Green Onions Likely Cause of Hepatitis

Green onions at a Mexican restaurant were the likely cause of a hepatitis A outbreak that has sickened at least 575 people and killed three, but the origin of those onions and how they were tainted has yet to be determined, state health officials said Friday.

"All the evidence suggests that people had direct contact with the green onions," said Joel Hersh, director of epidemiology for the Pennsylvania Department of Health.

The outbreak, centered around a Chi-Chi's in western Pennsylvania, is the largest single-source hepatitis A outbreak in U.S. history.

Most of the hepatitis A cases were traced to people who ate mild salsa or one of two entrees, which will be identified in an official report expected to be issued later Friday, health officials said.

The restaurant's hot salsa is packaged before it arrives at Chi-Chi's, but the mild salsa is made partially on-site, health officials said.

The Food and Drug Administration issued a national advisory shortly after the outbreak was confirmed Nov. 3 that consumers should only eat cooked green onions to ensure safety.

It is not known whether the scallions behind the outbreak are linked to those already known to have caused smaller outbreaks of hepatitis A in Tennessee and Georgia, though health officials have said the strain of hepatitis found in Pennsylvania is similar to the one found in Tennessee and Georgia.

The FDA announced Thursday that it has traced green onions behind the Tennessee and Georgia outbreaks to three Mexican firms. The FDA is inspecting all green onion shipments from those Mexican suppliers.

The number of victims announced Friday included 35 additional cases, though health officials believe the number of new cases will continue to diminish in the coming days.

People who were sickened said they ate at the restaurant as early as Sept. 14 and as late as Oct. 18, though investigators are now checking those statements against credit card records to determine their accuracy.

The vast majority of victims, 500, were from Pennsylvania, including 390 from Beaver County, where the outbreak began, Secretary of Health Dr. Calvin Johnson said Friday.

More than 9,100 people have received antibody shots meant to arrest development of the virus since the outbreak began and nearly 9,900 have been screened, health official said.

Officials still can't explain why the Pennsylvania outbreak was so much more extensive than the previous ones. More than 250 people got hepatitis A at more than a dozen Georgia restaurants in September, and 80 were infected at one restaurant near Knoxville, Tenn., about the same time.

At least eight people also were sickened after eating green onions at a single restaurant in North Carolina in September, according to the Centers for Disease Control and Prevention. The FDA is still trying to trace the source of those onions, too, CDC officials said Friday.

The large number of Pennsylvania cases may simply be because the Chi-Chi's restaurant at the Beaver Valley Mall, about 25 miles northwest of Pittsburgh, experienced such high-volume -- serving 11,000 meals in October, the month when nearly all those sickened ate at the restaurant, state health officials said.

Even before the FDA issued its green onion advisory Nov. 15, Louisville, Ky.-based Chi-Chi's had pulled green onions from its other 99 restaurants in 17 states stretching from Minnesota to the Mid-Atlantic. Taco Bell has pulled scallions from 6,000 American outlets, even though there have been no reports of hepatitis A at those stores. Boston Market has also removed green onions from its food.

Chi-Chi's filed for Chapter 11 bankruptcy protection Oct. 8 in a move unrelated to the outbreak. The company on Thursday asked a bankruptcy judge for permission to spend $500,000 on an insurance deductible to free up as much as $51 million in liability insurance. The restaurant hopes to use the money to settle out-of-court claims for medical bills, lost wages and other expenses brought by those sickened in Pennsylvania.

A bankruptcy judge could rule on that request as early as Friday.

Editors Note: Many south Jersey restaurants have stopped using green onions in their dishes as a precaution. At P.F. Chang's in Marlton, green onions are only being served cooked. Ask your server if you are concerned and are unsure of the restaurant's policy.

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