Long raging among the homeless living on city streets, San Diego’s deadly hepatitis A outbreak entered a new realm Friday with a warning from the county health department that involves possible exposure at a Pacific Beach restaurant.

The county Health and Human Services Agency said in a Friday morning statement that anyone who dined or drank at the World Famous restaurant on specific days and at specific times in late August and early September “may have been exposed to a person with hepatitis A virus.”

There is no evidence , said Dr. Eric McDonald, director of the county’s Epidemiology and Immunization Services Branch, that anyone picked up a hepatitis A in the restaurant, and it’s not yet clear whether the World Famous case is connected to the region’s ongoing outbreak.

Notifying the public, a step which has not occurred in six other cases where food service workers have become infected, was deemed necessary, he said, because any possible exposure would have occurred within the last two weeks.


Evidence shows that getting vaccinated within two weeks of exposure can prevent infection so reaching out to the public made sense, McDonald said.

“The shorter the amount of time between exposure and vaccination, the more efficacious it’s going to be, so we thought it was important to reach out,” McDonald said.

The news immediately spread coast to coast. Caitlin Kummeth of Pacific Beach said her cell phone started buzzing with text messages from friends who were with her at World Famous on Aug. 30 at about 5:30 p.m. which falls squarely in one of the time ranges indicated in the county’s notice. On business in Philadelphia Friday, Kummeth said she was considering getting vaccinated, especially after calling the restaurant and learning that the area most affected was the bar, which where she downed a Coke, two lobster tacos and lots of water.

“With the whole hepatitis A scare that’s going through San Diego right now, I’m quite worried. I’m going to have to figure out my next steps,” Kummeth said.


The notification arrived at a time when many were already on edge regarding an outbreak that has become the largest since the hepatitis A vaccine became widely available in 1999.

On Tuesday, the health department’s official case count pushed past 400 and added a 16th death, as emergency sidewalk and street washing began in downtown areas deemed “fecally contaminated” on the last day of August.

On Friday the county and the restaurant declined to say whether the person who had hepatitis A at World Famous on Pacific Beach Drive was an employee or a patron, though the list of exposure times, each eight or nine hours long, seemed more likely to involve a worker than a diner.

The dates and times of concern at the restaurant are:


Aug. 28, 29 and 30 from 3 p.m. to 11 p.m.

Sept.3 and 4 from 9 a.m. to 6 p.m.

Sept. 10 and 11 from 3 p.m. to 11 p.m.

The county’s North Central Public Health Center, 5055 Ruffin Road, will be open Saturday from 10 a.m. to 2 p.m. to provide free vaccinations to anyone who is concerned they may have been infected. McDonald said the weekend session is intended to serve those who think they may have eaten at World Famous during the times and dates indicated.

Erik Berkley, the restaurant’s general manager, said Friday he was notified of the possible exposure on Tuesday, Sept. 12. The notification, he said, prompted him to shut down operations immediately. He added that county health inspections found no evidence of hepatitis contamination in the facility but the company decided, out of an abundance of caution, to hire a private hazardous materials company to do a deep cleaning overnight.

“At no time did the health department shut us down. We took this step on our own because we wanted to make absolutely sure,” Berkley said.

World Famous re-opened Wednesday afternoon, he said.


The restaurant currently has an A grade from the county Department of Environmental health after an inspection on Sept. 11. However, a previous inspection on Sept. 8 found three major violations related to the sanitation of food-contact surfaces, food holding temperatures and protection from contamination.

Berkley acknowledged those problems but said they were immediately corrected, adding that he is confident they had nothing to do with the person involved in the county’s public notification.

“The individual in question doesn’t work with the food. The individual in question doesn’t serve the food,” Berkley said.

Though it is the first time that the health department has notified the public of possible hepatitis exposure at a local restaurant since the outbreak began, there have acutally been six food service workers who have become infected since it started in November of 2016, according to a recent outbreak update to the local medical community. That update says that “no secondary cases have resulted from the individuals working in these sensitive occupations.”


Unlike the World Famous case, the county has not issued any public notification of possible exposure for any of the other six food service workers. McDonald said that’s because none of those cases met criteria from the U.S. Centers for Disease Control and Prevention on when public notice is necessary.

“The World Famous case is the first one that met the criteria that the public should be notified,” McDonald said.

He said the CDC’s algorithm for determining if public notice is necessary takes many factors into account, starting with whether a worker was on the clock while they were infectious. The infectious period for hepatitis A, he added, starts about two weeks before symptoms appear and continues to a week after jaundice sets in.

Five of the six, McDonald said, were working while infectious, but did not meet additional criteria which included the type of job they performed, what type of food they handled and what their specific symptoms were. Because high temperatures kill the hepatitis A virus, cool foods are more likely to transmit an infection.


“Handling fresh produce without gloves that is eaten raw, that is a higher risk than something that is cooked and then served without handling,” McDonald said.

Providing examples from among the six workers whose specific circumstances did not generate public warnings, McDonald said one was responsible for serving food but not preparing. Simply serving food, research has found, carries a less than 1 percent chance of transmitting hepatitis A, McDonald said. Another involved a worker who was preparing food while wearing gloves 100 percent of the time.

In recent months, as the outbreak has grown, the county has worked with the local food and beverage associations to review food service sanitation procedures and has mounted a vaccination campaign for food service workers.


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paul.sisson@sduniontribune.com


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