A food handler infected with hepatitis A who worked at New Jersey’s Mendham Golf and Tennis Club is likely responsible for 27 illnesses including one death.

The outbreak, traced to the infected food handler who worked at the Mendham Township club between June 9 and June 30, was first reported in an advisory letter sent to township residents on July 5.

The state Department of Health does not determine the cause of death in outbreaks and does not release medical information, according to spokeswoman Donna Leusner. She did confirm one death among the 27 confirmed cases related to the outbreak.

A letter to club members recommended that anyone who dined at the club between June 9 and June 30 should seek advice from their medical provider.

“Secondary cases related to the food handler may develop until Aug. 19, 2019, which is 50 days from the date the food handler was last infectious,” warns a Mendham Township fact sheet.

During a July 25 inspection, health department officials provided the club’s staff with further instructions on food handling, employee hygiene, food storage, dating of foods, “and other pertinent regulatory items.”

Officials also requested increased cleaning of restroom facilities and possible fomites, such as doorknobs and common surfaces, and scheduled an onsite food handling class held Aug. 6. That training included interactive exercises with food handlers to emphasize the importance of handwashing.

Some people who contract hepatitis A may show no initial symptoms. Others may experience symptoms including fever, fatigue, stomach pain, diarrhea, poor appetite, vomiting, dark yellow urine, and yellow skin or eyes (jaundice).

According to the federal Centers for Disease Control and Prevention, hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus (HAV). It is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water. Hepatitis A is a self-limited disease that usually does not result in chronic infection.

Most adults with hepatitis A have symptoms, including fatigue, low appetite, stomach pain, nausea, and jaundice, that usually resolve within two months of infection.

Children, less than six years of age, often do not have symptoms or have an unrecognized infection. Antibodies produced in response to hepatitis A infection last for life and protect against reinfection. The best way to prevent hepatitis A virus is to get vaccinated.

The New Jersey outbreak is likely part of the broader phenomenon of hepatitis A infections occurring among the nation’s drug users and homeless. However, in some states one-fourth to one-third of infected people are neither homeless not drug users. In the past three years, 30 states have publicly reported 24,688 confirmed hepatitis A cases. Sixty percent of those cases required hospitalization, and the virus has killed 240.

“Nearly every day there is news of yet another hepatitis a positive food service employee who worked while infectious putting customers at risk,” said William Marler, managing partner at Marler Clark and publisher of Food Safety News. “I have been warning about this risk, and advocating to vaccinating food service employees since 2000.  Perhaps this tragedy will prompt the restaurant industry to do the right thing for their customers and themselves,” added Marler.