KING COUNTY, WASHINGTON - Since October 15, Public Health - Seattle & King County has received 31 reports of hepatitis A virus infection among King County residents. Twenty-one of these infections have been reported in people who live or work in Northeast Seattle or East Shoreline.

An ongoing investigation by Public Health suggests that many infections are associated with consuming food from one of two different Subway Salads and Sandwiches outlets during the month of September. The locations of these outlets are:

• 12354 15th NE, Seattle, and
• 18002 15th NE, Shoreline

"If you have eaten at these restaurants during September and are ill with symptoms of hepatitis, you should seek prompt medical evaluation," said Dr. Alonzo Plough, Director of Public Health - Seattle & King County.

There is no evidence of continuing risk of illness from food or beverages served at these outlets. No other Subway outlets have been implicated in this outbreak.

Because the incubation period for hepatitis A is 2 to 6 weeks, additional illnesses may appear between now and November 14. If hepatitis A is diagnosed early, treatment can be given within 2 weeks of exposure to prevent spread to family members and close personal contacts of infected persons.

Persons who ate at these restaurant outlets in September and are not ill should see their health care provider if they develop symptoms of hepatitis over the next ten days. As always, everyone should practice thorough handwashing after toileting and before handling food.

Preventive treatment is only effective when administered within 14 days of an exposure to hepatitis A, and, consequently such treatment is not recommended for persons who were exposed to hepatitis A in September. In addition, blood testing will only detect hepatitis A after symptoms have begun; therefore, getting a blood test when you are well is not helpful.

Hepatitis A is a viral infection of the liver. Early symptoms include nausea, vomiting, diarrhea, fatigue, poor appetite, abdominal cramps, and fever. Subsequently, dark yellow or brown urine, pale or white bowel movements, and yellow skin or eyes can develop. Persons can have some or all of these symptoms.

Adults tend to have more symptoms than do children. Hepatitis A virus lives in the stool of an infected person and must enter another person's mouth to spread the infection. The usual way this happens is when unclean hands handle food or other objects that are swallowed. Thorough hand washing after toileting and before handling food can prevent transmission of infection.

Hepatitis A can be prevented in adults and children 2 years of age or older through vaccination. Although hepatitis A vaccination will not protect people from an exposure that has already occurred, persons who have not had hepatitis A can be protected from future infection by receiving the vaccine. The hepatitis A vaccine is over 95% effective in preventing hepatitis A and is available from most health care providers including Public Health.

Information is also available on a recorded message at (206)296-4949.