucky I didn't get sick," Jennifer said. "But I know a
lot of people did."

In the towns and boroughs in Beaver County, about 20 miles northwest
of Pittsburgh - which has the distinction of having produced an
unusual number of world-class football players, including Joe Namath
and Mike Ditka - it seemed everyone either ate at Chi-Chi's last month
or knows someone who did. Three people have died and more than 500
have been sickened by an outbreak of the disease linked to the
restaurant.

Jennifer's older sister, Dana, came in contact with the virus when the
woman she baby-sits for came down with a serious case of hepatitis A
and had to be hospitalized. Doctors recommended that Dana Seevers, 19,
and her 9-month-old daughter, Cassidy, be vaccinated.

"It's pretty crazy because it just affects everyone," Dana Seevers
said. "Everyone eats there. You just don't know who could be sick."

Health officials in Pennsylvania said the number of illnesses and
deaths was likely to rise through this week as more people developed
the virus, which takes nearly a month to produce symptoms and can be
deadly in some cases.

Richard McGarvey, a spokesman for the Pennsylvania Department of
Health, said that while further deaths were possible, officials hoped
that the antibody inoculations given to more than 8,500 people in the
weeks since news of the outbreak was made public would reduce the
number of new infections.

This is the biggest outbreak of food-borne hepatitis A in the United
States, the Centers for Disease Control and Prevention said.

The exact cause of the infection is not known, but investigators are
looking closely at green onions, or scallions, which are used in
several dishes Chi-Chi's offers and are often served raw. Outbreaks of
hepatitis A in Tennessee, North Carolina and Georgia in September were
linked to scallions, investigators said.

"We haven't been able to pin it down yet," Mr. McGarvey said. "Green
onions and scallions are obviously one of the sources we are looking
at."

On Saturday, the Food and Drug Administration recommended that
scallions be thoroughly cooked to avoid infection.

The source of the virus in the Tennessee outbreak appeared to be
Mexico, the agency said. Investigators are working with Mexican
officials to determine where the shipment originated and where the
scallions went.

All the people sickened in the Pennsylvania outbreak ate at a
Chi-Chi's restaurant at the Beaver Valley Mall, which draws patrons
from a string of working-class towns along the Ohio River west of
Pittsburgh, between early October and Nov. 2, when the restaurant
voluntarily closed. Eleven workers at Chi-Chi's tested positive for
hepatitis A and are being treated, Bill Zavertnik, chief operating
officer of Chi-Chi's, told The Associated Press. The earlier outbreaks
of hepatitis A did not involve restaurants in the Chi-Chi's chain,
based in Louisville, Ky.

Hepatitis A is caused by a virus, and it is most commonly transmitted
by what doctors call the fecal-oral route, meaning that people catch
it from food or drinks that have been contaminated with fecal matter
from an infected person. People with hepatitis A who fail to wash
their hands after using the bathroom and then handle food can spread
the virus; hand washing is an important means of preventing the
disease from spreading. Contaminated foods that are eaten raw or are
lightly cooked can be a source of infection.

Mr. Zavertnik told The Associated Press that all workers at Chi-Chi's
were trained in federal food safety standards.

The average incubation period is 28 days, with a range of 15 to 50
days, and people may transmit the virus before they themselves develop
symptoms.

In children, the disease is usually mild; some may have no symptoms at
all. Adults are more likely to have symptoms, including jaundice, dark
urine, fatigue, abdominal pain, loss of appetite, nausea, diarrhea and
fever. A blood test is needed to make the diagnosis. There is no
specific treatment once the illness develops, but infected people are
advised to avoid drinking alcohol until they recover fully, to avoid
damaging the liver. Many people recover within a few weeks, but in
some cases the symptoms can last two months or longer.

Fewer than 0.4 percent of all cases in the United States are fatal,
and those are usually in elderly people. Unlike hepatitis B and C,
hepatitis A does not turn into a chronic infection.

According to the Centers for Disease Control and Prevention, 10,616
cases of hepatitis A were reported in 2001. Not all cases are
reported, and the agency estimates that there were actually 45,000
acute cases that year.

State health officials in Pennsylvania first learned of the outbreak
from emergency room doctors in Beaver County who reported an unusual
number of cases of hepatitis A in late October. Investigators from the
health department began interviewing the people who had fallen ill and
quickly determined the common thread: all of them had eaten at
Chi-Chi's at the Beaver Valley Mall.

Once the department isolated the restaurant as the probable source of
the infection, Chi-Chi's closed the restaurant voluntarily. But
pinning down the source of the illness within the restaurant has been
more difficult, Mr. McGarvey said. While several employees are
infected with hepatitis A, the sheer size of the outbreak made it seem
less likely that a single person transmitted the disease, he said.
However, he added, the department has not ruled out that possibility.

"We first started the investigation looking at food handlers, but the
numbers kept going up," Mr. McGarvey said. "We had no idea the numbers
would go up that high."

--------