Thursday, November 06, 2003

By Gary Rotstein and Christopher Snowbeck, Pittsburgh Post-Gazette

Nurses, crying children, irritated adults and other Mexican food aficionados trying to wipe out the threat of fever, vomiting and jaundice took over the student gymnasium at Beaver County Community College yesterday.

Almost 3,000 recent patrons of the Chi-Chi's restaurant at Beaver Valley Mall in Center left home, work and school to receive injections of antibodies to ward off hepatitis A.

	Seth Smallwood, 2, from Beaver receives a vaccination yesterday as his mother, Bridget, and brother, Shane, 7, watch.(Pam Panchak, Post-Gazette)

An outbreak of the illness began surfacing around Beaver County emergency rooms and physician's offices Friday, with 85 cases confirmed by yesterday. Investigation by state officials determined employment or dining at Chi-Chi's to be the common connection.

Health officials suspect a worker may have contaminated food by failure to follow basic hygiene in cleaning hands after using the bathroom. It's a typical manner of spreading hepatitis A, which can produce nasty symptoms for weeks, but it's not an explanation that many restaurant patrons were ready to excuse.

"To think about all this because of someone's stupid mistake, or whatever it was," fumed one mother, Sherry Modro of Beaver Falls, with two toddlers in tow receiving shots administered by the state Department of Health. "It's scary -- you think you're taking kids someplace safe to eat, and now we're afraid to eat out."

The Modros, who ate at the restaurant on Oct. 24 and Nov. 1, were among 2,974 individuals to arrive by 4 p.m. for shots at the gymnasium. Most waited in line from one to two hours to receive free injections of immune globulin from a team of 40 state health department employees operating a three-day temporary clinic.

The state ordered 5,600 doses of the antibodies, at an average cost of $15 each from Bayer Corp., based on information from the restaurant on how many people dine there. The immunizations are only effective for those exposed to the virus within the past 14 days, and symptoms typically show up between 15 and 50 days after exposure.

Anyone who ate at the restaurant before Oct. 23 and begins experiencing fever or other symptoms should consult a physician. The shots are for those who still have time to avoid the illness, though it seemed little consolation to the salsa-and-chips lovers filling the college's domed gym.

"It's kind of crazy -- there's such a big opportunity for this to affect a lot of people," Geneva College student Ben Delaney said as he surveyed the throng.

The 22-year-old, who is also a mall jewelry store employee, said he and a co-worker put in a rare Chi-Chi's order for convenience two weeks ago. He normally prefers his wife's homemade tacos.

Because the restaurant is popular with families, plenty of children came for shots, few of their own volition. Their screams of anticipation beforehand and crying afterward regularly punctuated the proceedings. Lollipops from nurses and promises of toys from parents were a mild antidote.

The 85 confirmed cases of hepatitis A include three employees and 82 patrons. Seventy-four of the confirmed cases are Pennsylvanians, seven are from Ohio and four are from West Virginia. The number of confirmed cases is expected to increase, said health department spokeswoman Jessica Seiders.

Last year at this time, there had been 267 hepatitis A cases in the state, Seiders said. While the Chi-Chi's outbreak will boost the statewide total for this year, that number was already high, with 418 cases of the illness, which is rarely fatal but can cause fever, fatigue, nausea, vomiting, abdominal pain and jaundice.

"Hepatitis A is something that jumps around," Seiders said. "There are a lot of unknown cases out there."

While the cause of the outbreak has not been pinpointed, investigators are focused on the hygiene of workers at the restaurant, said Dr. Andre Weltman, a public health physician with the state Department of Health.

"It's more likely to have been a food-worker problem than a food item" that spread the virus, said Weltman.

It's rare that the Department of Health would issue any kind of sanction in such an outbreak, Weltman said, unless there was evidence that someone tried to harm people. That's not the case at the Beaver Valley Chi-Chi's, he said, adding: "This probably just has to do with lapses in good practices."

Restaurants in Beaver County and many parts of the state are inspected by the Department of Agriculture, while those in Allegheny County are regulated by the county Health Department. Inspectors from both agencies look at basically the same issues, said county Health Department spokesman Guillermo Cole.

But the county requires that restaurants always have an employee on site who's been trained in food safety by the county or an equivalent program in food safety, Cole said.

Starting in July, the Department of Agriculture will ask all restaurants to meet a similar requirement, but John Stella, the department's food safety regional supervisor in Richland, said he doubted the rule would have prevented the Chi-Chi's outbreak. Hand-washing problems haven't been observed in the department's last two inspections, Stella said, and Chi-Chi's does a good job of training employees.

The Department of Agriculture could file a summary offense against Chi-Chi's in connection with the outbreak, which could bring a fine of $50 to $300, Stella said. The department could also implement a civil penalty with a bigger fine, he said.

"One thing they would consider, is, how much more punishment does the company need to go through?" Stella said. "They're paying dearly right now, whether it's their fault or not."

Prandium Inc., the Irvine, Calif., company that owns Chi-Chi's, did not return calls seeking comment. Stella said the restaurant voluntarily shut down and has brought in cleaners to ensure cleanliness. The department will do a preliminary inspection of the restaurant today, Stella said.

Consumers were mixed on whether they're likely to return to the restaurant. Frank Pruszenski, 79, of Hopewell, was among the more tolerant.

"This could happen anywhere, what happened to them. This is a big, crowded world," he said.

The public immunization clinics continue from 8 a.m. to 7 p.m. today and tomorrow at the college, located at 1 Campus Drive in Monaca. More information can be obtained from the health department at 1-877-724-3258.

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