The Maine Center for Disease Control and Prevention on Friday refused to name a Cumberland County restaurant where a worker with acute hepatitis A had served food for weeks, possibly exposing customers to the virus.
A CDC alert released Friday said the agency examined food preparation practices at the restaurant, where the person who was infected worked from Sept. 29 to Oct. 11, and determined others could have been exposed.
When asked about the hepatitis A case at a campaign stop in Yarmouth, Gov. Paul LePage didn’t directly address the question but blamed immigrants living here illegally for the spread of infectious diseases. He didn’t explain what connection, if any, immigrants had to the restaurant.
“I have been trying to get the president to pay attention to the illegals in our country because there’s been a spike in hepatitis C, tuberculosis and HIV, but it’s going on deaf ears,” LePage said. Asked a follow-up question on hepatitis, LePage instead spoke about Ebola and the case of Kaci Hickox, the nurse in Fort Kent who has battled the governor on a proposed in-home quarantine. Requests to LePage’s office for clarification of his remarks were not answered Friday afternoon.
Rep. Richard Farnsworth, D-Portland, House chair of the Legislature’s Health and Human Services Committee, said the Maine CDC “has failed miserably” in recent weeks by not using science to make decisions.
“The CDC has panicked for no reason over one person who does not have Ebola. Meanwhile, they’re not concerned about the spread of a communicable disease where many people could have been exposed,” said Farnsworth, who decades ago contracted hepatitis A and was sick for months.
Hepatitis A is more transmissible than Ebola, according to the federal CDC.
John Martins, a spokesman for the Maine CDC, said in an email that releasing the name of the restaurant would “risk identifying” the employee, violating state law regarding patient privacy. Plus, he said, there was no public benefit to releasing the restaurant name because the 14-day period in which people who are exposed to the virus can receive a vaccine had passed.
“Maine CDC’s longstanding practice has been to only release details in situations where doing so would have a public health benefit,” he said.
Martins did not immediately respond Friday evening to a question about whether there was a public benefit in notifying patrons who become sick and could benefit from testing. He wrote in his email that hepatitis A is the least serious form of viral hepatitis, often mimicking a stomach bug if it produces symptoms at all. The alert was intended primarily for physicians who may treat affected patients, he said.
While some people may clear hepatitis A from their bodies without any trouble, others can become sick for months. The virus can have more serious effects in people who are older or have pre-existing liver disease. The virus is transmitted by the fecal-oral route, often through contaminated food or water.
Dr. Dora Anne Mills, director of the Maine CDC from 1996 to 2011, said the agency historically has released the location where exposures have occurred to protect the health of people who may still be at risk.
Mills said there’s a public health benefit to disclosing the name of the restaurant because hepatitis A can be treated better if caught early, and the symptoms sometimes mimic other diseases, like the flu or chronic fatigue.
“Sometimes you wouldn’t know what was wrong with you, and two months later you find out it’s hepatitis,” Mills said.
In some cases, such as at a catered wedding, it would be possible to notify everyone who dined at an event, and public disclosure is unnecessary, she said. Finding everyone who dined at a restaurant where exposure happened over an extended period likely would be impossible.
“If you can’t identify everyone at risk, then you should release the name of the restaurant,” Mills said.
Maine hasn’t had a state epidemiologist since Dr. Stephen Sears resigned in May. The state is reviewing candidates to replace Sears, officials have said.
Dr. Lisa Ryan, president of the Maine Medical Association, said the state alert is not useful if the restaurant is unknown because people don’t know whether they are at risk. Nearly 1,000 restaurants serve customers in Cumberland County, according to the Maine Restaurant Association. Jessica Grondin, city of Portland spokeswoman, said the restaurant was not in city limits.
“I don’t see why they wouldn’t (release the name) in this instance,” Ryan said. If restaurant patrons “start having some mild symptoms, they wouldn’t know to get tested.”
In October 2013, the Maine CDC named a Durham church where a person serving food at a community supper had hepatitis A. In that case, the state was notified within the 14 days and set up a clinic.
Bill Marler, an attorney in Seattle who specializes in food safety cases and writes a blog on the issue, said in an email that state disclosure policies are “all over the map” and that there’s no national standard on when to release the names of restaurants where outbreaks could occur. Even the U.S. CDC isn’t consistent with how it releases such information, he said.
Friday’s announcement comes while the Maine CDC is embroiled in a controversy over restrictions being placed on Hickox, a Fort Kent nurse who treated Ebola patients in West Africa but who has no signs of the disease. The state filed a court petition to restrict Hickox’s public activities, setting up the nation’s first legal case weighing individual freedoms and public health concerns. A judge on Friday ruled in Hickox’s favor to give her more freedom of movement.
Greg Dugal, president and CEO of the Maine Restaurant Association, said he leaves it to the experts at the Maine CDC to weigh public disclosure versus the rights of the business owner.
“If they decide to release a name, we’re not going to argue with them,” he said.
Dugal said that, in many cases, businesses must close once a possible exposure is known publicly, even if there was no longer a public health threat. Martins said “there is no additional risk” for anyone dining in the unnamed restaurant because the worker is no longer contagious.
The state encouraged health care providers to watch for symptoms of hepatitis A infection in patients, including jaundice, clay-colored stool, dark urine, abdominal discomfort and fever. People with the virus begin to exhibit the symptoms 15 to 50 days after exposure. A person is considered infectious between about two weeks before symptoms appear and one week after. Most people who are infected recover completely with no permanent liver damage.
All cases of suspected and confirmed hepatitis A should be reported by phone to the 24/7 disease reporting and consultation line at (800) 821-5821.