Hepatitis A outbreaks among restaurant patrons have been traced to food contamination by foodservice workers who are infected with hepatitis A, as well as to food items that were delivered to restaurants already contaminated, but were served raw so were never heated to a high enough temperature to kill the hepatitis A virus.

In 2008, San Diego County health officials announced that a number of hepatitis A (HAV) infections had been traced to a Chipotle Grill restaurant, located at 8005 Fletcher Parkway in La Mesa, California, near San Diego. Officials advised customers who had eaten at the restaurant between March 1 and April 22 they may be at risk for infection. By early May, more than 22 people who ate at the La Mesa Chipotle restaurant during the exposure period became ill and subsequently tested positive for infection with HAV. See Chipotle Grill Hepatitis A Litigation.

In 2004, a hepatitis A outbreak was traced to the Maple Lawn Dairy Family Restaurant in Elmira, New York. At least four people were confirmed ill with hepatitis A, including one man who developed fulminant hepatitis and died. Individuals who had eaten at the restaurant and had been exposed to the hepatitis A virus were encouraged to receive immune globulin injections to prevent infection. The Chemung County Health Department investigated the hepatitis A outbreak, and determined that a food worker was the source of the outbreak. The worker, who handled food items while infectious, was diagnosed with hepatitis A several weeks before the outbreak was announced. See Maple Lawn Dairy Hepatitis A Outbreak Litigation.

In November 2003, public health officials from the Pennsylvania Department of Health (PDOH), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and other state and local public health agencies joined to investigate a hepatitis A outbreak among patrons of a Chi-Chi’s restaurant in Monaca, Pennsylvania. Over 600 people became ill with hepatitis A infection during the outbreak; 124 were hospitalized, and four developed fulminant hepatitis A. Three of the four outbreak victims with fulminant hepatitis A died; one received a liver transplant and survived. All restaurant workers were tested, but none were identified who could have been the source of the outbreak. Investigators determined that green onions were the source of the hepatitis A outbreak and that they were contaminated before arrival at the restaurant. Investigators concluded that the inclusion of contaminated onions in large batches of salsa served to all customers contributed to the size of the outbreak. A trace-back of the green onions led to the conclusion that the implicated green onions were contaminated with hepatitis A virus before or during packing into shipping boxes on farms in northern Mexico. See Chi-Chi’s Hepatitis A Outbreak Litigation.

In 2001, the Massachusetts Department of Public Health (MDPH) investigated a hepatitis a outbreak among customers of two D’Angelo’s restaurants. The restaurant’s corporate office notified MDPH that a D’Angelo’s employee had been working while infectious with hepatitis A, and while MDPH and the Swansea Board of Health monitored the restaurant, they learned that seven individuals had become ill with hepatitis A infection several weeks after eating at the restaurant during the time period when the infected employee worked there. The investigation yielded a total of 53 cases meeting the outbreak case definition. An epidemiological analysis of the case interviews revealed an association between the hepatitis A illness and the consumption of food from D’Angelo’s. MDPH concluded, “This large outbreak of HAV was most likely caused by improper foodhandling while an ill employee was shedding hepatitis-A virus in his stool.” Two confirmed cases were food workers employed at Rudy’s Country Store. Both employees had eaten at the Swansea D’Angelo’s three to four weeks prior to the onset of their HAV infections. Accordingly, patrons of Rudy’s received immune globulin injections to prevent infection with hepatitis A. Over 1,600 people received the injections. See D’Angelo’s Hepatitis A Outbreak Litigation”.

In 2000, the Florida Department of Health and Lake County Health Department (LCHD) investigated a hepatitis A outbreak among patrons of the Fruitland Park Taco Bell restaurant. While the Lake County investigation was ongoing, LCHD learned from the CDC that hepatitis A outbreak investigations were also underway in Russell County, Kentucky and Clark County, Nevada. Epidemiologic and environmental investigations and laboratory analysis implicated green onions served at Taco Bell locations in three states as the source of the hepatitis A outbreak. LCHD concluded, “[a]lthough most foodborne outbreaks of hepatitis A are due to food contaminated by an infected food preparer, we believe the ingredients were contaminated prior to arrival at the outlet in this outbreak. . . . The most likely contaminated ingredient is green onion.” See Taco Bell Hepatitis A Legal Cases.