San Diego Hepatitis Cases Still On The Rise

The number of victims in the Chipotle-linked hepatitis outbreak now stands at 18, according to a report yesterday on San Diego's Channel 10 News.

It would not be surprising if the number of cases continues to climb. The county is encouraging anyone who ate at the Chipotle Mexican Grill on Fletcher Parkway in La Mesa between March 1st and April 22nd, and who is experiencing symptoms of hepatitis, to see a doctor and be screened for the virus.

Hepatitis A has a very long incubation period – between 10 and 50 days, according to FDA. And some people – especially young children – may be infected without ever experiencing symptoms. Hepatitis A infection produces a range of symptoms, including fever, malaise, nausea, loss of appetite, and abdominal discomfort, followed in several days by jaundice. Symptoms usually last for about 1-2 weeks, but some victims may suffer from chronic fatigue during their convalescence.

Hepatitis A virus is shed in feces even before symptoms appear, while the victim is suffering from gastrointestinal symptoms, and even after jaundice develops. The highest risk time for transmitting the disease is before a victim realizes that he or she is incubating the virus.

Investigators with the county's Department of Environmental Health are no closer to finding the source of the virus. None of the restaurant's 26 employees have tested positive for the disease. Nevertheless, eating at Chipotle's on Fletcher Parkway seems to be the common link for the 18 reported cases.

But, if the source of the virus wasn't an employee, where did it come from? Investigators should be looking into several possibilities.

1. Chipotle may be a false scent – it could be just coincidence that all the victims ate at that location. A thorough case-control epidemiological study might uncover another common link.
2. The virus might have been introduced by a customer. Perhaps someone who was incubating the disease used a washroom and left some virus particles behind on a faucet, door handle or some other surface in the washroom – or even on a table or chair in the eating area of the restaurant.
3. The source of the virus might have been a food ingredient, such as chopped green onions or some other produce item.

Last year, San Diego experienced 82 cases of hepatitis A infection. Including this current outbreak, the 2008 total has already reached 44 cases – and rising.