Hepatitis A Outbreak in Western Pennsylvania Prompts Broadened Donor Deferrals

In response to a recent outbreak of hepatitis A at a Chi-Chi’s restaurant in Beaver County, Pennsylvania, Pittsburgh’s Central Blood Bank last week implemented precautionary measures to ensure the safety of the blood supply. “There is a minimal risk that blood donors exposed to hepatitis A could transmit the virus through their donation,” Central Blood Bank said in a press release (11/7/03).

On November 7, Central Blood Bank instituted the following donor question “Have you eaten at the Chi-Chi’s restaurant in Beaver Valley Mall, Center Township from October 1 through November 2?” Donors responding “yes” to this question will be deferred for a three-month period. Donors who have received immune globulin vaccine will be deferred for one year. The blood bank also is asking that anyone who ate at the restaurant during the one-month period and who then donated blood to contact the center, so that their blood products may be removed from inventory.As of November 13, over 410 people who ate at the restaurant had contracted hepatitis A. Five were hospitalized in critical condition and a 38-year old man died of the disease. In an interview with the Pittsburgh Post-Gazette (11/10/03), Allegheny County Health Department director Bruce Dixon, MD said it is “decidedly unusual” for someone to die of hepatitis A. Less than one percent of those stricken with it die from the illness, he said.

This week, after the State Health Department concluded that the virus might have been present at Chi-Chi’s as early as September 20, Central Blood Bank extended the time frame for those who want to donate blood.

Donors now are being asked whether they have eaten at the Beaver Valley Mall Chi-Chi’s between September 1 and November 2.

“What we are doing is being proactive to prevent anyone who has been exposed to the virus from donating and addressing the potential for transmission from a small number of previous donations,” said Joseph Kiss, MD, Central Blood Bank medical director.

Reported cases of hepatitis A from receiving a blood transfusion are very rare—in the range of one in one million units transfused, Dr. Kiss said. Hepatitis A is typically mild and of relatively brief duration, al-though he acknowledged that serious illness is possible. “The community has no reason to be alarmed or fearful of the blood supply,” Dr. Kiss emphasized. He added “With the year-end holiday season soon upon us, healthy individuals are needed to come in and donate.” The Northern Ohio Red Cross Blood Service announced an even more conservative donor deferral policy. Donors who ate at the Chi-Chi’s restaurant will be deferred for 12 months. “Our No. 1 priority is to ensure safety for both patient and donor health,” David Plate, CEO of Red Cross’s northern Ohio region told Cleveland’s Channel 5 News. “The addition of this question will supplement existing questions already in use that are designed to identify donors at potential risk of disease transmission, and a prudent action in response to this recent outbreak.” To protect people infected with hepatitis A and prevent them from spreading it to others, the state Department of Health established a temporary clinic at the Beaver County Community College, offering shots of immune globulin. The treatment lessens the chance of acquiring the disease if given within 14 days of exposure

While the majority of people treated at the clinic thus far have been those who ate at the Chi-Chi’s restau-rant in the Beaver Valley Mall since October 22, an increasing number are people with close contact to those recently diagnosed with hepatitis, the Post-Gazette reported.

Public health authorities are keeping an eye out for newly sick people who work in day care centers and restaurants.

“It continues to be a scramble to prevent additional cases. We don’t want a repeat of the Chi-Chi’s,” said Dr. Andre Weltman, a public health physician with the state. A sick restaurant employee who didn’t follow hand-washing rules is a possible cause of the hepatitis A outbreak.

By December, all Pennsylvania restaurants will be required to implement new food code regulations and Beaver-area establishments are being asked to do so sooner, said John Stella, the Agriculture Department’s food safety regional supervisor. The new regulations prohibit bare-hand contact with food that’s ready to be served and demand that sick employees be excused from work, he said.

(From the ABC Newsletter)