Hepatitis Cases Don’t Add Up to Outbreak, Health Officials Say

Orange County public health officials stressed Thursday there is no reason to believe there is a countywide outbreak of hepatitis A despite a string of cases in a South County school district and a rare public notice about possible exposure of patrons at a San Clemente restaurant.

County epidemiologist Dr. Hildy Meyers called the combination of events “very rare.”

Two more cases at two other schools in the Capistrano Unified School District were confirmed Thursday by the Health Care Agency, said district Supt. James A. Fleming. However, neither of these students attends Harold Ambuehl Elementary in San Juan Capistrano, where nearly 400 youngsters received inoculations Thursday because three of its students previously were confirmed as having the communicable disease, school officials said. Inoculations with immune globulin will continue today at Ambuehl, which has 850 students.

As part of its containment effort involving Ambuehl, Health Care Agency nurses Monday and Tuesday inoculated about 100 staff and students at the A-Team, a Mission Viejo after-school care center, center director Beverly Woolley said. The center is attended by two unidentified brothers who are among the three Ambuehl students found to have hepatitis A.

Meyers declined to discuss whether the A-Team facility played any role in the transmission of the illness, but she said “not all the children have [the center] in common.”

The rate of hepatitis A, a viral disease that seldom is life-threatening, remains at historic lows in the county, Meyers said.

“[The recent cases] do not indicate there is a countywide outbreak,” she said. “Of course, we will keep our eye on it. We don’t have any indications that we are entering a communitywide outbreak situation.”

Mild Symptoms for Most Hepatitis A Cases

The majority of people who contract hepatitis A--unlike hepatitis B and C, which can result in long-lasting effects on liver function--have mild symptoms and more than 99% recover with no lasting effects, health experts say. The disease can be prevented by vaccination or antibody shots.

Symptoms include jaundice, vomiting, lack of appetite, malaise and sometimes fever and abdominal pain. The symptoms can range from serious to mild, with younger children showing fewer. The virus that causes hepatitis A is transmitted through contact with contaminated feces and blood. Good hygiene and hand washing commonly prevent transmission, experts said.

Meyers declined Thursday to say where the two new cases had occurred. The cases at Ambuehl involved two brothers; one in kindergarten and the other in fourth grade, and another fourth-grader.

School district officials, who have been widely criticized by parents for failing to give timely notification of the hepatitis A risk, said they are following the Health Care Agency’s lead in providing inoculations for Ambuehl students and in adopting a wait-and-see attitude at the second school.

“We have expertise in the field of children,” said Fleming. “When it comes to public health, we rely on the experts in public health. Sometimes it is not easy to do that.”

Word that school officials had not told Ambuehl parents of the first two cases of hepatitis A, which occurred in late January and early February in the two brothers, caused a storm of protest this week at the school.

Parents, many of them misinformed about the differences in the varying forms of hepatitis, accused school and health care officials of being secretive and controlling.

Meyers rejected such allegations again Thursday, particularly in connection with the latest case at the district.

“We are not covering something up,” said Meyers. “We are protecting confidentiality and taking action where it needs to be taken.”

In the case of the restaurant exposure, health officials are trying to contact patrons of the Fisherman’s Bar in San Clemente who ate there from March 11-13. Those patrons have “a low risk” of infection from exposure to a restaurant employee who had hepatitis A, County Public Health Officer Dr. Mark Horton said.

Shot Effective but Only if Given Quickly

Customers can receive an immune globulin shot, which provides antibodies to combat the disease. It is only effective if given within 14 days of exposure. Immune globulin differs from a vaccine, which contains a specific virus and causes the body to develop its own antibodies to a disease.

Those seeking more information, or the inoculation, should call the Health Care Agency at (714) 834-8330.

A public hepatitis warning involving a restaurant happens only rarely, said Meyers, adding that this is almost certainly the only one in Orange County in the past 10 years. A similar warning, however, was issued this week to alert patrons of a Mimi’s cafe in Bakersfield, after a waitress was diagnosed with the disease.

But such warnings involving an infected food handler happen seldom because three factors must be present: The infected person must have worked without gloves and handled food that is served without being cooked, such as salads; he or she also must have had deficient hygiene practices or diarrhea; and patrons who may have been exposed must be reachable for treatment within two weeks of the contact.

“It is pretty frequent that one of those three criteria are met, but almost all the time at least one is not present,” Meyers said.