Hepatitis outbreak claims first fatality


A patient infected with hepatitis A died last night at UPMC Presbyterian, the first fatality stemming from an outbreak of sickness that has been traced to a Beaver County restaurant.

The person who died was one of three patients who had been hospitalized in critical condition, said hospital spokeswoman Susan Manko. Two other patients remained in fair condition.

The patient was identified as Jeffrey Cook, 38, of Aliquippa, according the Allegheny County coroner's office.

Allegheny County Health Department Director Dr. Bruce Dixon said it is "decidedly unusual" for someone to die of hepatitis A, noting that less than 1 percent of those stricken with it die from the illness.

The fatality occurred as the number of confirmed hepatitis A cases rose to 185 yesterday and Pennsylvania officials worked to prevent those who were sickened from inadvertently causing future outbreaks.

The state Department of Health announced late yesterday that it is extending a clinic at the Beaver County Community College, offering shots of immune globulin today and Monday. The antibody treatment lessens the chance of acquiring the disease if given within 14 days of exposure.

While the majority of people treated at the clinic thus far have been those who ate at the Chi-Chi's restaurant in the Beaver Valley Mall since Oct. 22, an increasing number are people with close contact to those recently diagnosed with hepatitis. Public health authorities are keeping an eye out for newly sick people who work in day care centers and restaurants.

"It continues to be a scramble to prevent additional cases. We don't want a repeat of the Chi-Chi's," said Dr. Andre Weltman, a public health physician with the state. A sick restaurant employee who didn't follow hand-washing rules is a possible cause of the hepatitis A outbreak.

When the Health Department finds restaurant and day-care workers who have hepatitis A, it gives immune globulin to all other workers in the establishment, Weltman said. The department also investigates to determine what kind of job the sick worker performed and, depending on the circumstances, advises patrons to also receive shots.

"In 99 percent or 98 percent of the cases, you don't have to worry about the patrons," said Richard McGarvey, spokesman for the Health Department.

People who ate at the Beaver Valley Chi-Chi's before Oct. 22 and have no hepatitis symptoms should take special care to wash their hands after using the bathroom, Weltman said. The virus is contained in feces and an infected person can shed the virus for up to two weeks before symptoms appear.

Transmission of the virus from person to person requires more than just casual contact, however. Typically, a person is exposed to the virus by eating a contaminated food item or placing a contaminated utensil or other object in his mouth.

Weltman noted that while the current number of cases suggests that several hundred people might ultimately get sick, that's just a fraction of the estimated 11,000 meals served at that Chi-Chi's last month.

"I don't want people to be upset just because they happen to know someone who happened to eat there," he said.

Three investigators from the federal Centers for Disease Control and Prevention will be assisting in the investigation and were expected to arrive in Pennsylvania last night or sometime today. The state's public health resources are being consumed by the prevention efforts and assistance is needed with the ongoing investigation, said Jessica Seiders, a state Health Department spokeswoman.

As of 4 p.m. yesterday, a total of 6,847 people had been screened and nearly 6,400 had received shots of immune globulin in three days at the clinic.

The clinic will be open today from 10 a.m. until 2 p.m. and Monday from 11 a.m. to 3 p.m. under the Dome at Beaver County Community College.

Restaurant inspections in Beaver, Butler and Washington counties have been temporarily halted so that workers can concentrate on educating restaurant employees in the area, said Donna Pinkham, spokeswoman for the state Department of Agriculture.

Those inspectors have visited 250 restaurants in Beaver County this week, asking managers to inquire about the health of workers and whether they had close contact with people involved in the outbreak.

All Pennsylvania restaurants will be required by December to implement new food code regulations and Beaver-area establishments are being asked to do so sooner, said John Stella, the Agriculture Department's food safety regional supervisor. The new regulations prohibit bare-hand contact with food that's ready to be served and demand that sick employees be excused from work, he said.

"We're going to every restaurant in Beaver County in person," he said. "There have been employees from Chi-Chi's that are working at other establishments, or had worked at Chi-Chi's and now work somewhere else."

In some cases, those restaurants are being asked to call the Health Department. But none of those situations has constituted a public health threat, said McGarvey.

Agriculture inspectors visited the Beaver Valley Chi-Chi's yesterday morning and the inspection went well, Stella said. The restaurant might reopen on Monday, he said. Officials with Prandium Inc., the Irvine, Calif.-based parent company of Chi-Chi's, didn't return phone calls seeking comment.

The outbreak in Beaver County was the latest dose of bad news for Prandium, which operates 128 Chi-Chi's restaurants in 20 states. On Oct. 8, the company put those eateries under Chapter 11 protection in U.S. Bankruptcy Court for the District of Delaware.

Of the 185 confirmed cases reported as of yesterday, Pennsylvanians accounted for 158. There were 21 cases in Ohio, four in West Virginia, one in Florida and one in South Carolina. The number of confirmed cases among Chi-Chi's employees remained at four.

Although a 47-year-old man reportedly was being evaluated for a possible liver transplant Thursday as a result of the outbreak, no update on his condition was available yesterday. In addition to the patients who were in critical condition, UPMC continued to treat two other patients who were in fair condition.

Doctors at Children's Hospital said they have treated five patients with confirmed cases of hepatitis A and two patients with suspected cases during the week, said hospital spokesman Marc Lukasiak. All patients were evaluated, treated and released except for one who was in fair condition. The children ranged from 4 months to 10 years old.

Many hepatitis A patients have sought care at The Medical Center, Beaver, but a hospital spokesman would not release numbers yesterday.

Central Blood Bank officials said yesterday there is a small risk that blood donors exposed to hepatitis A could transmit the virus through donation. So the blood bank is asking that people who ate at the Beaver Valley Chi-Chi's between Oct. 1 and Nov. 2 and have donated blood to contact the blood bank so that their products may be removed from inventory.