The nation's biggest known outbreak of hepatitis A is causing such a panic that people are lining up by the thousands for antibody shots and no longer eating out.
A third person died Friday and nearly 500 others who ate at a Chi-Chi's Mexican restaurant have fallen ill in the outbreak that has prompted the Centers for Disease Control and Prevention to send assistance.
Health investigators are focusing on whether contaminated produce — perhaps scallions — caused the outbreak linked to the restaurant in the Beaver Valley Mall, about 25 miles northwest of Pittsburgh.
"We're very concerned. It's very serious and we've sent a team of people out there to assist," said CDC spokesman David Daigle.
Health officials Friday met with worried shoppers at the mall to try to squelch rumors that the virus was spreading out of control to other restaurants in the region. State Rep. Mike Veon attended a news conference at the mall and ate a sandwich he bought there.
Officials at the mall said sales at the food court were off by as much as 40 percent and sales throughout the mall were down up to 25 percent.
"I won't go to Chi-Chi's again," Barbara Barrickman said as she shopped at the mall. "I know that's unfair, but that's just how I feel."
At least 490 people have been sickened in the outbreak — believed to be the largest on record in the United States, Daigle said.
The Chi-Chi's involved has been shut down and the restaurant chain removed scallions from kitchens at all its 100 locations, said Bill Zavertnik, chief operating officer of the Louisville, Ky.-based company.
In September, about 280 people in Georgia and Tennessee were infected with hepatitis A from contaminated scallions, or green onions, including 210 people who ate at restaurants in the Atlanta area. The infections were linked to 12 restaurants — none of them Chi-Chi's.
"We've taken the action to remove them based on our abundance of caution with regard to green onions," Zavertnik said. "There's no definitive information that green onions played a role. However, we don't know. Authorities are looking at them."
If the source of the outbreak was food shipped into the restaurant, there is a chance that tainted food could have been sent to other places as well, state Health Secretary Calvin Johnson said.
Between 125,000 to 200,000 people each year contract hepatitis A, an infection that attacks the liver. It can be spread by an infected person who does not wash his hands before handling food or utensils. It can also be spread on uncooked foods, such as salads.
Symptoms include fever, nausea, diarrhea, jaundice, fatigue, abdominal pain and loss of appetite. Hepatitis A usually clears up in about two months, but patients can get antibody shots that greatly reduce the chances of contracting the disease if given within 14 days after exposure.
About 8,500 people have received the shots at a gymnasium near the restaurant and at surrounding health centers since the cases began appearing at the start of the month.
Health officials initially suspected Chi-Chi's employees who had failed to wash their hands were the source of the infection. Investigators are now focusing on food, but have not ruled anything out.
Infectious-disease experts say finding the source could be challenging because hepatitis A has a long incubation period, meaning the virus could spread to many places before it is detected. Pennsylvania health officials began warning the public Nov. 3.
The most recent victim, John Spratt, 46, of Aliquippa, died Friday from complications of hepatitis A, according to the Allegheny County Coroner. It was the second death in three days connected to the outbreak.
Dineen Wieczorek, 52, died in a Cleveland hospital Wednesday while awaiting a liver transplant, said her daughter, Darleen Trunzo. Jeff Cook, 38, died on Nov. 7 of liver failure in a Pittsburgh hospital.
All three ate at the Chi-Chi's in October, according to family members. Eleven restaurant employees have been diagnosed with hepatitis A.