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The Madison County Health Department is investigating a single case of hepatitis A in a food handler who worked while infectious at Mario’s Pizza on Chestnut St. in Berea this past month, according to a health department press release.

Hepatitis A is caused by a virus that is passed person to person through fecal-oral contact. The risk to patrons who ate at Mario’s is very low, according to the health department.

Across the state, there have been more than 3,450 cases of hepatitis A since November 2017 when the state Department of Public Health identified an outbreak of acute hepatitis A. In Madison County, there have been more than 65 confirmed cases.

“We’re pretty sure that we haven’t reached the peak of the outbreak, so we would anticipate that there could be additional cases in Madison County both in food handlers and in the general population,” said Jim Thacker, public information officer for the health department. “That’s why we’re advocating community wide vaccinations, that not only protects individuals but helps to slow the spread and end the outbreak sooner rather than later.”

Since October, the health department has been recommending hepatitis A vaccination for everyone in the community as the number of cases in the county, region and throughout the state continues to climb. The health department declared county wide outbreak status on Oct. 24.

This is just the fourth confirmed case involving a food handler — McDonalds on Glades Road in Berea, Sonny’s BBQ in Richmond and the Artisan Center Cafe in Berea.

“The health department has been actively educating our local restaurants about the dangers of hepatitis A since we had the first case in April,” Thacker previously told The Register. “I am very pleased to be able to report that many of the restaurants in Madison County have been proactive in getting their employees vaccinated as a preemptive measure.”

Health department officials said Mario’s is fully cooperating with local and state health officials to investigate this case and to ensure the health and safety of its employees and patrons. Officials also noted that Mario’s received a score of 95 percent on its most recent health department inspection.

“We’re glad to have the guidance and expertise of the Madison County Health Department on this issue and all of our remaining employees are being vaccinated as soon as possible,” said restaurant owner Jim Upton in the release.

Hepatitis A can be spread, according to health officials, when an infected person does not wash his or her hands properly after going to the bathroom and then touches objects or food; a caregiver does not properly wash his or her hands after changing diapers or cleaning up the stool of an infected person; someone engages in certain sexual activities. Hepatitis A can also be spread through food or water through an ill food handler or by using contaminated items.

Symptoms of infection usually appear 15 to 50 days after exposure and can include fever, jaundice, grey-colored stools, dark urine, abdominal pain, vomiting, fatigue, loss of appetite, nausea and joint pain. Some people, especially children, may have no symptoms. Symptoms usually resolve in two months but can last as long as six months, the health department’s release notes.

Hepatitis A can be prevented by receiving the hepatitis A vaccination. This vaccination is available to anyone 12 months of age or older and is given in two doses six months apart.

Any parent who is concerned about their child’s immunization status may go to the Madison County School Systems Infinite Campus portal to review their child’s immunization record, according to the release. Hepatitis A vaccines have been recommended, but not required, for several years and many children have received the vaccine. However, as of July 1, 2018, it is now a requirement for all children over the age of 12 months.

Further information on hepatitis A and prevention of infection can be found at or Information for food service employers or employees can be found at

Jonathan Greene is the editor of The Register; follow him on Twitter @jgreeneRR.

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