The total includes 30 Pennsylvania residents, three Ohio residents and one West Virginian.
The volume of cases is uncommonly high for a hepatitis A outbreak stemming from a restaurant, said Jessica Seiders of the state health department. Pennsylvania's last case was in 2002 in an upscale restaurant in Lancaster County and involved only two or three people, she said. No other recent cases have been reported locally.
Anyone who ate at the restaurant during October or November could be at risk. The first confirmed case of hepatitis A was from someone who ate at Chi-Chi's on Oct. 2, Seiders said.
In a press conference Tuesday, Center Police Chief Barry Kramer said more than 11,000 people were served at the restaurant between the October and November dates, all of whom could be at risk for the virus.
All Chi-Chi's employees were tested Tuesday for the hepatitis A virus. Twelve of about 50 employees are showing symptoms of the virus, but no cases have been confirmed, Seiders said.
Health officials will be at the Community College of Beaver County's Golden Dome from 8 a.m. to 7 p.m. today through Friday offering immune globulin injections to anyone who ate at the restaurant from Oct. 22 through Nov. 2 and has not yet shown symptoms of hepatitis A.
Kramer said it is difficult to estimate how many people will show up for the injections. "The number has fluctuated between two and 10,000," he said.
For those already showing symptoms, there is nothing to do but let the disease, which is usually not fatal, run its course. The antibody treatment will not work on diners who were exposed before Oct. 22.
Karen Cope of Economy said she and her husband, Jim, ate at the restaurant Saturday night and brought home food that the couple's two daughters, Sara, 14, and Susan, 12, ate.
Though no one is showing any symptoms, Karen Cope said she's taking the entire family, including their son, Donald, 16, who didn't eat any of the food, to CCBC.
"I'm concerned," Cope said Tuesday. "You hear hepatitis, and it scares the crap out of you. You just don't want to take a chance with this."
The Medical Center, Beaver, began treating people showing symptoms of the virus over the weekend. By Tuesday morning, hospitals, doctor's offices and the health department were deluged with calls from worried Chi-Chi's diners.
Center Medical Associates in Center Township had 36 voice-mail messages within 10 minutes Tuesday morning, all from people who had eaten at the restaurant, site manager Sandy Gall said. Some had minor symptoms they thought might portend hepatitis; some were worried about transmitting the disease to grandchildren.
The Medical Center got an "overwhelming number" of calls asking about the virus Tuesday, spokesman Scott Monit said. The number of people coming into the emergency room was up 15 percent over the normal.
About 50 people somehow got the phone number of the health department's press office in Harrisburg and called Tuesday morning asking for information. The health department is asking people to call (877) 724-3258 with any questions. That line also was deluged with calls Tuesday.
Steve Sprowl, a Chi-Chi's divisional vice president, said the outbreak did not extend to any Chi-Chi's restaurants beyond the Beaver Valley Mall.
"We want everyone to understand that this was an isolated incident in one location," he said. "We made a voluntary decision to close the restaurant until we get to the bottom of what's going on."
The restaurant will not reopen "until we are confident the health and safety of our employees and guests are not in question," Sprowl said.
State inspectors visited the restaurant Saturday and found it in compliance with all health regulations, Sprowl said. He would not say what prompted the visit but said it was not a routine visit.
The restaurant also "scored 100 percent" during a follow-up visit Monday, he said.
Sprowl said an outbreak of hepatitis at another restaurant chain, not in this area, was leading inspectors to target green onions as a possible source of the virus.
Officials think people were exposed to the virus after eating food prepared by someone already infected.
The inspectors would have come from the state Department of Agriculture, Seiders said. Officials from that department were not available for comment Tuesday.
Hepatitis A is very contagious, and there is only one way to prevent its spread: Wash your hands after you use the toilet.
Hepatitis A is transmitted via fecal matter, even the most minuscule piece, Seiders said. An infected person cannot transmit the disease by breathing on another person, although someone can inhale a fecal particle from somebody's hands.
If you don't wash your hands, anything you touch could be contaminated with feces.
Symptoms include jaundice, or the yellowing of the skin and the whites of the eyes, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, vomiting, and fever.
You are considered contagious one week before the first symptom appears, and two weeks afterward, Seiders said.
If you develop jaundice, you are considered contagious two weeks prior to the appearance of jaundice and one week afterward.
If you do not develop symptoms 50 days after you might have been exposed to the virus, consider yourself in the clear.
IMMUNE GLOBULIN INJECTION
Anyone who has eaten at the Chi-Chi's restaurant in the Beaver Valley Mall between Oct. 22 and Nov. 2 is encouraged to get an injection of immune globulin to prevent infection from a known or likely exposure to hepatitis A.
People who are or have been in direct contact with a confirmed hepatitis A patient are also encouraged to get the antibody injection.
People who ate at the restaurant before Oct. 22 will not benefit from the injection.
Individuals who previously were vaccinated against hepatitis A or those who had a hepatitis A infection in the past are not at risk.
The Pennsylvania Department of Health will administer the immune globulin for free at the Community College of Beaver County's Golden Dome from 8 a.m. to 7 p.m. today, Thursday and Friday.
There will be no testing for the hepatitis A virus at the Golden Dome. Testing must be done through your family doctor.
All those coming to get an injection will be directed to park in the upper lot adjacent to the Dome.
People experiencing symptoms or who feel they are at risk should contact their family doctor.
Physicians are reminded that confirmed or suspected cases of hepatitis A must be reported to the state. Any questions may be referred to the state health department at (877) 724-3258.
Times staff writers Amanda Gillooly and Bill Vidonic contributed to this report.