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Laura Seitz, Deseret News
Melissa Sandgren, a registered nurse, answers a call at the Utah County Health Department's offices in Provo on Wednesday, Jan. 10, 2018, concerning a hepatitis A outbreak. As of Monday, there have been 133 confirmed cases of hepatitis A in Utah during the current outbreak, according to the Utah Department of Health.

SPANISH FORK — Utah County health officials say finding hepatitis A in employees at an Olive Garden and Sonic Drive-In has them concerned about the possibility that an ongoing monthslong outbreak of the virus could affect populations not previously considered to be at significant risk.

"I think this is a good indication that it could be moving from a more defined population potentially into a grayer (area), which certainly is a concern," said Aislynn Tolman-Hill, spokeswoman for the Utah County Health Department.

"And that's something we really do want to limit as much as possible. That is something that is really a concern for everyone and certainly for food establishments to take into consideration."

On Tuesday, the department issued an alert saying that anyone who patronized the Sonic Drive-In at 971 N. Main or Oliver Garden at 1092 N. Canyon Creek Parkway in Spanish Fork on certain days last month could have been exposed to hepatitis A.

Customers who visited that Olive Garden anytime from Dec. 21 to Dec. 30 are considered at risk, while those who visited the Sonic Drive-In on Dec. 23 or Dec. 24 could have been infected, according to Tolman-Hill.

"The recommendations we have given (are) obviously to exclude the sick employee, which they've both done, and also to do a sanitization of all the food contact surfaces (as well as) nonfood contact surfaces, especially the restrooms," said Sam Marsden, food safety program manager for the Utah County Health Department.

The two restaurants became the second and third Wasatch Front eateries to be singled out since Sunday as potentially presenting a risk of hepatitis A infection to customers.

The Salt Lake County Health Department published a warning over the weekend that there was a risk to those who bought hot food, fountain or self-serve beverages, or used the restroom at the 7-Eleven store at 2666 W. 7800 South in West Jordan anytime between Dec. 26 and Jan. 3.

The hepatitis A outbreak that has resulted in 133 confirmed cases in Utah since May has so far predominantly affected people who are homeless, use recreational drugs or are incarcerated, which has allowed health administrators to specially target their messaging campaigns and on-the-spot vaccination drives over the last several months.

"It's been a huge effort to try to contain it," said Ralph Clegg, executive director of the Utah County Health Department. "This is the first jump we've seen into the general population: The concern with the restaurants."

In a typical year, Utah County has one to two confirmed hepatitis A cases. But as of Jan. 2, according to data kept by the state, there have been 26 cases since May 2017.

Tolman-Hill said it's plausible more Utah County restaurants could be found to have an infected employee. Whenever those infected with hepatitis A "do work at a food service establishment ... that is a big concern for us," she said.

"I think time will tell whether we have any additional food service establishments that could come to light in the coming days and weeks," she told the Deseret News. "Is it a possibility? Absolutely."

Both employees with hepatitis A had duties that included handling food, Tolman-Hill said. At some point, "they did become symptomatic and went to a health care provider and had testing done and that testing came back positive," she said, and the county was alerted to both cases Tuesday.

Tolman-Hill was unsure of how many customers may have been exposed, but said "we are estimating that it would be in the thousands."

Olive Garden and Sonic Drive-In both issued statements saying they have been cooperating with health workers in ensuring no further risk to their customers at the affected locations.

"As soon as we learned that one of our team members was diagnosed, we immediately partnered with the health department," said Hunter Robinson, spokesman for Olive Garden, in an email. "The team member has not been in the restaurant since being diagnosed and will not be permitted to return to work until being officially cleared by health officials."

"We’ve been working closely with the health department to ensure we have all of the right processes in place to protect our team members and our guests, including thoroughly sanitizing the restaurant for two consecutive days, arranging for all team members to receive inoculations, and reinforcing our ill employee policy."

Jason Acock, a spokesman for Sonic Drive-In, referred to the infected worker as "a former drive-in employee" in a statement.

"It is regrettable that the former employee contracted hepatitis and came to work unaware of the illness," Acock said.

Officials say it frequently takes several weeks after being exposed to hepatitis A for a person to begin showing symptoms.

He also said that the former worker "has not worked in the drive-in since Sunday, Dec. 24" and that "the franchisee who owns and operates the drive-ins is working closely with health department officials to ensure all necessary food safety precautions are being met."

"The drive-in has a history of good health inspection ratings and has taken additional steps with the guidance of the health department to limit any potential spread of this illness," Acock said.

Marsden agreed that the restaurants have been cooperative.

"We haven't found any reason to suspend their permits or anything, because they've been proactive about dealing what they need to deal with," he said.

Marsden said health officials are taking the opportunity to remind restaurants to be properly cautious about sick employees.

"What we reiterate on all our inspections is every establishment needs to have an employee health policy where employees are trained on certain symptoms to look out for, and certain disease diagnoses to look out for to report to management," he said.

Any food worker diagnosed with hepatitis A needs formal clearance from the Utah County Health Department, Tolman-Hill said.

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Local health officials have established an online screening tool where people can get their risk of exposure evaluated by answering questions about their visits to both Spanish Fork restaurants. Those determined by the questionnaire to be at risk are then asked to call a hotline at 801-851-HEPA to speak with someone from the county who can help them decide what to do next.

The screening webpage had received about 1,200 visits by Wednesday morning, and by 1:30 p.m., about 300 people had called the county's hotline, which was being manned by 10 health workers, Tolman-Hill said.

"We've been running pretty much capacity for our phone line," she said.

Contributing: Caitlin Burchill, Ladd Egan