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Hepatitis outbreak in Beaver County reaches 130

One may need liver transplant; 2 or 3 others in intensive care

The medical picture emerging from a hepatitis A outbreak in Beaver County got worse yesterday, with the number of confirmed cases rising to 130 and one patient reportedly needing a liver transplant.

Two or three hepatitis A patients have been transferred to UPMC Presbyterian, where they were being treated in intensive care for serious liver problems, said hospital spokeswoman Lisa Rossi.

A Seattle attorney said he was contacted yesterday by the family of a 47-year-old man with liver failure here who needed a transplant at UPMC. The attorney, William Marler, said the family didn't want more information, including the man's identity, released.

Marler said he was planning other lawsuits related to the outbreak.

The chance of fatality among hepatitis A patients is about one in 1,000, but that risk increases in older patients and those with underlying liver problems, said Dr. Andre Weltman, a public health physician with the state Department of Health.

Weltman said he could not confirm details about the 47-year-old man's condition, but "this is a pretty severe situation."

While hepatitis A does not typically cause such serious illnesses, reports of patients needing intensive care are not surprising considering how many people have been sickened by the current outbreak, he said. The total grew from 84 on Wednesday to 130 yesterday, which includes four restaurant workers.

A cause of the outbreak has not been determined, but investigators are focusing on the hygiene practices of restaurant workers during the first week of October at the Chi-Chi's in the Beaver Valley Mall.

The Chi-Chi's outbreak is quickly becoming one of the larger restaurant-based situations involving hepatitis A. Outbreaks linked to a single restaurant typically involve 25 to 200 cases on average, said Llelwyn Grant, spokesman for the Centers for Disease Control and Prevention.

At a clinic yesterday in Beaver County Community College, the state Department of Health continued to provide shots of immune globulin to people who ate at the restaurant from Oct. 22 through Nov. 2. Immune globulin is not a vaccine, but provides temporary immunity to hepatitis A.

As of 2 p.m., 1,337 had shown up for the clinic and the health department had administered 1,148 shots, said spokesman Richard McGarvey. On Wednesday, 2,974 people attended the clinic and the health department administered 2,805 injections, he said.

Some people were turned away late Wednesday because there weren't enough health-care workers, but staff was increased to 20 on Thursday from 12 on Wednesday, McGarvey said.

"This is the biggest clinic of any type that the Department of Health has conducted in at least 10 years," he said.

The largest hepatitis A outbreak on record was in 1988 when about 300,000 people in China ate contaminated clams. Forty-seven people died in that outbreak.

In 1997, a U.S. outbreak involving shipments of frozen strawberries caused 262 people in five states to become infected. Earlier this year, an outbreak in several restaurants in Georgia, Tennessee and North Carolina was linked to shipments of green onions.

The outbreak should serve as a reminder that a hepatitis A vaccine is available, said Dr. David Greenberg, director of the vaccine research program at Children's Hospital. The vaccine is recommended for children in 11 Western states where the incidence of hepatitis A -- 20 cases per 100,000 population -- is significantly higher than the national average.

Children tend to have milder cases of hepatitis A than adults, but it makes sense to vaccinate them because they often pass the virus to their parents, Greenberg said. Plus, there's already a mechanism for vaccinating kids, he said.

There are about 270,000 cases of hepatitis A each year and it's fatal only in rare cases, Greenberg said. Usually, people suffer a few weeks of flu-like symptoms, but they have no lasting liver problems from the virus.

"With hepatitis B or C, there are long-term effects," he said. "Once hepatitis A is over with, it's done."

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