Great Lakes Article:

Green Bay News
08/27/2002
A young woman has died. Her child and a friend's child have been infected. And now two more adults close to her have tested positive for hepatitis A.

The woman, Jessica Van Straten, 19, worked at a local McDonald's, as did her friend and the father of her baby, both of whom tested positive for the disease. The father works at Erbert's and Gerbert's, 227 N. Washington St. Both restaurants remain voluntarily closed.

Brown County Health Department and restaurant officials claim that the restaurants' spotless health code records point to an outside source, not the restaurants, as the source of the hepatitis cases. Could the answer lie in the waters of Green Bay and Lake Michigan?

For weeks throughout this summer, beach after beach in Door County temporarily closed because of high fecal coliform bacteria levels in the bay. Ingesting fecal matter is the main cause of hepatitis A.

Hepatitis A enters through the mouth, multiplies in the body and is passed in the stool, which becomes highly infectious. Children still in diapers, food or drink handled by an infected individual, or improperly treated sewage are direct sources of contamination.

Health department officials in Door County have unofficially pointed to raw sewage in the water as the cause for contamination. The sewage might have come from boats using the bay and possibly from Menominee, the Michigan city that experienced sewage treatment plant overflow into the bay earlier this summer during a heavy rainstorm.

Questioning of Van Straten's family by the health department has not turned up a timeframe when Van Straten might have been in the bay. But Bonnie Sorenson, nurse manager at Brown County Health Department, said the bay of Green Bay isn't the only place where raw sewage is in the water. Milwaukee has experienced overflow of raw sewage into Lake Michigan this year.

Sorenson said it might not have been Van Straten who visited the water and possibly picked up the bacteria. It could have been a friend or someone else she came into close contact with.

"I'm not saying that's where it came from," Sorenson said. "We don't know that. But there is no indication that it came from the restaurants. We have asked the families that question and it's not certain that anyone was up there. But with raw sewage, you never know."

The Door County Health Department did not immediately return a phone call to The News-Chronicle.

Symptoms of the disease include profound fatigue, poor appetite, fever, vomiting, darker urine and yellowing of the skin (jaundice).

The disease is rarely fatal - an estimated one to three people out of 1,000 infected die - and most people recover without complications after several weeks. Almost half of those with hepatitis A never know they have it.

People with pre-existing liver conditions, particularly anyone with hepatitis C, can become extremely ill if they contract hepatitis A.

Symptoms may appear between two and seven weeks after exposure, but generally within four weeks. Once a person recovers from the disease, however, they are immune for life, much like chicken pox.

Van Straten died Thursday night after being flown to University Hospital in Madison earlier in the week for a liver transplant. She became so ill she was unable to have the surgery, said hospital spokesman Tim Le Monds.

"Hepatitis A is something that a lot of people get and don't even know they have," he said Friday. "It's rare for someone to get really sick from hepatitis A, let alone die from it."

The two children - both of whom attended KinderCare Learning Center, 1101 S. Taylor St. - were never hospitalized, said Jim Kazmierczak, epidemiologist with the state Division of Public Health. He said lab results indicate the two had hepatitis A several weeks ago and have since shed the virus.

"At this point, those children would not be considered infectious, and they would not be considered at risk for hepatitis A because they are immune," he said.

Children don't typically get very sick from the virus, Kazmierczak said. The children had the disease before Van Straten acquired it, but he could not say whether they gave it to her.

"As far as the source, we can't speculate," Kazmierczak said. "Everybody gets it from somewhere. It just doesn't arrive spontaneously."

There was no indication the virus was transmitted to anyone who ate at the McDonald's, 2600 Packerland Drive in Ashwaubenon. The health department found no history of hygiene problems at the restaurant.

"We would caution people not to jump to conclusions, as the investigation is ongoing," said restaurant owner David Schanock.

Employees of the McDonald's and Erbert's and Gerbert's restaurants; about 100 children, parents and staff at KinderCare; and other people who came into close contact with Van Straten or the children were tested for the virus and given immunoglobulin injections to minimize the chances of becoming ill with the disease, Kazmierczak said. The results were pending.

The Associated Press contributed to this report.