Los Angeles County public health officials confirmed Wednesday that hepatitis A outbreaks last fall hit a popular Mexican restaurant in downtown Los Angeles and a North Hollywood catering company favored by big movie studios.
At La Golondrina on Olvera Street, 15 patrons fell ill after eating there Sept. 14 or 15, said Elizabeth Bancroft, a county medical epidemiologist.
On Oct. 3, Silver Grill Catering served what the county suspects was contaminated baby green lettuce, leaving 19 ill.
Public health officials had for weeks resisted naming the likely sources of some outbreaks, saying it was not necessary because the window for prevention was "long over" by the time the county had traced the illnesses to their point of origin.
However, the agency has been under pressure from some news organizations to disclose more details about the autumn outbreaks, which collectively sickened more than 300 people at various locations in Los Angeles County.
"If we have a few cases and we think it's traceable to a restaurant, but [the infections occurred] six weeks ago and … there's no evidence of continuing problems, what's the benefit" of identifying the restaurant? said Dr. Jonathan Fielding, county public health director. "It may simply be they got a bad head of lettuce."
The county said its inspection of La Golondrina showed that no employees were ill with hepatitis A during the time of infection, and the restaurant's food preparation practices met federal guidelines. Only patrons in the two-day period in September were affected, and by the time the county uncovered the connection in November, it was too late to give anyone a preventive shot of immune globulin, or antibodies to prevent infection.
By contrast, county officials did identify the restaurant when five workers at Café Pinot fell ill with hepatitis A in December because the outbreak was traced in time to give the shots to patrons.
But some patrons of La Golondrina said that they would have preferred to have been notified of the outbreak.
"I would like to have known," said Michael J. Partos, a downtown lawyer. "I wouldn't have eaten there if I knew that they were under a hepatitis investigation."
Marie Tervalon, a customer service representative for the MTA, agreed.
"That was wrong, that was really wrong," she said of the county's resistance to releasing the information. "I guide people all over the place, and this is one of the places I recommend."
Still, the news won't keep Tervalon away. She noted that the restaurant gives MTA employees a 15% discount.
Tervalon's husband, Kenneth, saw no problem with the county's approach.
"Why let anyone know now, if they had cleaned up the problem?" he said. "What do you want them to say? 'We had an outbreak of hepatitis A three weeks ago, but it's OK now?' "
La Golondrina's manager, Almy Leon, said officials had found no fault in the way employees handled food. Although no employees were found to have been ill in September, Leon said, all were recently sent to a clinic to get tested for hepatitis A as a precaution. None tested positive. The inspectors checked everything, Leon said, and "we still have a letter A" health rating from the county. "They didn't find anything wrong with us. Otherwise, we'd be closed right now."
Antoine Mascaro, owner of Silver Grill Catering, said he changed produce suppliers after the county identified contaminated baby green lettuce as the likely source of infection in his company's case. The company also has begun washing bagged lettuce that is labeled pre-washed. Public health officials in December recommended using cool, running water.
Mascaro declined to name the company that had supplied the lettuce.
KTTV-TV Channel 11 first identified the two locations in a report last month.
Hepatitis A cases began to increase significantly in August 2005. From then through December, 344 cases of hepatitis A were confirmed, peaking in November with 113 cases. Before August, the county averaged nine cases a month.
The numbers have declined in recent weeks. There were 43 cases in December and nine in January, although those figures are likely to increase as the county continues to investigate reports of infection.
Fielding said hepatitis A is a particularly difficult disease to monitor, because unlike other food-borne illnesses, it takes several weeks for symptoms to appear after exposure.
Contaminated food often is discarded, and people have a hard time remembering where they ate weeks before.
"In many of the outbreaks of food-borne illnesses, we don't find a definitive source," Fielding said.
In a report to the Board of Supervisors, the county said it had traced other infections during the fall to a downtown communal home that ran a soup kitchen and a drug treatment center.
Hepatitis A is normally spread from person to person through fecal matter. Symptoms include fever, chills, muscle aches, fatigue, jaundice, nausea, vomiting and cramps.
About 7,000 people fall ill with the disease annually in the U.S. While most recover with medical attention, hepatitis A kills about 100 each year.