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Community Is Reeling From Hepatitis Outbreak

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."

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