State officials aren't ready to say the nation's worst hepatitis A outbreak is tapering off, but the numbers were doing the talking yesterday, as 10 new cases brought the total to 530.
It was the fifth consecutive day of slow growth, with just 40 new cases confirmed since Friday. Last week, by contrast, the case count climbed from 240 to 490 in just five days.
The Chi-Chi's outbreak has not yet been conclusively tied to green onions, but the viral strain sickening people here is very similar to those in Southern outbreaks that were green-onion based.
A watchdog group yesterday questioned why the Food & Drug Administration didn't alert consumers and restaurants to potential green onion problems following the outbreaks in September and October in Tennessee, North Carolina and Georgia.
The FDA didn't put out an advisory about green onions until this past weekend.
State officials, in providing the most detailed information thus far about the outbreak, said yesterday that 199 people who got sick ate at the restaurant between Oct. 2 and Oct. 6.
Given that time frame, those people would not have benefited from a more prompt response from the FDA because green onions were not implicated in the other outbreaks until Oct. 10.
One outbreak victim remained in critical condition yesterday at UPMC Presbyterian and two were in fair condition. Three patients have died since the outbreak began.
There's reason to think there won't be another spike in cases in the coming days. That's because the protective effect of the immune globulin shots administered to thousands of people should kick in this week. Nonetheless, state Health Department spokesman Jay Pagni said it was too early to be sure there wouldn't be more cases.
The state's study of which food items were eaten by those who got sick won't be completed for several days, Dr. Calvin Johnson, state health department secretary, said during a briefing with reporters.
Investigators continue to interview people who ate at the restaurant in early October and didn't get sick in order to contrast their cases with those who contracted hepatitis A. So far, 400 patrons who didn't get sick have been interviewed.
"I think we're getting close to the number we need," Johnson said.
Caroline Smith DeWaal, director of food safety for the Center for Science in the Public Interest, criticized the FDA yesterday for waiting until Nov. 15 to issue a consumer advisory about green onions. The advisory advised consumers that people concerned about the possibility of getting hepatitis A from green onions should not eat them raw or lightly cooked.
It would have been more helpful if the agency had told consumers whether they should be worried about green onions, DeWaal said. But her broader criticism was with the timing of the advisory, which she said was late and indicative of how FDA regulates produce.
"What we have is a system where FDA's investigation begins only after people are getting sick," said DeWaal, whose nonprofit health advocacy group publishes the Nutrition Action Health Letter. It was founded in 1971 by microbiologist Michael Jacobson, who began his career working for Ralph Nader.
But Dr. Bob Brackett, FDA's director of food safety and security, said the advisory couldn't have been issued sooner because the agency lacked trace-back information about the source of onions in the Southern outbreaks.
FDA announced for the first time this weekend that contaminated onions in the Tennessee outbreak came from Mexico. Lab information showing a close similarity in the viral strains of all four outbreaks wasn't available until this past week, he added.
"We wanted to know that there was some connection," he said. "We didn't know if they were isolated events."
FDA has also traced the Georgia onions to Mexico, Brackett said yesterday, but he didn't know what farms might be involved. The search for the source of the Beaver County onions continues, he said, but it's not clear whether they came from Mexico, too.