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Adam Fondren, Deseret News
The 7-Eleven at 2666 W. 7800 South in West Jordan is pictured on Monday, Jan. 8, 2018. Health officials issued a warning Sunday that some customers at the store may have been exposed to hepatitis A and should receive an injection to prevent infection.

WEST JORDAN — Salt Lake County health workers were busy taking calls Monday after warning people over the weekend that about 2,000 recent customers of a 7-Eleven could be at risk of contracting the hepatitis A virus.

"We have nine call-takers … at our call center, and the phones are constantly busy," said Nicholas Rupp, Salt Lake County Health Department spokesman. "The phones haven't stopped."

"The message got out there, which we appreciate."

By 1 p.m., 256 people who had called had been "referred for a vaccine because they had an exposure that we considered risky," Rupp said. He didn't have a final tally of the callers for the rest of the day.

The county issued an alert Sunday saying a 7-Eleven employee who was ill with the virus recently worked at the chain's West Jordan location, 2666 W. 7800 South.

The county is recommending a hepatitis A vaccine for customers who visited that store between Dec. 26 and Jan. 3 to use the restroom or to purchase fountain drinks, self-serve beverages, or hot food case items such as chicken wings, hot dogs, pizza and taquitos.

"Those are the folks we want to call us so we can ask them a few questions, get their contact information and make sure they know where they can get the hepatitis A vaccine, so they can get protected," Rupp told the Deseret News.

"We are aware this infected person was handling food," he added.

Rupp also cautioned Monday that the preventive vaccine is only effective in warding off the virus for up to about two weeks after a person contracts hepatitis A, so for those who may have been exposed to the virus on Dec. 26, "they only have until (Tuesday) to get that."

But those who purchased pastries or prepackaged foods at that 7-Eleven, or simply went there to buy gas, are not believed to be at risk, according to Rupp.

County health officials believe approximately 2,000 customers could have been exposed to the virus, based on estimates of the store's traffic. Anyone who believes they may be at risk is asked to call the county at 385-468-4636 for instructions.

In a statement, 7-Eleven said the head of the store took immediate action after learning that a worker had hepatitis A.

"As soon as the franchisee was notified of the store associate’s illness, he began sanitizing the store and destroying any items the store associate touched," the company said.

"The health department has been back to the store since it was sanitized and has cleared us to operate as normal. The affected store associate will not be allowed back to work until cleared by a physician," the statement says. "As a precautionary measure, the health department has also administered the hepatitis A vaccine to every store associate working in this store."

Rupp also confirmed that "there is no reason" to avoid visiting the store.

"The other employees have all been vaccinated. We did that all last week," he said. "(The store has) sanitized — everything according to our specifications."

The store was not required to temporarily close.

Rupp said "food service regulation requires … that anyone who is ill with (a) variety of diseases … is precluded from working in a food services establishment."

"This person will need to be completely better," he said, before he or she is authorized to return to work.

He added the incident is a good reminder to all businesses that serve prepared food that employees should stay home if they have any communicable illness, particularly any condition that causes nausea, vomiting or diarrhea.

Rupp said it is believed that the employee's infection is related to an unusual hepatitis A outbreak that has resulted in 93 confirmed cases in Salt Lake County since May.

"We think that the individual who was infected who was working at the store was in contact with a person in the high-risk population," he said.

Utahns who are most at risk of hepatitis A infection are those who are homeless, using recreational drugs or are incarcerated, health officials have said in recent months. However, state and Salt Lake County officials warned in late November that without proper preventive measures, it is possible infections could spread to other groups as well.

Outbreak of the virus

Jeffrey Eason, viral hepatitis epidemiologist for the Utah Department of Health, said 133 confirmed outbreak-related cases have been reported in the state since May 8, 2017, with an additional 12 to 15 potential additional cases still being investigated. That's in comparison with just a handful of such cases statewide most years, including an average of just four per year in Salt Lake County.

Utah's outbreak has led to 68 hospitalizations. All but 13 of the total statewide cases have been reported in either Salt Lake County or Utah County.

"The outbreak is ongoing. We are still receiving cases every week, and while we haven't seen any large peaks in cases, the overall average number of cases reported every week is continuing," Eason told the Deseret News. "We haven't seen a big drop-off."

Eason said he is closely monitoring for any signs that the hepatitis A cases could be migrating to different population groups.

"We may be looking for new ways or new groups of people that the disease may be affecting," he said. "Currently that has been remaining low."

Eason believes the outbreak could be much worse if it were not for vigorous campaigns from local health departments in getting vaccines to at-risk groups, as well as busily promoting proper hand hygiene before preparing or eating food and after using the restroom.

"If our local health jurisdictions weren't out there working with our community members, we would be seeing double, triple the number of cases, maybe even more than that," Eason said.

Last month, Intermountain Healthcare donated $248,000 to the Utah Department of Health for the purchase of nearly 9,000 hepatitis A vaccine kits, to add to the more than 7,000 vaccine doses that had been administered by health workers through late November.

In Salt Lake County, officials say, those staffers have been performing vaccinations wherever there are large numbers of homeless people or drug users, such as various places along the Jordan River, in shelters, at drug treatment centers and at Pioneer Park.

Rupp said it's difficult to know when the hepatitis A outbreak will have peaked, since it can take up to seven weeks for symptoms to become apparent.

"It can be almost two months before someone who is newly infected shows symptoms," he said. "That's why we see a first round … of people who are infected, and then (because) they don't know they are infected but pass it on … we get that second wave," he said.

Despite that uncertainty, Eason is optimistic that things can turn around in early 2018.

"We really have a lot of vaccination efforts going on, as well as increased public awareness, and as long as we continue with these efforts at the rate that we are, I'm very hopeful we'll starting seeing a decrease in the coming months," he said.

According to the Mayo Clinic, hepatitis A is an inflammation of the liver that is associated with several serious symptoms that include fatigue, sudden vomiting or nausea, clay-colored stool, dark urine, severe itchiness, jaundice, and stomach and joint pain.

The virus can move from person to person through tiny traces of feces from someone who is infected, making it vulnerable to being spread through contaminated food and drink. It can additionally be shared via sexual contact.

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A two-shot hepatitis A vaccine has been shown to be more than 99 percent effective at preventing the disease for about 20 to 25 years, but it has only been required for Utah students entering kindergarten since 2002, Rupp has said previously.

Hepatitis A can ultimately prove fatal in some cases. In the San Diego area, 683 confirmed outbreak-related cases have caused 21 deaths as of Dec. 29, according to data kept by the Centers for Disease Control and Prevention. Salt Lake County health officials noted in September that the strain of the virus in and around San Diego was found to be the same as the one causing so many problems in Utah.