Schools to Begin Offering Hepatitis Inoculations Today

As thousands of parents fretted that their children might have contracted the hepatitis A virus from a school lunch strawberry dessert, the Los Angeles Unified School District on Wednesday rushed to set up inoculation clinics at 17 schools. Three of the clinics will open today.

Meanwhile, equally frustrated federal investigators labored to peg responsibility in the food chain.

There was finger-pointing on both sides of the U.S.-Mexican border--and one straightforward acknowledgment of wrongdoing: The president of the San Diego company that processed the fruit resigned. His firm’s parent company said the processor had violated federal rules by using strawberries from outside the United States; in this case, Mexico.

The corporate owner also promised in an interview to pay for the immune serum globulin inoculations of Los Angeles school district children.

The strawberries consumed by 9,000 students and others in the Los Angeles district last week came from the same batch that has been implicated in a hepatitis outbreak in Michigan, where more than 150 schoolchildren and adults became ill.

In a Ping-Pong-style blame game, the San Joaquin Valley food packer that put the sliced fruit in individual serving containers said the problem must have originated south of the border, while Mexican officials denied responsibility.

“I am convinced our strawberries don’t have hepatitis. . . . The hygienic checks we have are rigorous,” said Conradio Gonzalez, president of the Union of Produce Growers in Baja California Norte, the state in which the berries were grown.

News of the possible contamination rattled households throughout the Los Angeles school district, drawing droves of parents to the affected schools.

Greeted by television cameras as they walked their children to school, parents shared their worries with everyone who would listen--reporters, the school gate guard, passing teachers, the principal and each other.

Late Wednesday, school officials said clinics would open at 9 a.m. today for students at three elementary schools: Coldwater Canyon in North Hollywood, Ramona west of downtown and Dayton Heights in east Hollywood.

Fourteen other clinics will follow on Friday, Monday and Tuesday, providing the protection within the estimated two-week incubation period between exposure and onset of symptoms such as nausea and jaundice.

Virgil Middle School will open its clinic Tuesday, along with Mt. Vernon Middle School and Trinity Street Elementary. Between now and then, the school district plans to open clinics at six elementary schools on Friday--Weemes, Magnolia, Plummer, Strathern, Holmes and Wilton Place. On Monday, three high schools--Bell, Garfield and Fremont--and one elementary school--Alta Loma--will have clinics.

(At an 18th school put on alert, Hazeltine Avenue Elementary in Van Nuys, only two adults sampled the dessert and no clinic will be established.)

Mostly Schools in Poor Areas Affected

Some parents voiced outrage that the problem had hit mostly the poorest areas of town--both because only crowded year-round schools were in session last week when the fruit was served, and because poor children are the most likely to qualify for the government-subsidized lunches.

“I bet they don’t have this problem in the private schools,” said grandfather Ernest Alexander Hill, who took time off from work Wednesday to attend a special meeting at Trinity Street Elementary School in South-Central Los Angeles, where up to 1,000 students were given the dessert Thursday.

Reflecting the sentiments of many parents, Hill said the district should inoculate all children at the 17 schools that served the fruit.

Some parents were not willing to wait for the clinics. At Magnolia Elementary School in the Pico-Union district, John Mejia, 4, winced as his mother pulled up his T-shirt sleeve to show a Band-Aid--evidence of the shot she got him Tuesday at a nearby free clinic, shortly after hearing the news on Spanish-language television.

“I was afraid and concerned about it,” Monica Mejia said. “Now I feel very calm.”

In other developments:

* School district nurses were working with teachers to whittle down the number of students who need to receive the inoculations, cognizant not only of the possibility of bad reactions by some to the serum, but also of the limited supply.

* County health officials defended their decision to wait until Tuesday to disclose the problem, saying they did not have full confirmation of which schools were involved until Monday. They said the desserts had been quietly pulled from food lines Friday, the day after they learned of a possible link with the Michigan outbreak.

* Federal officials announced that the berries may have been used in commercial food products outside the school systems, but provided no details.

* In addition to five other states known to have received strawberries from the same lot as the Michigan fruit, 10 more states and the District of Columbia received warnings from federal officials not to use strawberries from the San Diego processor, Andrew & Williamson Sales Co., until the investigation is completed.

The complicated route of the berries made it difficult to determine the cause of the outbreak.

“Where the source of introduction of the virus is we can’t be exactly sure,” said Michael Friedman, principal deputy commissioner of the U.S. Food and Drug Administration, at a news conference in Washington.

Friedman said the number of contaminated lots of frozen strawberries might be very small. But “we spread the net relatively broadly in order to inform people.”

Picked a year ago in fields 150 miles south of Tijuana, the strawberries traveled to San Diego, where they were washed, sliced and frozen by Andrew & Williamson. From there, they traveled to various packers and storage facilities across the country. The strawberries destined for Los Angeles spent nearly 10 months in a Vernon cold storage facility before the school district contracted with a large institutional packer in the San Joaquin Valley community of Clovis to mix them with frozen blueberries and put them in rectangular cups.

“The contamination doesn’t come from us,” said Lynn Joyner, executive vice president of Wawona Farms in Clovis. “It probably comes from Mexico. . . . The outbreak began in Michigan with fruit that we never handled.”

The case illustrates the massive scale of food operations in Los Angeles Unified, which serves more daily meals than any other school district except New York City’s--178,000 breakfasts and 321,000 lunches. Fewer than 10% of the Los Angeles meals are cooked in district kitchens, throwing the district into a role akin to a commodities broker, arranging deals between food producers and food processors--sometimes even sending along the district’s own recipes.

Firms Says Berries Grown in Mexico

At Wednesday’s news conference, federal officials would not confirm that the berries had been grown in Mexico. However, in a statement issued Wednesday, Epitope Inc., the new owner of Andrew & Williamson, said the berries were grown in Mexico and processed in the United States.

FDA official Friedman said suspect berries apparently also found their way into other commercial food products, but he said it was not yet known whether any were still on shelves. A U.S. Department of Agriculture official said an investigation is continuing but would not comment on its progress.

Epitope, a biotechnology company based in Beaverton, Ore., said the strawberries were processed before it bought Andrew & Williamson in December. It said Andrew & Williamson’s president and chief executive, Fred L. Williamson, a member of the firm’s founding family, had resigned.

Shares of the company, traded on the Nasdaq exchange, tumbled Wednesday $1.875 to $8.25. Late in the day, the company offered to pay for the shots required to treat schoolchildren and others.

At Strathern Street Elementary School in North Hollywood, district communicable disease nurse Margaret Robin-Goldberg interviewed students from a list of those who had eaten the meal containing the fruit in question.

“Do you understand what’s happening? Why I asked you if you ate the fruit cups?” Robin-Goldberg asked a fourth-grader.

“It has germs?” the girl asked.

Confusion sometimes was evident even among those in control.

Strathern Principal Rosemarie Kubena said she told one worried child who had not eaten the fruit that she was not at risk of contracting it from other students because the virus is spread “through oral, not airborne, contact. And in elementary school, hopefully no one is kissing each other.”

In fact, health officials said, hepatitis A is spread primarily through contact with feces, for example when someone infected with the disease does not wash his or her hands well after using the bathroom.

A class of parents gathered to learn English at Magnolia School stared suspiciously at one of the sloppy red desserts, which a special education teacher had stored in a refrigerator, originally planning to tote it out for a snack.

How could their younger children be expected to remember what they had eaten a week ago? several asked. And, even if they did, what was to keep their classmate or best friend from remembering wrong.

“Better to give it to them all,” said mother Judith Romero. “It’s incubating inside them.”

Later Wednesday, district medical director Dr. Helen DuPlessis said that because they cannot trust the recollection of the youngest children, the district would inoculate all students in first grade or younger who were in attendance on the days the desserts were served and ate cafeteria meals. But older children would be asked.

Dr. Ian Williams, an epidemiologist with the Centers for Disease Control and Prevention in Atlanta, said immune globulin is “somewhat in undersupply,” but there should be enough to inoculate those at risk in Los Angeles as long as it is used judiciously.

“Shots should be limited to people who ate strawberries from these contaminated lots in the past two weeks, not family members or others” unless they have been in contact with someone who has acute disease, he said.

At Bell High School, student Pablo Garcia, 18, said that he clearly remembered eating the frozen fruit cups, which he described as “these slimy little purple balls in frozen stuff,” and that he already felt ill. He was not completely dissuaded by explanations from the nursing staff that the signs of the disease could not be appearing yet.

Virgil Middle School science teacher Joseph Llamas tried to ease the tension with information, folding the hepatitis alert into his lesson plan Wednesday for his eighth-grade physical science class, taught in Spanish. A third of the 15 students volunteered that they had eaten the berries.

Llamas had a captive audience at the Koreatown school as he removed the liver model from the life-size, plastic human anatomy figure and discussed how the hepatitis virus can harm the organ. Some students nervously joked about their skin turning yellow.

Student Luis Donis posed a question: What if you did not eat the strawberries but your girlfriend did and then you kissed her?

“I am nervous for that,” he said.

The teacher said Luis should consider getting the immune serum globulin shot and at least watch closely for any symptoms.

Llamas’ lecture continued. Wash your hands carefully for two minutes three times a day. There are no excuses. If the bathrooms are out of soap, they could borrow the bottle of liquid soap from his room. And if they need a longer hall pass for the washing, he would sign the pass.

Contributing to this story were Times staff writers Angie Chuang, Abigail Goldman, Larry Gordon, Julie Marquis, Josh Meyer and Lucille Renwick; Times correspondents Maki Becker and Michael Krikorian in Los Angeles, and Times staff writers Mark Arax in Fresno, Mary Beth Sheridan in Mexico City, Anne-Marie O’Connor in San Diego and Sam Fulwood III in Washington.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

The Strawberry Trail

Here is how the contaminated strawberries made their way to schools in California and other states:

HOW THEY GOT HERE

1) Strawberries grown in Mexico.

2) Shipped to processor in San Diego; frozen and sent to various states.

3) Desserts headed for L.A. Unified are shipped to San Joaquin Valley for packaging.

4) Sent back to L.A. and distributed to schools.

****

WHICH STATES ARE AT RISK

Received berries that bore the same lot number.

Arizona

California

Georgia

Iowa

Tennessee

Michigan

*

Received shipments from the same company but with different lot numbers.

Florida

Illinois

Indiana

Maine

New Jersey

New York

North Carolina

North Dakota

Wisconsin

Source: L.A. Unified School District; Associated Press

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Hepatitis Scare--a Chronology

April and May 1996: Strawberries are harvested in Baja California Norte, Mexico.

April 19, May 7-8, 1996: Strawberries are washed, sliced and frozen in San Diego, at Andrew & Williamson Sales Co.

Dec. 3-6, 1996: Fruit is shipped from Andrew & Williamson to storage and packing facilities in Michigan, Arizona, Southern California, Florida, Iowa and Tennessee.

Feb. 28, 1997, and March 5, 1997: Packer Wawona Farms of Clovis, Calif., picks up 100,000 pounds of the strawberries and 30,000 pounds of blueberries from a Vernon, Calif., storage facility. Under contract with the Los Angeles Unified School District, the company packs the fruit into 370,752 cups.

March 14, 1997: Wawona ships 84,000 frozen strawberry/blueberry desserts to the L.A. school district.

Early March 1997: First clusters of hepatitis A are identified in Michigan by local and state officials.

March 23, 1997: Disease sleuths from the federal Centers for Disease Control and Prevention are called to Michigan to help determine the cause of the hepatitis outbreak, which eventually spreads to more than 150 people.

March 25, 1997: The first Los Angeles students are served the desserts at school.

March 27, 1997: Los Angeles County Department of Health Services is notified by the U.S. Department of Agriculture that an outbreak of hepatitis A in Michigan has a possible link to Southern California. Los Angeles Unified School District received a call the same day.

March 28, 1997: Los Angeles Unified School District identifies 46 schools that received the shipments and uses a phone tree to tell all cafeteria managers to stop serving the dessert. A total of 17 schools had already served it, some as recently as that morning, to 9,006 individuals. Cafeteria workers had sampled it at one other school.

March 29, 1997: The county’s chief of acute communicable disease control is notified by federal and state officials that the Los Angeles fruit did indeed come from the same lot as the tainted Michigan fruit. Officials in four other states--Arizona, Georgia, Iowa and Tennessee--also are contacted.

March 31, 1997: Remaining desserts are retrieved from schools and put in storage while officials research disposal options.

April 1, 1997: Word of the problem leaks out during a county Board of Supervisors meeting, leading to angry grilling of Health Director Mark Finucane about who knew what when. County officials join school district officials in an afternoon news conference.

April 2, 1997: Letters go out to all 18 affected Los Angeles district schools for distribution to parents.

April 3, 1997: The first three immune serum globulin clinics are to be set up in Los Angeles schools, with 14 others to follow.

April 8, 1997: Last date to immunize most children who ate the fruit.

DAMAGE CONTROL: Farmers react quickly, seeking to quell consumers’ fears. D1