Last week the Washington State Department of Health declared an outbreak of hepatitis A in multiple counties in people who are living homeless or who use drugs. The outbreak includes 13 confirmed cases: nine in Spokane County, two in King County, one in Snohomish County and one in Pend Oreille County. Nationwide, since this outbreak began in 2016, 23,978 people have been sickened, with 14,330 hospitalized and 236 deaths.

Yesterday, a food service worker positive for the hepatitis A virus was discovered at a Lynnwood restaurant prompting public health official to urge restaurant patrons to be vaccinated and shuttering the restaurant.  Hundreds of customers have been exposed in the days that ill worker may have handled food and are now at risk of contracting hepatitis A.  Patrons exposed in the last two weeks have been urged to receive a hepatitis A vaccine.

The hepatitis A virus travels in feces, and can spread from person to person, or can be contracted from food or water. In cases of contaminated food, it is usually the person preparing the food who contaminates it. The food handler will probably not know they have the virus, since the virus is most likely to be passed on in the first two weeks of illness, before a person begins to show symptoms.

Symptoms of hepatitis A infection usually appear around 28 days after infection but can start as early as two weeks after exposure to the virus. only 30 percent of children with hepatitis A actually develop symptoms. Early symptoms of hepatitis A infection include muscle aches, headache, jaundice, fever, loss of appetite, weakness, and fatigue. After a few days of experiencing these symptoms, 70 percent of patients develop jaundice, a yellowing of the skin, eyes, and mucous membranes. Jaundice also causes dark urine and light, clay-colored feces.

Symptoms usually last less than two months, although they sometimes last up to six months, and jaundice can linger for up to eight months. Patients can also experience severely itchy skin for a few months after symptoms first appear.

An acute hepatitis A case can develop into Fulminant Hepatitis A. This is a rare but severe complication of Hepatitis A, in which the toxins from the hepatitis virus kill an abnormally high number of liver cells (around ¾ of the liver’s total cells), and the liver begins to die.  Fifty percent of patients with this condition require an immediate liver transplant to avoid death. Fulminant hepatitis A can also cause further complications, including muscular dysfunction and multiple organ failure.

Hepatitis A is the only common foodborne disease preventable by a vaccine.

As a lawyer, I have seen first-hand the impacts on consumers exposed.  Here are a few examples of cases involving ill workers and the impact on customers and restaurants:

McDonalds in Skagit County in 1998 was implicated in a cluster of Hepatitis A illnesses linked to an exposure by a Hepatitis A positive assistant manager.

In 1999 nearly 40 became ill after being exposed to a Hepatitis A positive working at two Subway locations in the Seattle area.  Several of the patrons were hospitalized with one young boy suffering acute liver failure requiring a liver transplant.

A Carl’s Jr. was hit in Spokane in 2000 with a Hepatitis A cluster that sickened over a dozen after being exposed to an ill worker.

In 2001 a Massachusetts D’Angelo’s Hepatitis A ill employee was linked to several customers who became ill after being exposed to contaminated food served at the restaurant.

A Hepatitis A positive employee at Maple Lawn Dairy in New York sickened at least six customers in 2004, including one patron who suffered acute liver failure and died.

In July and August of 2009, public health officials in the Quad-City region of Illinois identified at least 32 confirmed cases of hepatitis A among residents of Rock Island, Henry, Mercer, Warren, and Woodford Counties. People became ill after eating food purchased from the Milan McDonald’s restaurant and then developing a Hepatitis A infection.

In 2017 Bartaco in New York at least 5 people sickened with Hepatitis A many of who were hospitalized with hundreds of thousands in medical bills and wage loss.

In 2017 a McDonald’s in Waterloo, New York was linked to the death of one woman who was exposed to a hepatitis A ill worker.

And, just last week, the New Jersey Department of Health announced that 23 people contacted hepatitis A after being exposed to an ill worker at the Mendham Golf & Tennis Club.

The restaurants above have collectively paid (or will pay) millions in damages to customers either exposed or who became ill. Many governments paid thousands of dollars for vaccines.

No doubt each restaurant and the local health authorities – after the fact – wish that worker had been previously vaccinated.

And, it is not just those that contract the potentially deadly virus.  At times, hundreds, and at times thousands, of customers are required to receive the vaccine to prevent the illness and to prevent the further spread of the disease.

In 2000, I wrote this:

In light of the recent, large-scale Hepatitis A exposure in the San Francisco Bay Area, food safety attorneys of the Seattle-based law firm of Marler Clark, are asking restaurants and food manufacturers to voluntarily vaccinate all workers against Hepatitis A. “In the last six months Hepatitis A exposures have been linked to two Seattle-area Subways, a Carl’s Jr. in Spokane, WA, Hoggsbreath, a Minnesota restaurant, and three restaurants in Northwest Arkansas, IHOP, U.S. Pizza, and Belvedeers…” Marler continued, “Restaurants and food manufacturers must take action and voluntarily vaccinate all of their employees.”

Usually, after an ill food worker is recognized, restaurants rush to vaccinate their other employees and to clean the restaurant.  Generally, this is too little, too late.  Few restaurants ever consider proactively offering hepatitis A vaccinations, and just as many governments consider ordering the vaccinations of food workers as a way to prevent the spread of the disease.

A few weeks ago, I challenged a large restaurant chain to offer vaccinations to all food service workers and I would never sue them again – an offer that has yet gone unaccepted.  And, since then, that restaurant in fact was linked to a hepatitis A positive ill worker.  That same scenario has repeated itself nearly daily over that last few weeks at restaurants across the country.

However, there are some spots of hope.  A local government in Missouri that is seeing a spike in hepatitis A cases, and has experienced three recent exposure events at restaurants, has now ordered all food service workers to be vaccinated.  And, a restaurant in Florida – which is experiencing its own increase in disease – offered vaccination to all employees before there was a problem in that restaurant.

So, hey, Washington State health authorities and restaurants, make me proud and lets vaccinate food service workers against Hepatitis A – before the problem gets any worse.