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Green onions culprit in hepatitis A outbreak

Luis Fábregas
| Saturday, Nov. 22, 2003

Raw green onions used to make mild salsa and chili con queso at a Beaver County Mexican restaurant have been identified as the elusive source of a hepatitis A outbreak now considered the biggest ever in the nation, health authorities announced Friday.

The tainted green onions came from Mexico, according to preliminary information in a report issued late Friday by the U.S. Centers for Disease Control and Prevention.

Federal investigators are trying to determine whether any of three Mexican firms linked to September outbreaks of hepatitis A in Tennessee, Georgia and North Carolina also supplied green onions to Chi-Chi's Mexican Restaurant in the Beaver Valley Mall. Authorities have not identified the companies. CDC officials said that the Beaver County strain is similar to the strain of hepatitis A found in the September outbreaks.

On Thursday, the U.S. Food and Drug Administration ordered inspectors at the Mexican border to hold for examination any green onions coming from the three firms.

A Chi-Chi's spokeswoman said the announcement by the CDC highlighted the lack of testing of produce that comes into the U.S. from other countries.

"That's the linchpin of this whole problem," said April McIntyre of the public relations firm CCG Strategic Communications in California. "Chi-Chi's is very concerned about this, and they're only getting produce from domestic sources."

Dr. Bernard Goldstein, dean of the Graduate School of Public Health at the University of Pittsburgh, said the U.S. Department of Agriculture and the FDA test only about 2 percent of food imported into the United States.

Chi-Chi's Chief Operating Officer Bill Zavertnik said in a statement issued yesterday evening that there is no industry-accepted means of testing produce for the hepatitis A virus and no effective way to wash it off green onions. Zavertnik said the statements made by health officials "confirmed that Chi-Chi's employees were not the source of this incident, that there was nothing we could have done to prevent the outbreak, and that this is an isolated incident."

Even if health officials nail down a source, a more pressing question is how the green onions, chopped by a machine into tiny pieces and mixed with tomatoes and other salsa ingredients in 80-quart batches, became infected.

"It can stem from the field, how it was shipped or how it was packed," said Bobby McLean of the state agriculture department's food safety bureau.

The outbreak, first uncovered on Nov. 2, has been linked to three deaths and at least 575 confirmed cases of hepatitis A, a virus that can be extremely dangerous to the liver and other organs. In most cases, hepatitis A is a relatively mild disease that presents itself with flu-like symptoms such as nausea and fever. Yet three of the Beaver County hepatitis victims died.

The highest concentration of those hit by the illness ate at Chi-Chi's between Oct. 1 and Oct. 8. Health authorities said one sickened person ate at the restaurant Sept. 14, the earliest known date linked to the outbreak. Most of those who became infected -- at least 200 people -- ate at Chi-Chi's between Oct. 2 and 4.

"It makes sense that it was the salsa," said Wayne Flaminio, 44, who ate at Chi-Chi's with his wife, Tammy, and four other friends Oct. 4. "Everybody eats salsa. That's one thing you look forward to when you wait for your dinner. It makes sense that so many people got sick."

The tainted green onions also were used to make chili con queso, another popular menu item containing cheese sauce and uncooked green onions. At least 52 items on the Chi-Chi's menu contained green onions, according to a report by the CDC.

Only the mild version of the restaurant's salsa has been linked to the outbreak because the restaurant's hot salsa was made out-of-state and shipped to Beaver County. A report issued yesterday by the Centers for Disease Control and Prevention said 94 percent of those infected with hepatitis A ate mild salsa.

Mild and hot salsa are served with tortilla chips to Chi-Chi's patrons free of charge.

At a news conference in Beaver County yesterday, health authorities could not say what amount of green onion a person had to eat to get sick. They could not say for certain whether the virus might have contaminated other food items or serving utensils touched by the tainted salsa.

"I'm sure that's possible," said Joel Hersh, the state's director of epidemiology. "But we have no evidence of cross-contamination."

Health authorities said the tainted green onions -- shipped in 81/2-pound crates and wrapped in bundles of eight -- were not distributed to other restaurants, although they couldn't explain why.

"We have no indication to believe that other restaurants are implicated in this or have been the source of other infections," said Dr. Calvin B. Johnson, secretary of the Pennsylvania Department of Health.

Still, federal authorities are urging people to refrain from eating raw green onions.

"If you're going to eat green onions, cook them thoroughly," McLean said.

Chi-Chi's pulled green onions from its other restaurants in Western Pennsylvania and across the nation.

The restaurant at the Beaver Valley Mall voluntarily closed on Nov. 3 and is not expected to reopen until at least Jan. 2.

Before they targeted the widely used green onions, state investigators examined about 102 ingredients used to prepare meals at Chi-Chi's. They interviewed hundreds of patrons, trying to jog their memories about what they ate and when they ate.

The investigation initially targeted restaurant workers because hepatitis A is usually transmitted when infected people do not properly wash their hands after going to the bathroom. Authorities have ruled out that angle. At least 13 Chi-Chi's workers were sickened by the virus.

On Thursday, FDA officials ordered inspectors at the Mexican border to hold for examination any green onions coming from the three firms linked to other hepatitis A outbreaks.

By the numbers


  • Total number of confirmed cases in the hepatitis A outbreak at the Chi-Chi's restaurant in Beaver County: 575

  • Total number of deaths: Three

  • Number of people in Pennsylvania who received shots of immune globulin to get protection against hepatitis A: 9,108

  • Median age of patrons who ate at Chi-Chi's Oct. 3-6: 34

  • Percentage of hepatitis A victims who ate mild salsa: 94

  • Percentage of victims who ate chili con queso: 15

  • Number of ingredients used in Chi-Chi's recipes: 103

  • Shelf life, in days, of the salsa refrigerated at Chi-Chi's: Three

    Source: Pennsylvania Department of Health, U.S. Centers for Disease Control and Prevention

    Additional Information:

    Hot line

    Chi-Chi's has established a toll-free number, (800) 328-7761, for customers and employees affected by hepatitis A or having questions on concerns about the virus.

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