Hepatitis A Blog

Rock Island County Health Department slates 2nd-dose hepatitis A clinics

Hepatitis A Attorney — Mon, 01 Feb 2010 12:02:52 -0800

According to the Quad-City Times, the Rock Island County Health Department announced this morning that it has scheduled a series of February clinics designed to get a second dose of hepatitis A vaccine to people who were inoculated last summer in connection with an outbreak of the disease.

A health department spokesperson said a second dose of the vaccine or Immunoglobulin is recommended by the Centers for Disease Control and Protection, or CDC, six months or more after a first dose to provide the maximum protection available through immunization.

The people who should receive a second dose are those who consumed products originating from the McDonald’s restaurant in Milan, Ill., during July 2009.

The clinics will be 8 a.m. to noon and 1-4:30 p.m. on Thursdays this month: Feb. 4, 11, 18 and 25. They will be held at the Rock Island County Health Department, 2112 25th Ave., Rock Island. The clinics will be held on a walk-in basis, with no appointment needed.

The cost is $30, regardless of one’s county of residence; cash or check only (no debit/credit cards).

The original vaccinations were free because the shots were provided as a public health response to an outbreak and were administered to prevent illness in those possibly exposed to hepatitis A and to control the further spread of the disease. Since the second dose is not part of the outbreak response, there is a moderate charge to cover the cost of the vaccine itself. The department is not charging for administering the shots. The customary fee for a hepatitis vaccination at the health department would be $45.

In July 2009, there were two different injections administered, depending upon the client’s age. People through the age of 40 years received Hepatitis A vaccine. People 41 years and older received Immunoglobulin.

Those who received Immunoglobulin, not a first dose of hepatitis A vaccine, are encouraged to attend one of the Thursday clinics to receive their first dose of the vaccine. A small number of people received their first dose of vaccine from another health-care provider. They are welcome to attend health department clinics.

About Hepatitis A - A Foodborne Illness

Bill Marler — Sat, 30 Jan 2010 16:37:41 -0800

The Hepatitis A Blog supplements Marler Clark's Web site www.about-hepatitis.com, a site that provides information about hepatitis A, the symptoms and risks of infection, hepatitis A testing/detection, and how to prevent the spread of the hepatitis A virus.

While about-hepatitis.com is informational in purpose, the hepatitis A blog is intended to be a forum for discussion among the site's authors and users. The authors of the hepatitis A blog conduct surveillance on matters related to hepatitis A's impact on individuals and families in different cities, states, and regions.

Please join us in a conversation about hepatitis A that includes subjects such as outbreaks, recalls, and legal cases by commenting on posts that you find interesting

About hepatitis A (HAV)

Hepatitis A is the only common vaccine-preventable foodborne disease in the United States (Fiore, 2004). It is one of five human hepatitis viruses that primarily infect the human liver and cause human illness. Unlike hepatitis B and C, hepatitis A doesn’t develop into chronic hepatitis or cirrhosis, which are both potentially fatal conditions; however, infection with the hepatitis A virus (HAV) can still lead to acute liver failure and death.

Hepatitis A is much more common in countries with underdeveloped sanitation systems. This includes most of the world: an increased transmission rate is seen in all countries other than the United States, Canada, Japan, Australia, New Zealand, and the countries of Western Europe. Nevertheless, it continues to occur in the United States; approximately one-third of the population has been previously infected with HAV (Fiore, 2004; Centers for Disease Control and Prevention [CDC], 2009a). Each year, approximately 30,000 to 50,000 cases of hepatitis A occur in the United States. Although the national incidence (1.0 case per 100,000 population) of hepatitis A was the lowest ever recorded in 2007, it is estimated that 25,000 new infections occurred that year after asymptomatic infection and underreporting were taken into account.

In 2007, a total of 2,979 acute symptomatic cases of hepatitis A were reported (CDC, 2009b). Among the 1,047 cases with available information regarding foodborne or waterborne exposure, 6.5% were found to be foodborne or waterborne related, about one-third the proportion reported at the last peak in 2003. However, 2500 cases remained without known risk factors.

Estimates of the annual direct and indirect costs of hepatitis A in the United States have ranged from $300 million to $488.8 million in 1997 dollars (CDC, 2007). Nationwide, adults who become ill miss an average of 27 work days per illness and 11 to 22 percent of those infected are hospitalized (CDC, 2009c). These are avoidable illnesses, since 21st Century medicine and the advent of hepatitis A vaccine have rendered hepatitis A infections totally preventable. 

How is Hepatitis A Infection Transmitted?

Hepatitis A is a communicable (or contagious) disease that spreads from person to person. It is transmitted by the “fecal – oral route,” generally from person-to-person, or via contaminated food or water. Food-related outbreaks are usually associated with contamination of food during preparation by an HAV-infected food handler (CDC, 2009c). The food handler is generally not ill: the peak time of infectivity (that is, when the most virus is present in the stool of an infectious individual) occurs during the 2 weeks before illness begins. Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A (Butot et al., 2008; Calder et al., 2003; Fiore, 2004; Hutin, et al., 1999; Wheeler, et al., 2005).

HAV is relatively stable and can survive for several hours on fingertips and hands and up to two months on dry surfaces, but can be inactivated by heating to 185°F (85°C) or higher for one minute or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (household bleach) in tap water (Advisory Committee on Immunization Practices [ACIP], 2006; CDC, 2009c; Todd et al., 2009). However, HAV can still be spread from cooked food if it is contaminated after cooking.

Although ingestion of contaminated food is a common means of spread for hepatitis A, it may also be spread by household contact among families or roommates, sexual contact, by the ingestion of contaminated water or shellfish (like oysters), and by direct inoculation from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play, unknown to their parents, who may later become infected from contact with their children. 

What are the symptoms of Hepatitis A Infection?

Hepatitis A may cause no symptoms at all when it is contracted, especially in children. Such individuals will only know they were infected (and have become immune – you can only get hepatitis A once) by getting a blood test later in life. Symptoms typically begin about 28 days after contracting HAV, but can begin as early as 15 days or as late as 50 days after exposure and include muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever, and malaise. After a few days of the aforementioned symptoms, jaundice (also termed “icterus”) sets in. Jaundice is a yellowing of the skin, eyes and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood. The urine will also turn dark with bile and the stool light or clay-colored from lack of bile. When jaundice sets in, the initial systemic manifestations (such as fever and headache) begin to subside.

In general, symptoms usually last less than 2 months, although 10% to 15% of symptomatic persons have prolonged or relapsing disease for up to 6 months. It is not unusual, however, for blood tests to remain abnormal for six months or more. The jaundice so commonly associated with hepatitis A can linger for a prolonged period in some infected persons – sometimes as long as eight months. Additionally, pruritus, or severe “itchiness” of the skin, can also persist for several months after the onset of symptoms. These conditions are frequently accompanied by diarrhea, anorexia, and fatigue. Relapse is possible with hepatitis A, typically within three months of the initial onset of symptoms. Although relapse is more common in children, it does occur with some regularity in adults. The vast majority of persons who contract hepatitis A fully recover, and do not develop chronic hepatitis. Persons do not carry hepatitis A long-term as with hepatitis B and C.

Fulminant hepatitis A is a rare but devastating complication of an HAV infection; as many as 50% of individuals with acute liver failure may die or require emergency liver transplantation (Taylor et al., 2006). Elderly patients and patients with chronic liver disease are at a higher risk of fulminant hepatitis A. In parallel with a declining incidence of acute HAV infection in the general population, however, the incidence of fulminant HAV appears to be decreasing (Taylor et al., 2006).

How is Hepatitis A Infection Diagnosed?

At onset, the various human hepatitis viruses cause very similar illnesses. Therefore, neither the individual nor the healthcare provider can tell by symptoms or signs if a given individual is suffering from hepatitis A.  

Fortunately, blood tests are widely available to accurately diagnose hepatitis A. These are tests for antibodies, or the affected person’s immune response to hepatitis A proteins. Immunoglobulin M (IgM) antibodies, which indicate acute disease, and immunoglobulin G (IgG) antibodies, which stay positive for life, should both be measured. Following is the interpretation of the results:

  * IgM negative / IgG negative: Most persons with these results have never contracted hepatitis A. Antibodies of the IgM variety develop five to ten days prior to the onset of symptoms.   * IgM positive / IgG negative: This result indicates acute hepatitis A.   * IgM positive / IgG positive: This result indicates that acute hepatitis A occurred within the last six months. By six months, the IgM reverts to negative.   * IgM negative / IgG positive: Persons with this result are immune to hepatitis A. They have either been infected with the virus months or years in the past (with or without symptoms), or they have been vaccinated for hepatitis A. However, if they are currently ill, it is not likely to be due to hepatitis A.  Treatment for Hepatitis A Infection (Viral Hepatitis)  Once a clinical infection is established, there is no specific treatment for hepatitis A. Affected individuals generally suffer from loss of appetite, so the main concern is ensuring a patient receives adequate nutrition and avoids permanent liver damage (Mayo Clinic, 2009). An individual’s perception of the severity of fatigue or malaise is the best determinant of the need for rest.

Treatment of those suffering from fulminant hepatic failure depends largely on the affected person’s status. Those who have not developed brain complications, like encephalopathy or cerebral edema, generally undergo an intense course of supportive treatment. But for those whose liver failure is so complete that it has led to these complications, timely liver transplantation is often the only option. Unfortunately, many individuals with irreversible liver failure do not receive a transplant because of contraindications or the unavailability of donor livers (Feldman, 2002).    How to Prevent Hepatitis A Infection

 Hepatitis A is TOTALLY PREVENTABLE. Although outbreaks continue to occur in the United States, outbreaks NEED NOT OCCUR if responsible preventive measures are taken. Food handlers must always wash their hands with soap and water after using the bathroom, changing a diaper, and certainly before preparing food. Food handlers should always wear gloves when handling or preparing ready-to-eat foods, although gloves are not a substitute for good hand washing. Ill food-handlers should be excluded from work.  After exposure, immune globulin (IG) is 80% to 90% effective in preventing clinical hepatitis A when administered within 2 weeks of last exposure (CDC, 2007). Efficacy is greatest when IG is administered early in the incubation period; when administered later in the incubation period, IG might only attenuate the clinical expression of HAV infection. The Advisory Committee on Immunization Practices (ACIP) recommends IG exclusively for postexposure (CDC, 2007). Hepatitis A vaccine, if recommended for other reasons, could be given at the same time.

In 2006, the ACIP recommended routine hepatitis A vaccination for all children ages 12-23 months, that hepatitis A vaccination be integrated into the routine childhood vaccination schedule, and that children not vaccinated by two years of age be vaccinated subsequently (ACIP, 2006). The vaccine is recommended for the following persons:

* Travelers to areas with increased rates of hepatitis A
* Men who have sex with men
* Injecting and non-injecting drug users
* Persons with clotting-factor disorders (e.g. hemophilia)
* Persons with chronic liver disease
* Persons with occupational risk of infection (e.g. those who work with hepatitis A-infected primates or with hepatitis A virus in a laboratory setting)
* Children living in regions of the U.S. with increased rates of hepatitis A
*Household members and other close personal contacts (such as regular babysitters) of adopted children newly arriving from countries with high or intermediate rates of hepatitis A (CDC, 2009d)

The vaccine may also help protect household contacts of those persons infected with hepatitis A (CDC, 2009c; Sagliocca, et al., 1999). Although generally not a legal requirement at this time, vaccination of food handlers would be expected to substantially diminish the incidence of hepatitis A outbreaks. Persons traveling to a high-risk area less than four weeks after initial dose of hepatitis A vaccine, or travelers who choose not to be vaccinated against hepatitis A should receive a single dose of Immune Globulin, which provides protection against hepatitis A infection for up to three months (CDC, 2009c; Piazza, et al., 1999).

 Outbreaks

* Carl’s Jr. Hepatitis A Outbreak 
* Chi-Chi’s Hepatitis A Outbreak 
* D’Angelo’s Hepatitis A Outbreak 
* Friendly’s Hepatitis A Exposure 
* Maple Lawn Dairy Hepatitis A Outbreak 
* McDonald’s Hepatitis A Outbreak 
* Quizno’s Hepatitis A Exposure 
* Silver Grill Catering Hepatitis A Outbreak 
* Subway Hepatitis A

Outbreak   References

Advisory Committee on Immunization Practices (ACIP), Fiore AE, Wasley A, Bell BP. (2006). Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP).

MMWR Recomm Rep.55(RR-7):1-23. Bialek SR, Thoroughman DA, Hu D, Simard EP, Chattin J, Cheek J, Bell BP. (2004).

Hepatitis A Incidence and Hepatitis A Vaccination Among American Indians and Alaska Natives, 1990–2001. Am J Public Health. 94(6):996-1001. Bownds L, Lindekugel R, Stepak P. (2003).

Economic impact of a hepatitis A epidemic in a mid-sized urban community: the case of Spokane, Washington. J Community Health. 28(4):233-246. Butot S, Putallaz T, Sánchez G. (2008).

Effects of sanitation, freezing and frozen storage on enteric viruses in berries and herbs. Int J Food Microbiol. 126(1-2):30-35. Calder L, Simmons G, Thornley C, Taylor P, Pritchard K, Greening G, Bishop J. (2003).

An outbreak of hepatitis A associated with consumption of raw blueberries. Epidemiol Infect. 131(1):745-751. Centers for Disease Control and Prevention (2009a).

Disease Burden from Viral Hepatitis A, B, and C in the United States. Available at http://www.cdc.gov/hepatitis/PDFs/disease_burden.pdf). Centers for Disease Control and Prevention (2009b).

Surveillance for Acute Viral Hepatitis --- United States, 2007. Surveillance Summaries. 58 (SS03):1-27. Centers for Disease Control and Prevention (2009c).

Hepatitis A. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, McIntyre L, eds. 11th ed. Washington DC: Public Health Foundation, pp. 85-97. 

Centers for Disease Control and Prevention (2009d). Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 58(36):1006-7. CDC (2007).

Update: Prevention of Hepatitis A after Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 56(41);1080-1084. Detry O, De Roover A, Honore P, Meurisse M. (2006).

Brain edema and intracranial hypertension in fulminant hepatic failure: pathophysiology and management. World J Gastroenterol. 12: 7405-7412. Feldman, M, Friedman, LS, Sleisenger, MH. (2002). Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 80: 1571. Fiore, AE. ( 2004).

“Hepatitis A Transmitted by Food.” Clinical Infectious Diseases. 38:705-715. Gilkson M, Galun E, Oren R, Tur-Kaspa R, Shouval D. (1992).

Relapsing hepatitis A. Review of 14 cases and literature survey. Medicine. 71:14-23. Hutin YJF, Pool V, Cramer EH, et al. (1999).

A multistate, foodborne outbreak of hepatitis A. N Engl J Med. 340:595–602. Jaykus L. (1997).

Epidemiology and Detection as Options for Control of Viral and Parasitic Foodborne Disease. Emerg Infect Dis. 3(4):529-539. Mayo Clinic. (2009).

Hepatitis A. Available at http://www.mayoclinic.com/health/hepatitis-a/DS00397.  Piazza M, Safary A, et al. (1999).

Safety and immunogenicity of hepatitis A vaccine in infants: a candidate for inclusion in the childhood vaccination program. Vaccine. 17:585-588. Rawls RA and Vega KJ (2005).

Viral Hepatitis in Minority America. J Clin Gastroenterol. 39:144–151. Sagliocca L, Amoroso P, et al. (1999).

Efficacy of hepatitis A vaccine in prevention of secondary hepatitis A infection: A randomized trial. Lancet. 353:1136-39. Scharff RL, McDowell J, Medeiros L. (2009).

Economic Cost of Foodborne Illness in Ohio. J Food Prot. 72(1):128-136. Schiff ER. (1992).

Atypical Manifestations of hepatitis-A. Vaccine. 10(Suppl. Vol. 1): 18-20. Taylor R, Davern T, Munoz S, Han S-H, McGuire B, Larson AM, et al. (2006).

Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes. Hepatology. 44:1589-1597. Todd EC, Greig JD, Bartleson CA, Michaels BS. (2009).

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 6. Transmission and survival of pathogens in the food processing and preparation environment. J Food Prot. 72(1):202-219. Wheeler C, Vogt TM, Armstrong GL, et al. (2005).

An Outbreak of Hepatitis A Associated with Green Onions. N Engl J Med. 353: 890-897. Willner IR, Uhl MD, Howard SC, Williams EQ, Riely CA, Waters B. (1998).

Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States. Ann Intern Med. 128:111-114.

Illinois McDonald Hepatitis A Outbreak Report

Hepatitis Lawyer — Mon, 07 Dec 2009 05:59:22 -0800

McDonalds confirmed as link to Milan Hepatitis A Outbreak

Bill Marler — Wed, 02 Dec 2009 21:54:17 -0800

The Illinois Health Department has released its investigation into this summer's hepatitis A outbreak. It concluded the source of most of cases was food eaten at the Milan McDonald's.

The first case of hepatitis A in the Quad city area was discovered last June. As we first reported back then, the first confirmed case of the liver illness was an employee at the Milan McDonald's. Over the next two months, a total of 34 confirmed hepatitis A cases were reported.

A state investigation has concluded most of the cases originated at the Milan McDonald's and most of the cases *would have been prevented* if only that one employee had properly washed hands.

The findings of the investigation by the Illinois Department of Public Health concludes "the index case was a food handler at the McDonalds in Milan, Illinois and had onset of illness June 11." Investigators also found "other possible sources in the community were ruled out."

And, "The source of the outbreak for the majority of outbreak cases was food eaten at the McDonalds, Milan, Illinois where a food handler worked while infectious and handled foods that were not later cooked."

The state investigation goes on to say that "if the first employee with hepatitis A had used proper hand-washing technique while working the transmission of hepatitis A through food would not have occurred."

And, "proper hand-washing by the index case would have prevented the majority of the cases in the community. Reporting of the index case by designated reporters before June 25 would have.. reduced the number of cases in the community."

Hepatitis A is the most common type of hepatitis

Bill Marler — Fri, 20 Nov 2009 06:04:18 -0800

Washing your hands is one of the best ways to protect against this serious liver disease

Are you traveling to another country, such as Mexico, Africa, Central or South America, Asia (except Japan) or Eastern Europe? Do you have children in a daycare center, work directly with children or help ill adults? If you answered yes to any of these questions, you should consider receiving the hepatitis A vaccine.

Hepatitis A is a serious liver disease caused by the hepatitis A virus. It is the most common type of hepatitis and it can range from mild "flu-like" symptoms to sudden and severe onset liver failure. One in five people are actually hospitalized because of hepatitis A. Some common symptoms are feeling very tired, sick to your stomach, losing weight without trying, pain on the right side of the belly, under the rib cage, a fever or sore muscles. Additionally, older adults may have jaundice (yellow skin), along with dark urine and clay-colored stools.

How is hepatitis A spread? The virus is found in the stool of an infected person. It is spread when a person eats food or drinks water that has come in contact with infected stool. This can happen when an employee with hepatitis A does not wash his or her hands after using the bathroom and then prepares food. The same is true in a daycare center when workers do not wash their hands after changing a diaper.

Another way of contracting hepatitis A is by eating raw oysters or undercooked clams. Similarly, if you travel to a country where hepatitis A is common and you eat uncooked foods or drink tap water, you may contract the virus.

GET VACCINATED

A simple way you can protect yourself from hepatitis A is to get the vaccine. This involves a series of two shots and they are usually 100 percent effective when you get them both before you are exposed to the virus.

A vaccine, like any medicine, could possibly cause serious problems, such as a severe allergic reaction. However, the risk of hepatitis A vaccine causing serious harm, or death, is extremely small and getting a shot is much safer than getting the disease.

Some mild problems include soreness where the shot was given, headache, loss of appetite, and tiredness. Severe problems, which are very rare, would be an allergic reaction that would occur within a few minutes to a few hours of the shot. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heartbeat or dizziness.

There are certain people in the community who should be routinely vaccinated with the hepatitis A vaccine. First, all children age 1, and anyone age 1 and older traveling to or working in countries with high or intermediate prevalence of hepatitis A. Some of these countries are listed at the beginning of this article, but you should consult your physician for more information.

Next, all children and adolescents 18 years of age who live in states or communities where routine vaccination has been implemented because of high disease incidences should receive the vaccine. Lastly, persons who fall within the following groups should also receive the vaccine: men who have sex with men, addicts who use street drugs, people who are treated with clotting factor concentrates and those with chronic liver disease.

There are also certain members of the population who should not receive the vaccine. First, anyone who has ever had a severe (life-threatening) allergic reaction to a previous dose of hepatitis A vaccine should not get another dose. Anyone who has a severe (life threatening) allergy to any vaccine components should not get the vaccine. Next, anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Lastly, the safety of the hepatitis A vaccine for pregnant woman has not been determined. Nevertheless, there is no evidence that it is harmful to either pregnant women or their unborn babies and the risk, if any, is thought to be very low.

It is important to note that you can only get the hepatitis A virus once and it does not lead to long-term liver problems. After it is contracted, your body builds up a defense against it. It can, as previously explained, be prevented totally if certain precautions are taken and the vaccine is received. If you meet the criteria listed above, please contact your healthcare provider to learn more.

This column is provided by the Richmond County Medical Society. Dr. Scafuri is a member of the Society, and specializes in infectious disease. He maintains a practice in West Brighton.

Trinity Hospital pays Rock Island County $80,000 for Hepatitis A Outbreak

Hepatitis A Attorney — Fri, 16 Oct 2009 17:41:21 -0800

According to the Quad-City Times, Trinity Regional Health System has paid $80,000 to Rock Island County to help reimburse unanticipated expenses related to this past summer's hepatitis A outbreak.

Trinity Medical Center treated some of at least 32 patients who came down with the liver disease in July and August. The Rock Island County Health Department inoculated more than 5,324 area residents against the disease during vaccination clinics held in late July.

An investigation completed in early August by the Rock Island County Sheriff's Department concluded that Trinity Regional Health System and Metropolitan Medical Laboratory did not report cases of hepatitis A as promptly as required by law to the county health department, where the belated reports were not acted upon immediately because an employee was on vacation.

Iowa Reports On Spike In Hepatitis A Cases Experienced Last Year

Hepatitis A Attorney — Tue, 22 Sep 2009 09:04:57 -0800

Iowa experienced a 294 percent increase in Hepatitis A cases over the previous three-year period, the state Department of Public Health reports.

According to the annual Iowa Surveillance of Notifiable and Other Diseases report, the Cornhusker State went from a low of 13 Hepatitis A cases statewide in 2006 to 109 cases in 2008.

The uptick represents a 294 percent increase over 2005-2007, the previous three year average. A cluster of cases in southeast Iowa in 2008 was blamed on a restaurant server who continued to work while infected with the liver disease.

According to the Centers for Disease Control and Prevention (CDC), Hepatitis A is usually spread when the virus is taken in by mouth from contact with objects, food, or drinks contaminated by the feces (or stool) of an infected persons.

"The best way to prevent the spread of hepatitis A is to practice good hand washing at all times," said Deb Steffen, community health manager at Floyd Valley Hospital in LeMars, IA.

Steffen’s Plymouth County got through 2008 without a single Hepatitis A case. Nationally, the number of Hepatitis A cases is running at its lowest level in 40 years. A vaccine became widely available after 1995, and it has cut down on incidents of the diseases.

Milan McDonald's Stays On the Menu At Rock Island Courthouse

Hepatitis A Lawyer — Sun, 06 Sep 2009 19:44:51 -0800

Quad Cities residents are not going to soon forget the Hepatitis A outbreak at the Milan McDonald’s.

An Alpha, IL couple, Nichole and John Shannon, became the latest to sue McDonald’s and Milan, IL franchise owner Kevin Murphy in Rock Island County Circuit Court late last week. Mrs. Shannon was hospitalized from July 11-17, tested positive for the Hepatitis A virus, and suffered from liver damage, according the lawsuit.

The Milan McDonald’s was closed July15-17 on orders from the Rock Island County Health Department. The department took the action when a second McDonald’s employee was diagnosed with Hepatitis A on July 15.

At least 32 people testing positive for Hepatitis A are now associated in the Milan McDonald’s outbreak. Counties in both western Illinois and eastern Iowa have contributed to the count. Eighteen of those cases are from Rock Island County where the fast food burger joint is located.

In addition to the injured, 5,324 people who made the mistake of dining at the establishment took advantage of the health department’s offer for free vaccines, which can prevent sickness from occurring after exposure.

Those exposed to the virus and got shots are part of a class action lawsuit that has also been filed.

Cluster of Hepatitis A Cases Linked To Maine's Remote Swan's Island Claims At Least One Life

Hepatitis A Attorney — Tue, 01 Sep 2009 10:19:52 -0800

Swan's Island is a 30-minute ride on the Captain Henry Lee, a 17-car ferry out of Bass Harbor, Maine. When you arrive after Labor Day, there are only about 350 people on the 7,000 acre island.

Now one has died and at least five others are ill --all from Hepatitis A. The six victims and four other suspected cases all stayed in the same Swan's Island house, although apparently not all at the same time.

The fatality was a woman over age 50 who died after returning home. Other victims range in age from 13 to 69. One person remains in the hospital.

During the summer, visitors to Swan's Island increases the population to as many as 1,000. The Hepatitis A outbreak claimed victims from the Midwest and Middle Atlantic States who were apparently summer visitors.

The Maine Centers for Disease Control and Prevention's Dr. Dora Anne Mills says the source of the Hepatitis A is unclear. The house involved did have a septic system problem and nearby clam flats were closed down as a precaution.

Hepatitis A is spread through unsanitary conditions through saliva or fecal contamination. It is not common in Maine as the state averages only about 11 cases each year. No longer residents are involved in the current outbreak. Swan's Island is on the coast near Bar Harbor.

Free Hepatitis A Vaccines Offers To Imperial Beach Users

Hepatitis A Attorney — Mon, 24 Aug 2009 14:36:04 -0800

Outside of the Milan, IL McDonald's, the one place where you really should not be unless you have a Hepatitis A vaccine is Imperial Beach, CA.

That's because northbound ocean currents funnel the polluted water from the Tijuana River into the Imperial Beach surf. To say that the Mexican waters are polluted is to put it mildly. In addition to the usual sewage and garbage debris there are all the elements of Mexico's lively drug trade, including all those used needles and broken vials.

A 2007 survey by the nonprofit environmental group Wildcoast found that 60 percent of regular ocean users at Imperial Beach suffered from illnesses caused by water contamination.

In part of because of that study and past volunteer efforts, public health workers were on the beach Saturday offering free Hepatitis A vaccines to surfers and swimmers alike. San Diego State University studies have shown Hepatitis A is present in 80 percent of water samples taken from the beach.

"It's Possible This Outbreak Is Not Over"--30 Now Confirmed With Hepatitis A

Hepatitis A Attorney — Wed, 12 Aug 2009 14:18:36 -0800

Another lawsuit on behalf of a customer sickened in the Milan McDonald’s outbreak was filed today in the Circuit Court of the Fourteenth Judicial Circuit of Rock Island County. The lawsuit was filed against McDonald’s Inc., and Kevin Murphy, the owner of the McDonald’s restaurant at 400 West First Street in Milan, IL, by Marler Clark, the Seattle-based foodborne illness law firm, and Craig Mielke of the Illinois firm of Foote, Meyers, Mielke & Flowers LLC. This is the second illness lawsuit; a class action lawsuit was also filed on behalf of restaurant patrons who had to get a shot to avoid illness.

The lawsuit is being brought by Karie Fiegel and her 14-year-old daughter, both of whom ate at the Milan McDonald’s in early June, 2009. Hepatitis A Virus (HAV) has an incubation period of 15-50 days, and it was not until early July that Ms. Fiegel fell ill with nausea, vomiting, fever, and jaundice. She sought medical care, but her symptoms only intensified, and she was admitted to the hospital where she remained for three days. In the hospital, tests revealed that she had been infected with HAV. Hepatitis infects the liver, and Ms. Fiegel’s liver enzymes were found to be elevated during her hospitalization. Although she has been released, her liver enzymes remain elevated.

Meanwhile, her daughter also began experiencing symptoms of HAV infection. The teenager was tested and also diagnosed with Hepatitis A.

“There are 30 confirmed cases of HAV,” said William Marler, the family’s attorney. “Given the incubation period of hepatitis A, it’s possible that the outbreak is not over, and we may see additional illnesses. It is very important for anyone who ate at the Milan McDonalds in June to monitor their health—and their family’s heath—very carefully.”

A food worker at the Milan McDonald’s had Hepatitis A, and a series of mistakes exposed as many as 10,000 restaurant patrons to the virus before the restaurant was closed and cleaned (it has since re-opened). A separate class action lawsuit was filed July 21 on behalf of those who had to get Immune Globulin (IG) shots after exposure to HAV at the Milan McDonald’s restaurant. Almost five thousand people have already received shots in mass clinics coordinated by the Rock Island County Health Department. Eligible individuals are still joining the class action suit.

Milan, IL Hepatitis A Outbreak Broke One Month Ago Today At The McDonald's That Never Really Cleaned Up Its Act

Hepatitis A Attorney — Mon, 10 Aug 2009 11:21:08 -0800

One month ago today –before two of its employees exposed up to 10,000 people and infected at least 26 with Hepatitis A – the McDonald’s in Milan, IL would not have made the list for a book of business success stories like Jim Collins’ “From Good To Great.”

After an in-depth look at what was going on at the Milan McDonald’s before the Hepatitis A outbreak, the only book the ill-fated hamburger franchise might fit in would be called “From Not So Good to Worse.”

The poor sanitation record at the McDonald’s owned by the Moline, IL –based JKLM Inc., headed by Kevin J. Murphy of Bettendorf, IA was the subject of local media attention during last month’s Hepatitis A outbreak.

Most if not all of that attention, however, focused on the Milan McDonald’s in 2009, especially its inclusion on a small list of Rock County establishments that:

Had an average inspection score of less than 80 for the previous year.
Seven or more critical violations during the previous year for Category 1 (High Risk) facilities or five critical violations for Category 2 (Medium Risk) facilities. Critical items include such violations as incorrect holding temperatures for potentially hazardous foods, cross-contamination, incorrect store of toxic items, etc.
There have been two or more re-inspections within the past year for Category 1 or one or more re-inspections for Category 2.
An excessive number of repeat violations.

Paul C. Guse, Rock Island County’s Environmental Health Director, did not mince words in his letter to the problem establishments, telling the Milan McDonalds it had been “targeted for a more frequent inspection schedule in an effort to improve food safety practices.”

In addition to promising more frequent inspections, Guse demanded the Milan McDonalds come up with its own list of “measures you have or will take to be in substantial compliance with the food code this year.”

Problems at the Milan McDonald’s were, however, nothing new. Three years before its employees were implicated in spreading Hepatitis A to its customers, the Milan McDonald’s in May 2006 was being warned by the Rock Island County Health Department about its poor hand washing practices.

In October 2006, it went from not so good to worse, getting only a score of 82, down from 90, on the health department’s 100-point scale. There was mold in the ice-making machine, no lid on the McRib sauce, and cold unit lacked thermostats. Shredded cheese was being kept too warm

Hot cheese continued to be a problem for the Milan McDonald’s in March 2007. Sliced yellow cheese was found to be at 86 degrees, not 41 degrees or blow as required. Ten items were on the correction list, but an overall score of 88 amounted to a slight gain for the restaurant.

In a second inspection in late fall, shredded and Swiss cheese was found being kept at temperatures of 69 and 68 degrees, much warmer than the 41 degrees and below required. Food debris including raw hamburger was found in equipment.

In its first inspection in 2008, the Milan McDonald’s got an overall sanitation score of 81. It had insect and rodent problems, an ice cream machine-spilling product, plastic bags of products that were open, and grill that needed repair.

In its second inspection in 2008, the Milan McDonald’s overall score fell still lower to 76. The inspector watched as the same employee sweeping the floor was operating the French frying machine without washing hands between assignments. Other employees were observed eating and drinking on cook line.

A follow up on that poor inspection focused on the restaurant’s actual physical plant and required a remodeling plan be submitted to the department. The attention managed to raise the overall score to 97,

An over-heated HVAC fan, serving the dining room and located over the front counter, was the next equipment failure at the Milan McDonald’s. The “smoke/fire event” closed the McDonald’s on Friday night, Nov. 28, 2008, until the following Saturday morning.

Power was off for about 20 minutes and employees were tapped to clean up. Some spoiled food was thrown out. Fire fighters used about 60 gallons of water on the smoke.

In January 2009, owner Kevin Murphy shared his remodeling plans with Road Island County Health Department. All work was going to be done at night.

Also in January, the department investigated the complaint of a consumer who said they were served two raw chicken sandwiches with the meat pink in color.

On February 26, construction on the remodeling job had been underway for about two weeks. Notice was given that before the new area became operational, the health department must be called.

However, the inspection record for March 13 makes it clear that did not happen. “Failure to communicate with this department has been on ongoing issue that must be resolved immediately,” the report said. The new beverage service was put into service without notice.

On July 14, after the Hepatitis A outbreak was clearly underway, health officials descended on the Milan McDonald’s for a hand-washing seminar, giving special attention to those employees with cuts, and painted and fake nails who were advised to wear gloves.

Health officials returned on July 15 for a full inspection, giving the Milan McDonald’s an overall score of 78. Not good.

The inspection report notes that an initial employee was confirmed positive with Hepatitis A on June 9, 2009; and a subsequent employee was confirmed positive with Hepatitis A on July 15, 2009. The Milan’s McDonald’s was ordered to close until: all employees complete health histories with Rock Island County Health Department; all employees get vaccines or immunoglobulin shots; and all employees complete hand-washing training.

Three days later, the Milan McDonald’s was again open for business.

The July 15^th inspection report is the most detailed written by the department in the past three years. When the post-outbreak report is paired with the promises made in March by the Milan McDonald’s after it was included on list of establishments targeted for special attention, it’s apparent things went from bad to worse again.

McDonald’s promised to document hand washing on all shifts. The post-outbreak report says few employees were observed either washing their hands or turning off water properly with a paper tower.

McDonald’s promised to keep all equipment clean, including all coolers, ice cream machine, cream machine, coffee service, and orange juice machines with the job listed as a daily assignment for each shift. The post outbreak report found one cooler with ice building up with the temperature at minus five degrees; the coffee area needed cleaning and sanitizing, the ice machine was dirty, and the orange juice machine was running warm.

McDonald’s promised to store food property, keeping items off floors in both coolers and dry storage areas. Numerous food items were found at or near floor level, including many open products, according to the post outbreak report.

To be fair, McDonald’s promised to take better care when employees changed out their aprons, and that was one item they did not get written up on.

Another Hepatitis Lawsuit Filed Against Illinois McDonald's - Third Legal Action in Outbreak Tied to Sick Food Worker

Hepatitis A Attorney — Fri, 07 Aug 2009 18:12:10 -0800

Meanwhile, her daughter also began experiencing symptoms of HAV infection. The teenager was tested and also diagnosed with Hepatitis A.

“There are 26 confirmed cases of HAV,” said William Marler, the family’s attorney. “Given the incubation period of hepatitis A, it’s possible that the outbreak is not over, and we may see additional illnesses. It is very important for anyone who ate at the Milan McDonalds in June to monitor their health—and their family’s heath—very carefully.”

Quad City Health Officials Still Cleaning Up From Hepatitis A Outbreak

Hepatitis A Attorney — Thu, 30 Jul 2009 18:33:17 -0800

The Milan McDonald’s in Rock County, IL is doing normal business again, while health officials continue to clean up the Hepatitis A problem.

Another confirmed case of Hepatitis A brings the count for the outbreak to 26. Free inoculation clinics in Rock County handed out 5,366 does of either the Hepatitis A vaccine or immune globulin.

Two restaurant employees may have exposed an estimated 10,000 customers of the Milan McDonald’s to Hepatitis A. Located just off I-284, many Milan McDonald’s customers were probably travelers just passing through the Quad Cities.

The latest victim in the outbreak lives in Henry County, IL, just one county east of the bi-state Quad Cities area.

There 15 confirmed cases in Rock Island County, five in Mercer County, two in Henry County, and one each in Warren and Woodford counties, all in Illinois, as well as two cases in Scott County, Iowa. All the cases are part of the outbreak connected to the Milan McDonald’s.

Rock Island's Trinity Medical Center Steps Forward To Take Some Of The Blame For Milan McDonald's Outbreak

Hepatitis A Attorney — Fri, 24 Jul 2009 19:45:26 -0800

If confession is good for the soul, Trinity Medical Center’s Vice President for Hospital Operations Kathy Cunningham must be feeling better tonight.

On behalf of hospital, she stepped forward today to admit Trinity dropped the ball in not reporting a June Hepatitis A case to the Rock Island County Health Department within 24 hours as required by Illinois state law.

Timely reporting of that case might have prevented the Hepatitis A outbreak now surrounding the Milan, IL McDonald’s, which potentially exposed 10,000 people to the virus. To date, there have been 23 confirmed cases of Hepatitis A in the two-state Quad Cities metro area where Milan is located.

Cunningham told the media today the Rock Island County Health Department called Trinity on Monday, July 13^th, about the June case but the hospital was not able to locate any information about it.

What they could not find was the record of the June 16^th positive test result for McDonald’s employee Cheryl Scram. In the current outbreak, she is “Patient Zero.”

The Trinity investigation found the hospital failed to timely report both the June case and three others in July. “It is with genuine regret we share the information that our process of reporting was not within the required time frame because patient safety is a number one priority for us,” Cunningham said.

Hepatitis A cases must be reported “as soon as possible, within 24 hours.” Anyone with Hepatitis A “shall not work as food handlers or in sensitive occupations during the period when infection control precautions apply.”

The Illinois National Electronic Disease Surveillance System (I-NEDSS), a web-based system, for reporting, and other electronic means can also be used. However, it appears Trinity mailed the June report to the Rock Island Health Department where it went un-opened.

Rock County Health Department Has Some Explaining To Do About Those Dates Upon Which Hepatitis A Was Reported

Hepatitis A Attorney — Wed, 22 Jul 2009 14:19:14 -0800

The Hepatitis A outbreak associated with the McDonald’s in Milan, IL today is up to 23 confirmed cases, including two employees of the fast-food restaurant.

Two new cases from Scott County, IA, which like Rock County, IL is part of the two-state Quad Cities region. All others known to be stricken with Hepatitis A are from the Illinois side of the Mississippi River.

The Rock Island Health Department later today is expected to provide more information on the dates the various Hepatitis A cases were reported to health officials.

There have been numerous questions surrounding those dates because in the final analysis, the Milan McDonald’s Hepatitis A outbreak is not simply about who is lying or who is inept in this single instance. It is about whether the public health system for reporting and managing communicable diseases really works.

Like other states, Illinois requires all health care providers to notify local health authorities whenever they come across certain “reportable diseases”

In Illinois, the overall reporting requirements are found in Section 690.200 of the Public Health Code. Specific provisions for Hepatitis A are found in Section 690.450.

Interestingly, Hepatitis A cases must be reported “as soon as possible, within 24 hours.” Anyone with Hepatitis A “shall not work as food handlers or in sensitive occupations during the period when infection control precautions apply.”

In addition to a long list of health care providers who must report, under the Illinois code “any other person having knowledge of a known or suspected case or carrier of a reportable communicable disease or communicable disease death” is also legally obliged to report it.

How might these legal requirements apply to the facts on some key dates that are now critical to the Milan McDonald’s Hepatitis A outbreak?

June 16, 2009 – McDonald’s Employee Cheryl Schram learns from Trinity Medical Center in Rock Island, IL that she has tested positive for Hepatitis A.

June 25, 2009 – Cheryl Schram visits Milan McDonald’s and informs a manager known only as “Michelle” of her Hepatitis A status. This is confirmed by at least one witness.

July 10, 2009 – Multiple cases of Hepatitis A reported to both county and state health officials.

July 13, 2009 – McDonald’s franchise owner Kevin Murphy says he first learns of the Hepatitis A outbreak from the Rock Island County Health Department. The Illinois Department of Public Health first learns about the Cheryl Schram case, but does not know she was a food handler for McDonald’s until the next day.

July 15, 2009 – A second McDonald’s employee tests positive for Hepatitis A.

July 16, 2009 – There are 19 confirmed and two suspected cases of Hepatitis A, all involving people who ate at the Milan McDonald’s.

July 18, 2009 – The Rock Island Health Department announces free Hepatitis A vaccination and immune globulin clinics for the following Monday and Tuesday for all those who dined at the Milan McDonalds from July 6-10 and July 13-14, 2009.

July 20-21, 2009 – Of the estimated 10,000 who might have been exposed, about 4,000 take advantage of the vaccinations. The Milan McDonald’s is located just a couple blocks off the Interstate 280 beltway that goes around the Iowa-Illinois Quad Cities. Thousands who were exposed to Hepatitis A are far down the road by now.

There are obvious questions from all this that do not have answers at this point. Did Trinity Medical Center report within 24 hours on June 16th or 17th that Cheryl Schram had testing positive for Hepatitis A?

If Trinity did so, it probably used the Illinois National Electronic Disease Surveillance System (I-NEDSS), a web-based system.

When, if so, did the Rock Island County Health Department read the report? It would have included information on the Hep A patient and the attending physician. Finding out more would have required some investigation by the county health department.

Illinois law gives local health departments a lot of power to get investigations done. It requires businesses to cooperate and gives health officials emergency access to records. Finding out fast if someone with Hepatitis A is a food handler is clearly a major goal in the code.

How about the Milan McDonald’s manager who learned on June 25 that one of her employees, who she knew was recently released from the hospital, and now learns of the Hepatitis A diagnosis?

Illinois law obligates “any other person having knowledge of a known or suspected case… to contact local health officials that license restaurants to operate. The number is usually on the license on the wall by the phone.

Class Action Lawsuit Filed On Behalf Of Ten Thousand People May Have Been Exposed to Hepatitis A at Milan,IL McDonald's

Hepatitis A Attorney — Tue, 21 Jul 2009 12:39:56 -0800

A class action lawsuit was filed today in the Circuit Court of the Fourteenth Judicial Circuit of Rock Island County against McDonald’s Inc., and Kevin Murphy, the owner of the McDonald’s restaurant at 400 West First Street in Milan, Illinois. Marler Clark, the Seattle-based foodborne illness law firm, and the Illinois firm of Foote, Meyers, Mielke & Flowers LLC, filed the lawsuit on behalf of the named plaintiff, Cody Patterson, and all others who were forced to receive Immune globulin (IG) shots after being exposed to the hepatitis A virus (HAV) at the Milan McDonald’s.

An estimated 10,000 people were exposed to Hepatitis A at the Milan McDonald’s. If a person exposed to HAV can get a shot of IG within 14 days of exposure, they can avoid getting sick.

“This lawsuit is on behalf of the thousands of people who have to get IG shots because of exposure to Hepatitis A at McDonald's,” said William Marler, attorney on behalf of the plaintiffs. “These consumers chose McDonald’s in part because of the convenience, and now they have to wait hours in line or pay for a shot, and very likely miss work in order to do either one. Filing a class action suit on their behalf is a way to compensate them for the time, wage loss, and expense.”

“Our experience in handling large Hepatitis A exposures has allowed us to develop a system for helping as many people as possible recover for injuries sustained without the process being too taxing on individuals or the legal system,” continued Marler. “We filed a class action on behalf of the exposed who are able to avoid infection, and then help individuals who fall ill on a case by case basis.”

In 2007, Marler Clark represented members of a class action arising out of a hepatitis A outbreak at a Houlihan’s in Southern Illinois, where 3000 people received IG shots. Marler Clark represented 9000 people who received shots after a 2003 outbreak at a Pennsylvania Chi-Chi’s along with nearly 100 who became ill with HAV. The case of one individual resolved for $6,250,000. The firm also represented the state of Pennsylvania in recovering the cost of the investigation of the outbreak.

Marler Clark represented customers of Boston-area Quizno’s and Friendly’s Restaurant, both of which had HAV outbreaks in 2004. Additional HAV class action suits handled by Marler Clark include over 1,500 people who received shots after an HAV outbreak at D’Angeleo’s Deli in Massachusetts (2001) and 1,400 people after exposure at a Carl’s Jr. in Spokane, Washington (2000). Marler Clark has represented many victims who were unable to avoid infection and fell ill with HAV including suits against McDonald's, Subway and Taco Bell. The most recent group of cases involved those sickened at a San Diego-area Chipotle Grill in 2008.

Hepatitis A is a viral infection of the liver. The hepatitis A virus is commonly spread through the fecal-oral route, and symptoms include nausea, abdominal cramping, fatigue, and fever. In young children these symptoms can appear flu-like, but in some cases do not appear at all. Symptoms most often begin two to six weeks after exposure and can last several weeks. Preventative treatment (the IG shot) is only effective when administered within 14 days of exposure to the virus, after 14 days there is no treatment.

ABOUT MARLER CLARK: William Marler has been a major force in food safety policy in the United States and abroad. His food safety blog, Marler Blog, is read by over 1,000,000 people around the world every year. He and his partners at Marler Clark have represented thousands of individuals in claims against food companies whose contaminated products have caused serious injury and death. His advocacy for better food regulation has led to invitations to address local, national, and international gatherings on food safety, including recent testimony to US Congress Committee on Energy and Commerce. In 1998, Mr. Marler formed the not for profit, Outbreak Inc. He spends much of the year speaking on how to prevent foodborne illnesses.

Rock Island County Politics Heats Up Over Hepatitis A Outbreak Linked To Milan McDonald's

Hepatitis A Attorney — Mon, 20 Jul 2009 13:34:18 -0800

The chairman of the Rock Island County Board is calling for Sheriff Michael T. Huff to investigate the Hepatitis A outbreak linked to the McDonald's in Milan, IL. Democrat

Jim Bohnsack, who chairs the 25-member County Board, told the local News 8 that public health and tax dollars at stake, he wants to know whether the outbreak could have been avoided and who's at fault.

State budget cuts, according to Bohnsack, forced Rock Island County to cut two health department positions last month. He said he does not think the staff cuts have impacted how the county health department has handled the current outbreak.

With thousands of people are lining up in Rock Island County to receive Immunoglobulin (IG or Immune Globulin or Gamma Globulin) shots, the call for the sheriff to investigate should not come as a surprise.

"If our investigation shows the way I think I it's gonna be, McDonalds has got to be on the hook for that kind of money for all that expense that we've got", said Bohnsack.

IG is pooled/plasma-containing antibodies against a number of diseases like measles, rubella, varicella, and Hepatitis A. For protection against Hepatitis A after exposure, it must be given within two weeks of exposure and should be given concurrently with Hepatitis A to develop active immunity. A second dose of Hepatitis A is required six months later.

As many as 20 people have now been infected with Hep A due to their apparent association with the Milan McDonald's. The fast food outlet was apparently told by an employee in early June that she had been hospitalized for Hep A and the Milan McDonald's performed poorly in county health inspections conducted in April and July.

Quad-City Times & KWQC-TV6 Come Up With Much Of What We Need To Know About Hepatitis A Outbreak At Milan McDonalds

Hepatitis A Attorney — Sat, 18 Jul 2009 19:33:37 -0800

Thank goodness for what is left of a free press. If not for the Quad-City Times and KWQC, the folks of Rock Island County would not know the following about the Hepatitis A outbreak:

From KWQC - Hepatitis A Outbreak Latest

Rock Island County now has 14 with Hepatitis A. That brings the total number to 20 cases, with 11 people being hospitalized.
Two workers at the Milan McDonald's tested positive for Hepatitis A butthose tests came back a month ago.
Even though the first case was confirmed back in mid-June, the Rock Island County Health Department didn't close the McDonald's until this past Wednesday.
The health department now says it didn't respond back then because it didn't know back then. The health department says it didn't find out about the case on June 9th until July 10th, a month later because the provider who diagnosed a Milan McDonald's employee with Hepatitis A back on June 9th did not report that case as required. As a result, another month went by before steps could be taken.
The Health Department says in addition to the two confirmed cases at the Milan McDonalds, there are also confirmed Hepatitis A cases involving other local businesses.

From the Quad-City Times - Rock Island County to set up hepatitis A vaccination clinic Monday, Tuesday

The Rock Island County Health Department will offer vaccination clinics Monday and Tuesday at Rock Island High School for those people who dined at a Milan, Ill., McDonald's restaurant connected to a recent hepatitis A outbreak. The clinics will be from 10 a.m. to 6 p.m. Hepatitis A vaccine will be given to people ages 1-40, while immune globulin will be administered to people under 1 year of age or over 40 years of age. Eligible recipients of the vaccines are those who consumed food or beverages at the Milan McDonald's from July 6-10 and July 13-14.
If a person receives the vaccine or immune globulin more than 14 days after they have eaten at the Milan McDonald's, it might not provide protection.
The county has procured enough Hepatitis A vaccine and immune globulin to vaccinate between 5,000 and 10,000 people who may have dined at the restaurant during the specified time periods.

So, there has been Hepatitis A at McDonalds since at least late May (ill worker diagnosed July 9 would have been infectious weeks earlier). And, that working likely infected the other worker and customers over weeks.

One wonders why the physician who diagnosed the worker in June did not alter authorities? One wonders if management at the Milan McDonalds knew the worker to be sick?

The Hart Family Deals with McDonald's Hepatitis A Outbreak in Illinois

Hepatitis A Attorney — Fri, 17 Jul 2009 21:49:01 -0800

Local health departments continue to confirm 19 cases across Rock Island, Henry, Mercer and Woodford Counties. And those related to victims of the outbreak are starting to get vaccinated. According to QUAD TV, one family is struggling:

The Harts visited the Rock Island County health Department for their first shot in a series to combat Hepatitis A. Their son, Dylan, is infected with the disease. Angela Hart describes his symptoms, "He got a fever, thought it was just the flu, laid around didn't eat or drink much then his eyes were yellow so I took him to the doctor."

Her husband Shawn explains why they are frustrated, "11 year-old healthy boy then all of a sudden it's like somebody flipped a switch." Dylan Hart is not the only one. And as a precaution this McDonalds in Milan shut its doors and cleaned after the Rock Island County Health Department told them of their concerns. Shawn Hart, "I'm just hoping for the best, I hope he gets better and hopefully they find out where it came from and take care of it so nobody else has to go through it."

Angela Hart is angry, "They don't think about washing their hands and what it could do and now my baby is sick because someone didn't wash their hands."