UPDATE: Late this afternoon public health officials reported a third patient has died in this outbreak. No further details were released on the patient.

Another person has died in an outbreak of hepatitis A among patrons of a chain of restaurants in the Roanoke, VA, area.

State officials confirmed the death today but declined to release the name or other details to protect the privacy of the victim and her family. The adult woman is the second person to die in the outbreak.

The outbreak has sickened 49 people, with another person infected by contact with one of the direct outbreak patients. An unusually high number of the patients have been hospitalized, with 31 having been admitted. Health officials have said some of the patients have been discharged.

“A small number of cases are still under investigation. No new cases have been reported to RCAHD  (Roanoke City and Alleghany Health Districts ) this week,” according to a statement released today. “It is devastating that we have seen a high rate of severe disease associated with this outbreak.”

All of the sick people, except the secondary patient, ate at one of three locations of Famous Anthony’s restaurants at 4913 Grandin Road, 6499 Williamson Road, or 2221 Crystal Spring Ave. 

An employee who worked at all three restaurants from Aug. 10 through 27 has tested positive for the virus, which causes an infection that attacks the liver. One of the victims has received a liver transplant.

The cousin of the transplant patient reports the operation took place the weekend of Oct. 16-17. The patient’s husband and daughter were also infected, according to the cousin.

Christie Wills of the Roanoke City and Alleghany Health Districts says there is likely no ongoing threat to public health because the incubation time of the virus has expired. Generally, it can take up to 50 days for symptoms to manifest.

Additional patients could be identified if there are sick people who have mild symptoms that become more severe and they seek medical attention. Health care providers in the area are on alert to watch for people with symptoms. Symptoms can include jaundice: yellowing of the skin or the eyes, fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stools, according to the U.S. Centers for Disease Control and Prevention.

A person can be contagious for up to two weeks before exhibiting symptoms, therefore the infected restaurant employee could have been infecting customers unknowingly. The virus is preventable with vaccination.

Patients in the outbreak had tended to be older people, but as of an Oct. 21 statement from the health department, the patients had been trending toward younger people with the age range 31 to 79 years old at that time.

The first patient who died, James Hamlin, and his wife Victoria frequently ate at one of the implicated Famous Anthony’s restaurants, according to the local media. He died on Oct. 8 at age 75. He was a veteran of the Vietnam War.

“His daughter, Dana Heston of Cave Spring, said Hamlin was a strong and healthy man. He worked out three times per week — lifting weights, riding a stationary bike and walking. He did not have any serious medical conditions,” according to the Roanoke Times. Victoria Hamlin was also infected but is recovering.

The health department offered a vaccination clinic for other employees at the Famous Anthony’s restaurants. Free vaccinations are available to the public at the health district’s office in Roanoke.