2003 Chi-Chi's hepatitis A outbreak
{{Short description|Restaurant disease outbreak}}
{{Use mdy dates|date=March 2025}}
{{Infobox outbreak
| name = 2003 Chi-Chi's hepatitis A outbreak
| virus_strain = hepatitis A virus
| location = Monaca, Pennsylvania, U.S.
| first_reported = November 3, 2003
| date = September-December 2003
| source = Contaminated green onions imported from farms in Mexico
| confirmed_cases = 650
| deaths = 4
}}
The 2003 Chi-Chi's hepatitis A outbreak was an outbreak involving contaminated green onions (or scallions) at a Chi-Chi's restaurant at Beaver Valley Mall in Monaca, Pennsylvania, approximately {{convert|25|miles}} northwest of Pittsburgh, from September to November 2003. The source of the contamination was green onions (or scallions) imported from three farms in Mexico. The Food and Drug Administration (FDA) stated the contamination happened during the distribution system or through the growing, harvesting, packing, or cooling process.
Outbreak
On November 3, 2003, the Pennsylvania Department of Health (PDOH) issued a hepatitis A advisory, encouraging anyone who had eaten at the Chi-Chi's restaurant at the Beaver Valley Mall within the past 14 days to receive an immunoglobulin (Ig) shot to prevent becoming ill with the hepatitis A virus. The shot is only effective in preventing infection with hepatitis A if administered within 14 days of exposure to the virus. PDOH scheduled Ig immunization clinics in the metropolitan area over the following days.{{cite web |first1=Dan |last1=Flynn |access-date=January 6, 2025 |title=Chi-Chi's Hepatitis A Outbreak |url=https://www.foodsafetynews.com/2009/09/meaningful-outbreak-6-chi-chis-hepatitis-a-outbreak/ |date=September 19, 2009 |website=Food Safety News}} Approximately 9,000 people were potentially exposed to the hepatitis A outbreak.{{cite web |access-date=January 6, 2025 |title=Chi-Chi's hepatitis A Outbreak Lawsuits |url=https://marlerclark.com/news_events/chi-chis-hepatitis-a-outbreak |website=Marler Clark}}
The CDC conducted a case-control study to identify menu items or ingredients associated with illness. They identified 181 people as their case patients who dined at the restaurant during the peak exposure period, October 3–6, 2003. Chili con queso and mild salsa were the two menu items found to be associated with people having an illness. The menu items contained uncooked or minimally heated fresh green onions.{{cite web |access-date=January 6, 2025 |title=Hepatitis A Outbreak Associated with Green Onions at a Restaurant --- Monaca, Pennsylvania, 2003 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5247a5.htm |website=CDC}} Mild salsa was eaten by 94% of the 181 identified case patients. Salsa was prepared in batches and then refrigerated in containers with a shelf life of 3 days. Mild and hot salsa were ladled into bowls and provided free with tortilla chips upon seating in the restaurant.
Infection
Hepatitis A is an infectious disease of the liver caused by Hepatitis virus A (HAV). The virus is primarily spread by food contaminated with fecal matter. Hepatitis A can also be contracted from contaminated water, personal contact (such as being in the same household with a person who has the virus or through children at daycare centers), sexual contact, and illicit drug use. The incubation period of hepatitis A is usually 14–28 days.{{cite journal |last1=Matheny |first1=SC |last2=Kingery |first2=JE |title=Hepatitis A.|journal=Am Fam Physician |date=December 1, 2012 |volume=86 |issue=11 |pages=1027–34; quiz 1010–1012 |pmid=23198670 |url=http://www.aafp.org/afp/2012/1201/p1027.html|url-status=live |archive-url=https://web.archive.org/web/20140309112808/http://www.aafp.org/afp/2012/1201/p1027.html |archive-date=March 9, 2014}}{{cite web |date=July 20, 2023 |access-date=February 5, 2025 |title=Hepatitis A |url=https://www.who.int/news-room/fact-sheets/detail/hepatitis-a |website=World Health Organization}}
Green onions require extensive handling during harvesting and preparation for packing. Contamination of green onions could occur through contact with HAV-infected workers, especially children, working in the field during harvesting and preparation and with HAV-contaminated water during the product's irrigation, rinsing, processing, cooling, and icing.
Responses
Chi-Chi's filed for Chapter 11 bankruptcy protection in October 2003. An order issued in bankruptcy court on February 17, 2004, allowed people affected by the outbreak to attempt to mediate and settle their claims against Chi-Chi's despite the company's bankruptcy status. When the lawsuits were settled, Chi-Chi's had 65 restaurants, fewer than half of the number four years prior. The chain closed its remaining restaurants on the weekend of September 18, 2004.{{cite news|author=Lockyer, Sarah E. |work=Nation's Restaurant News|date=October 4, 2004|title=Chi-Chi's Inc. said adios last month and shuttered till 65 of its Mexican dinnerhouses as Outback Steakhouse I}}
In November 2003, the FDA issued a consumer alert and an import ban on green onions from four farms (including those that supplied green onions to Chi-Chi's) in Mexico. The import ban follows hepatitis A outbreaks in Georgia, Tennessee, and North Carolina in September 2003, a month prior.{{cite web |url=https://www.cidrap.umn.edu/foodborne-disease/fda-confirms-mexican-scallions-caused-three-hepatitis-outbreaks |date=December 10, 2003 |website=CIDRAP |access-date=January 22, 2025 |title=FDA confirms Mexican scallions caused three hepatitis outbreaks}} The restaurant chain removed green onions from their menu altogether.{{cite web |access-date=February 5, 2025 |title=Chi-Chi's Exec: We're Safe |url=https://www.cbsnews.com/news/chi-chis-exec-were-safe/ |date=November 24, 2003 |website=CBS News |via=Associated Press}}
The outbreak and other E coli outbreaks throughout the early 2000s led to the adoption of the Food Safety Modernization Act in 2011. This gave the FDA new authority to regulate how foods are grown, harvested, and processed.
References
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{{DEFAULTSORT:Chi-Chi's hepatitis A outbreak, 2003}}
Category:2003 disease outbreaks
Category:2003 disasters in the United States
Category:Disease outbreaks in the United States
Category:Restaurant food safety scandals
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