A diabetic Hopewell woman, one of some 410 people who have come down with hepatitis A after eating at a Chi-Chi's restaurant in Beaver County, has died of liver failure.
She is the second person to die in the outbreak.
Dineen Wieczorek, 52, died at the Cleveland Clinic Wednesday night less than a week after she was diagnosed with hepatitis A, her daughter, Darleen Trunzo, told The Associated Press.
Trunzo, 29, of Coraopolis, said her mother and father had eaten at the restaurant for their 32nd wedding anniversary Oct. 6. Dineen Wieczorek went to a hospital Sunday and was transferred Tuesday to the Cleveland hospital for a liver transplant, which she was awaiting when she died, Trunzo told the AP.
"One meal, one meal that's all it took. And people eat out every day, I go out to eat every day. And you never think something like this could come of it," Trunzo told Pittsburgh television station WPXI in an interview last night.
The first fatal victim, Jeff Cook, 38, died of liver failure Nov. 7 after receiving a transplant at a Pittsburgh hospital.
Federal officials describe the outbreak as one of the worst ever, noting that hepatitis A outbreaks like this one originating in one restaurant typically sicken between 25 and 200 people.
The numbers could keep rising through the weekend, said Richard McGarvey, spokesman for the state Department of Health.
In response to the outbreak, Chi-Chi's is removing green onions from its salsas, garnishes and every other item on its menu at restaurants across the country. Green onion contamination has not been identified as the cause of the outbreak, but it is emerging as a prime suspect, due in part to recent hepatitis A outbreaks at restaurants in Georgia and Tennessee.
"Out of an abundance of caution, we have decided to remove this ingredient from our menu," Bill Zavertnik, chief operating officer of Chi-Chi's, said in a statement.
The Centers for Disease Control and Prevention is performing tests to see if the virus spread in Beaver County matches the virus in the other outbreaks, said a CDC spokesman.
"The green onions are among a number of things we're looking at in this investigation," the spokesman said.
Lab tests this past weekend showed the virus matches a strain commonly found in Mexico, said John Stella, regional food safety inspector for the state Department of Agriculture. That helped turn the ongoing outbreak investigation toward consideration of a contaminated food source as the likely cause.
The Chi-Chi's restaurant in Beaver County bought green onions from three different food distributors -- one in Arlington, Texas, another in Salinas, Calif. and a third in Newport, Ky., Stella said. The first two distributors grow their own produce, but it wasn't clear where the Kentucky distributor got its onions, he said.
The Department of Agriculture supplied this "trace-back" information to health investigators last week, Stella said. But after consulting with the CDC, state officials opted not to focus on green onions because the suppliers of Chi-Chi's green onions didn't seem to match those involved with other outbreaks.
In addition to the weekend lab test results, the growing tally of confirmed cases and the information about what those people ate at Chi-Chi's led to a redirection of the investigation's focus, Stella said.
Hepatitis A is transmitted through the inadvertent consumption of an infected person's fecal matter.
Onions could be contaminated with hepatitis A virus via several different routes. One possibility is that a field where the onions are grown at some point might have been flooded with water contaminated with human feces, Stella said.
Another is that field is contaminated by the workers themselves because of a lack of proper sanitation facilities. That was cited as a possible cause of a 1998 hepatitis A outbreak in an Ohio restaurant. In that case, there were 43 confirmed cases and investigators concluded the cause was green onions from farms in either Mexico or California.
Contamination is most likely to occur during harvesting, when workers peel the outer layer of skin off each onion, secure the onions in bundles, cut the roots and trim the stems, according to investigators writing in the Journal of Infectious Disease in March 2001. Workers might have dirty hands because they sometimes must care for small children as they work, the researchers.
The U.S. Food & Drug Administration is aware of the Beaver County outbreak and is working with state and federal officials on the investigation. But a spokesman said the agency would have no further comment.
Several outbreak patients were discharged from local hospitals yesterday, including four of five being treated at Allegheny General Hospital. UPMC Presbyterian discharged one hepatitis A patient Wednesday night, but was still treating four in fair condition and two in serious condition, a spokeswoman said. A patient being treated at St. Clair Hospital was discharged.
Of those sickened, 280 are residents of Beaver County, said McGarvey, of the state Health Department.
The average incubation period for people infected by the hepatitis A virus is 28 to 30 days. Many of the people who might have been exposed to the virus after Oct. 22 at the Beaver Valley Mall Chi-Chi's received shots of a protective treatment of immune globulin.
Nothing is certain, McGarvey said, but it's likely that the impact of those treatments might not be seen in the daily incidence numbers before the middle of next week.
McGarvey said there is no indication that any of the people currently sick with hepatitis A have passed the infection to their close contacts. Infected people can shed the virus in their feces for up to two weeks prior to developing symptoms and for some time after symptoms set in.