The diagnosis of a supermarket employee in Raleigh, North Carolina with hepatitis A has health officials there concerned that thousands of store customers may have been put at risk of contracting the disease.
Separately, in Ashwaubenon, Wisconsin, two more cases of hepatitis A have been confirmed and a second restaurant voluntarily closed after the death of a McDonald's restaurant employee who contracted the disease, officials say.
In Raleigh, officials advised up to 7,500 grocery store customers to throw out food and receive treatment for hepatitis after the employee was diagnosed Friday.
Customers may have been exposed to the virus Aug. 10-18, when the employee worked in the deli of the Harris Teeter store, said Dr. Peter J. Morris, medical director of Wake County Human Services.
Morris said it was unclear how or when the employee contracted the illness. He was not hospitalized.
The county was offering immune globulin to any customer who purchased or ate food from the store's deli and restaurant. The treatment can prevent hepatitis A if it is administered soon after exposure.
"We are being really precautionary by doing this, but it is the right thing to do if people have been exposed," Morris said.
Harris Teeter spokeswoman Jessica Graham said deli employees were being treated with immune globulin. Products in the deli area at the time of exposure have been removed, she said.
Hepatitis A inflames the liver and is spread through close personal contact, inadequately washed hands and contaminated food and drink. The virus can require hospitalization, but is rarely fatal, with most people fully recovering after several weeks, health officials said.
No other hepatitis cases have been reported, but symptoms can take 30 days to appear. The symptoms include severe fatigue, poor appetite, fever and vomiting.
One of the two new cases confirmed in Ashwaubenon Friday by the state Laboratory of Hygiene in Madison, Wisconsin involved a female co-worker of the woman who died, said Bonnie Sorenson, a nurse manager at the Brown County Health Department.
She declined Saturday to give the woman's name, or the name of a man who also has hepatitis A, citing privacy protections.
But a family member told the Green Bay Press-Gazette that the man is an employee of Erbert & Gerbert's Subs & Clubs in De Pere and companion of the woman who died.
Jessica Van Straten, 19, of Green Bay died Thursday night after being flown to University Hospital in Madison earlier in the week for a liver transplant. She became so ill she was unable to have the surgery, said hospital spokesman Tim Le Monds.
"Hepatitis A is something that a lot of people get and don't even know they have," he said. "It's rare for someone to get really sick from hepatitis A, let alone die from it.
"A lot of our staffers were surprised at how rapidly she deteriorated."
Van Straten's 18-month-old son and the 18-month-old child of another employee at the McDonald's restaurant in Ashwaubenon were diagnosed with the virus.
That co-worker was confirmed Friday as having the disease.
Sorenson declined to release any information Saturday on the condition of that woman or the man with the disease. She said Erbert & Gerbert's had voluntary closed and the state Laboratory of Hygiene was conducting tests during the weekend on those who had been in contact with those confirmed to have the disease. She said a news conference was planned Monday by the Brown County Health Department on the matter.
The two children - who attended the same day care center - were never hospitalized, said Jim Kazmierczak, epidemiologist with the state Division of Public Health. He said lab results indicate the two had hepatitis A several weeks ago and have since shed the virus.
"At this point, those children would not be considered infectious, and they would not be considered at risk for hepatitis A because they are immune," he said.
Children don't typically get very sick from the virus, Kazmierczak said. The children had the disease before Van Straten acquired it, but he could not say whether they gave it to her.
"As far as the source, we can't speculate," Kazmierczak said. "Everybody gets it from somewhere. It just doesn't arrive spontaneously."
There was no indication the virus was transmitted to anyone who ate at the McDonald's restaurant in Ashwaubenon. The restaurant voluntarily closed for an investigation, and remained closed Friday, Kazmierczak said.
The health department found no current or past history of hygiene problems at the restaurant.
"We would caution people not to jump to conclusions, as the investigation is ongoing," said restaurant owner David Schanock.
About 40 employees of the McDonald's restaurant and other people who came into close contact with Van Straten or the children were tested for the virus and given immunoglobulin injections to minimize the chances of becoming ill with the disease, Kazmierczak said.
Results were pending.