BEAVER, Pa. – A hepatitis A outbreak that has killed three people and sickened nearly 600 others who ate at a Chi-Chi's (search) Mexican restaurant was probably caused by green onions from Mexico, health officials said Friday. But how the scallions became tainted remains unclear.
All the hepatitis A cases at the restaurant 25 miles northwest of Pittsburgh have been linked to green onions, and most of the victims likely contracted it through mild salsa and cheese dip, the Centers for Disease Control and Prevention (search) said. The two dishes both used raw or lightly cooked onions.
"All the evidence suggests that people had direct contact with the green onions," said Joel Hersh, epidemiology director for the state Health Department.
It is the nation's biggest known outbreak of hepatitis A (search).
The CDC stopped short of saying that the green onions in the Pennsylvania outbreak came from one of three Mexican companies known to have supplied the onions blamed for other outbreaks in Tennessee and Georgia.
The Food and Drug Administration (search) announced Thursday that it was stopping green onion shipments from the Mexican firms at the border for inspection. FDA officials planned a statement, but did not immediately comment on CDC's report.
The contamination could have been caused by anything from a sewage leak in a farm field to feces in a shipper's truck, health officials said. Workers who failed to wash their hands at any stage of the onions' transit from field to the restaurant are another possible culprit.
Chi-Chi's chief operating officer Bill Zavertnik said the company was "gratified" that state officials traced the outbreak to green onions and not to Chi-Chi's employees. He also noted that state officials confirmed there is no "industry-accepted" way to test green onions for hepatitis A or to clean them enough to ensure they are safe.
The restaurant at the Beaver Valley Mall has remained closed since the outbreak was confirmed Nov. 3.
Health officials have said the hepatitis strains in Pennsylvania, Tennessee and Georgia are very similar.
Health officials in Pennsylvania initially suspected that Chi-Chi's employees had failed to wash their hands after using the bathroom — another common way that hepatitis A is spread. But suspicion soon fell on the green onions, and last weekend the FDA issued a national advisory saying purchased green onions should not be eaten raw.
By then, Chi-Chi's had pulled green onions from its 99 other restaurants in 17 states from Minnesota to the mid-Atlantic.
Unlike Chi-Chi's hot salsa, which is packaged before it arrives at the restaurant, the mild salsa is made partly on site, health officials said.
Hepatitis A is a virus that attacks the liver and can cause fever, nausea, diarrhea, jaundice, fatigue, abdominal pain and loss of appetite. Hepatitis A usually clears up on its own in about two months.
More than 9,100 people received antibody shots in the Pennsylvania outbreak to reduce their chances of contracting the disease after exposure.
The restaurant chain filed for Chapter 11 bankruptcy protection on Oct. 8 in a move unrelated to the outbreak.
On Friday, a bankruptcy judge gave limited approval to Chi-Chi's plans to begin paying some expenses of those sickened in the outbreak — up to $20,000 per claim.
He did not, however, fully approve Chi-Chi's plan to spend $500,000 on an insurance deductible so the company could tap into as much as $51 million in liability insurance it may need to settle claims.