An outbreak of hepatitis A in Anchorage, Alaska, has been traced to flavored slush drinks served by a convenience store there.
The slush-flavoring mixture was prepared in a bathroom by a worker who had been exposed to two other people with the highly infectious virus, according to a study published in the June issue of the Western Journal of Medicine.
Employees who serve slushes at gas stations, movie theaters and convenience stores, who are not required to regularly wash their hands, should take extra care to do so often to avoid spreading the virus to those who drink the summer refreshments, said Dr. Michael Beller of the Alaska Department of Health and Social Services.
He studied a 1988 outbreak of hepatitis A among 57 people in Peters Creek, an Anchorage suburb of 4,000 people.
Of those, 32 people were considered primary cases, meaning they were infected earlier than the others and were thought to have passed the disease to them. All 32 had consumed slush drinks from the same convenience store, Dr. Beller reported.
Investigators tested the area's water supplies and ruled out infection from those sources.
At the convenience store, liquid drink mix was poured into an empty jug, then filled with water from a bathroom faucet and refrigerated. Mixing utensils for the slush were stored next to a toilet in a back room of the store.
The freezer used to dispense the slush also was not regularly cleaned, Dr. Beller wrote.
One of the two employees who mixed the slushes had two friends who had contracted hepatitis A two months before the outbreak. While the employee denied being sick, one of the friends said the worker had recently suffered jaundice, a common symptom of hepatitis A.
Outbreaks of hepatitis A that arise from the same source are fairly rare, said Dr. Richard Duma, director of the National Foundation for Infectious Diseases. It mostly is spread from person to person, he said.
Most people who get the infection and otherwise are healthy recover completely.
Hand washing, especially after going to the bathroom, is a good way to prevent the spread of the virus, Dr. Duma said. But businesses that do not focus on food preparation may not follow health rules as closely as places such as restaurants, he said.
"They may not be as familiar with some of the health regulations, and they aren't always monitored as well by health departments," Dr. Duma said. "Obviously, in this case there was very poor hygiene."