Hepatitis Inquiry Moves Deliberately From Farm to Plate

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November 18, 2003Hepatitis Inquiry Moves Deliberately From Farm to PlateBy LYDIA

POLGREEN

 

PITTSBURGH, Nov. 17 — At first, it just seemed like a nasty case of the flu.

Jeff Cook, a 38-year-old unemployed auto mechanic, felt achy and nauseated, so

he took some over-the-counter pain medicine and got some rest.

 

A couple of weeks earlier, about Oct. 6, he had eaten a plate of chicken and

beef fajitas with his wife, Christine, and their two daughters, at the Chi-Chi's

Restaurant at the Beaver Valley Mall not far from their home in West Aliquippa,

about 20 miles northwest of here. There was no reason to suspect any connection.

 

Less than a month after he ate that meal, Mr. Cook was at the University of

Pittsburgh Medical Center suffering from acute liver failure. Surgeons

transplanted a liver flown in from California, Mrs. Cook said in an interview on

Monday, but his other organs were shutting down.

 

" They did everything they could to try and save him, " Mrs. Cook said. " But it

was too late. "

 

Liver failure brought on by hepatitis A, a usually nonfatal viral infection,

killed Mr. Cook on Nov. 7. He became the first person to die in what federal

health officials say is the biggest food-borne outbreak of hepatitis A in the

United States.

 

Two others have died since then and more than 500 people have become infected.

Health officials are looking at similar but smaller outbreaks in Tennessee,

Georgia, North Carolina and Ohio to see if they are related.

 

State officials in Pennsylvania and federal officials from the Centers for

Disease Control and Prevention and the Food and Drug Administration are trying

to pin down the source of the infection that has struck Beaver County, which

includes a string of working-class towns along the Ohio River 20 miles northwest

of Pittsburgh.

 

" We have not identified any specific food source, " Dr. Calvin B. Johnson,

secretary of the Pennsylvania Health Department, said at a news conference here

on Monday. " We hope to get lab results soon that will identify whether it came

from a food source " rather than being passed from a person infected with the

virus, which is the most common method of transmission.

 

Dr. Johnson said that no new cases had been confirmed since Saturday, holding

the number of people sickened at 510. State officials said the number of new

infections might rise because the incubation period for the virus is about a

month, and the restaurant closed on Nov. 2. So far most cases that resulted in

illness appear to have involved people who ate at the restaurant in early

October.

 

Nearly 9,000 people have received immune globulin injections that can prevent

infection if administered within 14 days of exposure. Nearly 10,000 have been

tested for the virus.

 

So far the best guess for what killed Jeff Cook and two others and sickened

hundreds is green onions. Investigators suspect the onions could be the culprits

because they have been linked to outbreaks of hepatitis A in three other states.

 

Even if they do conclusively link the Beaver Valley outbreak to scallions,

tracking the ultimate source of the infection will not be easy. Agriculture

distribution is a complex business that involves many sets of hands, health

officials said.

 

" It could have happened anywhere between the farm and the person's plate, and

there are a lot of steps in that process, " said Richard Quartrone, a spokesman

for the Georgia Division of Public Health, which contended with a hepatitis A

outbreak in September and early October that sickened 250 people who ate green

onions.

 

As for the outbreak here, officials at Prandium Inc., the California company

that owns Chi-Chi's, worked to reassure customers at their hundreds of

restaurants across the country that their food is safe. Chi-Chi's, based in

Louisville, Ky., is considered one of the first restaurant chains to introduce

standardized Mexican fare to the American public.

 

A spokesman for the company said that Chi-Chi's had taken " extraordinary "

measures voluntarily to ensure the safety of its food, including removing green

onions from all of its 100 restaurants. The spokesman said that the Beaver

Valley Mall location had received scores of 90 percent or higher and one perfect

score in its last four health inspections.

 

Twelve employees of the Chi-Chi's branch in Beaver Valley tested positive for

hepatitis A and are being treated, said the spokesman, who would not give his

name or provide any other company representative who would allow himself to be

quoted by name.

 

As the company sought to reassure customers, families like the Cooks wondered

how something as simple as a visiting a popular chain restaurant could bring so

much pain. The Cooks chose Chi-Chi's because their 10-year-old daughter,

Cassandra, liked eating there.

 

It was a fateful choice. The couple's 8-year-old daughter, Courtney, does not

like Mexican food, Mrs. Cook said, so she had a hot dog and French fries.

Cassandra, who had the chicken burrito, also contracted hepatitis A, but she has

recovered.

 

A few weeks after eating at the restaurant Mr. Cook began to feel sick, said

Mrs. Cook, who did not become ill.

 

" He would have aches, run low-grade fever, then it would go away, " said Mrs.

Cook, who is an emergency room nurse at a local hospital. But on Nov. 2, his

fever spiked to 104 degrees, so Mrs. Cook took him to the emergency room, where

he tested positive for hepatitis A.

 

Doctors told the Cooks that the disease was not usually fatal and would run its

course.

 

But Mr. Cook got worse. His fever and nausea increased, and by the second day he

had become jaundiced and seemed confused. " He was brushing his teeth without

toothpaste, stuff like that, " Mrs. Cook said.

 

She took him back to the hospital, where it became clear that he had serious

liver problems. Doctors transferred him to the University of Pittsburgh Medical

Center, a well-known transplant hospital. By Friday, surgeons had given Mr. Cook

another liver, but it was too late.

 

Now the family mourns the sudden death of an energetic father. Because Mr. Cook

was laid off from his job at an auto body shop, he had spent much time with his

daughters while his wife worked.

 

" He was so close to the girls, he just lived for them, " Mrs. Cook said.

 

The impact of the hepatitis outbreak on the Chi-Chi's chain is likely to be

substantial, restaurant industry experts say.

 

" It's not like a month later everything is back to being fine again, " said

Dennis Lombardi, executive vice president of Technomic Inc., a Chicago food

service consulting firm. " It doesn't work that way. In a minor case, like

salmonella, that's going to have a very minor impact. But when it's a case where

there are deaths involved, that's a different story. "

 

 

 

Sherri Day contributed reporting for this article from New York.

 

Copyright 2003 The New York Times Company

 

 

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