Food infection, medical concept

Possible hepatitis A exposure in restaurants is a hot headline across the Midlands in 2019 — as it is in the rest of the state and country — and it doesn’t seem to be slowing down. As recently as July 1, a Huddle House in Kershaw joined the list of restaurants in Aiken, Augusta, Columbia, Hilton Head, Lexington, North Augusta and North Charleston that have experienced potential exposures to the virus.

“The outbreak has been going on across the country since 2016, and got to South Carolina at the end of 2018,” says Johnathan Knoche, medical consultant for the Division of Acute Disease Epidemiology at the S.C. Department of Health and Environmental Control. “Why this is happening is the million dollar question, but the groups at the highest risk are drug users, homeless, recently incarcerated and men who have sex with men.” 

When a potential hepatitis A exposure is announced by DHEC, it’s to alert people that someone involved in the preparation of food at a restaurant is confirmed to have the virus and that those who dined there may have been exposed.

Hepatitis A is a short-term viral infection that inflames the liver. Symptoms include fever, stomach pain, nausea, vomiting, diarrhea, dark urine, a tell-tale yellowing of the skin, and feeling sick for several weeks. People who are carriers can never develop symptoms, but when they do occur it is usually two to six weeks after exposure. Hepatitis A usually spreads when someone ingests something contaminated by human waste from someone with the virus; poor sanitary conditions and poor personal hygiene habits make this more likely. Infections can be prevented with a hepatitis A vaccine.   

There have been 156 confirmed cases of potential hepatitis A exposure between November 2018 and June 2019 in South Carolina, with only one reported death. Not all of these cases are from exposure in restaurants. In fact, very few of them are. 

“The likelihood of spread of infection is extremely low, as hepatitis A is not a food-borne illness,” Knoche explains. “While the restaurants get media attention, it’s only a very small percentage of the case count.” 

Since restaurants do get the most media attention, DHEC’s Division of Food emailed 19,0000 food establishments in the beginning of June to remind them to reinforce good hygiene and normal sanitary practices. Restaurant owners can recommend their employees get the hepatitis A vaccine as a preventive measure, but DHEC can’t tell restaurants what to do in that regard. 

“Once someone knows they have hepatitis A they should not attend work and should seek evaluation to find the source of their illness,” Knoche says. “If someone turns yellow, that gives you a clue.” 

National Restaurant Association food safety expert Vito Palazzolo says that restaurant employees must wash their hands frequently, avoid bare-hand contact with ready-to-eat food by wearing proper gloves, and that sick employees must not come to work. He adds that restaurant managers and owners should encourage employee vaccinations, monitor employees for signs of symptoms and educate staff on hepatitis A. 

Tim, a manager at the Columbia location of a national restaurant chain who wished to remain anonymous, says that complete honesty from workers is required to keep exposures from becoming an issue. 

“Short of requiring workers to get tested, which then comes at the company’s cost, there isn’t much managers and owners can do to prevent it from happening,” Tim offers. “The symptoms are pretty much ones not noticeable by anyone other than the person infected, except for jaundice.”

Unfortunately, restaurant workers have compelling reasons to be less than honest — fear of losing their jobs, loss of wages and fear of judgement — plus they may not even show symptoms until it is too late. Even though there is no inherent promise of confidentiality like there would be with a doctor, Tim encourages restaurant employees who think they may be infected to seek private counsel with a manager. He hopes that any manager would understand the gravity of the situation and approach it with discretion.  

According to the Centers for Disease Control, since this wave of outbreaks was first identified in 2016, 21,230 cases of potential hepatitis A exposure have been reported in 25 states, causing 203 deaths through June 28. This number includes all instances of hepatitis A, not just those limited to restaurants. 

DHEC publishes information on ITS website ( about potential exposures. Recent exposure alerts in the Midlands include the Huddle House on W. Dekalb St. in Kershaw, the Hardee’s on Killian Road and the Wild Wing Cafe on Bower Parkway, joining several others in spots from Aiken to Hilton Head Island. 

DHEC encourages anyone who thinks they may have dined in an establishment during a potential exposure period to contact their local health department.

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