One person has died in a hepatitis A outbreak associated with three restaurants in the Roanoke, VA, area, according to state officials, and two more people have been added to the patient list.

“We don’t believe there is an ongoing threat to the public,” said Christ Wills of the Roanoke City and Alleghany Health Districts, which is a subagency of the Virginia health department.

However, Wills told Food Safety News today there will likely be more sick people than the 37 who have been identified because of the long incubation time for the virus. As of today, 26 of the patients have been so sick they had to be admitted to hospitals. The age range of patients is now trending to include younger patients with people from 31 to 79 years old now infected.

During a press conference today local health district director Cynthia Morrow, MD said the agency is currently investigating additional cases, which could be added to the total, but the symptoms of those patients are not severe. Some of the patients who have required hospitalization have been discharged, but some still remain in hospitals, she said.

Wills said she does not know whether the restaurant employee who has been identified as the carrier of the virus has recovered, Morrow would not release any information regarding that employee. The employee worked at three Famous Anthony’s restaurant locations while infected with the liver virus. Wills said the restaurants were closed for a day after the infection trend was identified.

“We offered a vaccination clinic for other employees,” Wills said. “We are also offering free vaccinations for the public at our office (in Roanoke).”

The outbreak is just now hitting the 50-day mark, Wills said, which is traditionally considered the incubation window for the hepatitis A virus. However, Wills said that is a general benchmark and more people who are just now developing symptoms will likely seek treatment and be added to the patient list.

She said the Famous Anthony’s restaurant chain is a well-respected family-owned chain and has not had a history of problems in the past. She said the agency is continuing to monitor the situation, but there is little public health employees can do at this time except to wait for more patients to be identified.

“Hepatitis A virus typically causes self-limited inflammation of the liver, however in this outbreak, we have seen a high rate of severe disease,” said local health district director Cynthia Morrow, MD, MPH.

The agency continues to give the public the same advice, which is to monitor themselves for symptoms if they ate at any of the restaurants implicated in the outbreak. Anyone who visited any of the following Famous Anthony’s locations — 4913 Grandin Road, 6499 Williamson Road, or 2221 Crystal Spring Ave. — from Aug. 10 through 27, is urged to seek medical attention if they develop any of the following symptoms:

jaundice: yellowing of the skin or the eyes
fever
fatigue
loss of appetite
nausea
vomiting
abdominal pain
dark urine
light-colored stools

“It is also very important for people with symptoms to stay home from work, especially if they work in food service, health care, or childcare,” according to a public alert issued by the public health department.

“Hepatitis A is a vaccine-preventable disease. The hepatitis A vaccine is specifically recommended for children, for travelers to certain countries, and for people at high risk for infection with the virus, however, since Virginia is experiencing multi-year widespread outbreaks of hepatitis A, vaccination is recommended for everyone.

“Anyone who is not vaccinated against hepatitis A is encouraged to get the vaccine, which is currently available from many healthcare providers and local pharmacies. The Roanoke City Health Department is located at 1502 Williamson Road.”

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