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Since early November, there has been an outbreak of hepatitis A in Western Pennsylvania, with 520 confirmed cases and three deaths that appear to be linked to the disease.

According to Richard McGarvey, a spokesperson for the Pennsylvania Department of Health, the source of the outbreak was a Chi-Chi's restaurant in Beaver County, near Pittsburgh.

The Chi-Chi's restaurant in Beaver County voluntarily closed on Nov. 2, McGarvey said. Chi-Chi's is a chain of Mexican restaurants, with locations throughout the mid-western and eastern United States.

"The infection has been stopped. There's not more people getting ill because of Chi-Chi's," McGarvey said.

Now, McGarvey said, the Pennsylvania Department of Health is trying to determine the exact cause of infection.

According to Paul McGovern, an instructor of medicine in the Department of Infectious Disease at the Medical School, hepatitis A is transmitted through either contact or ingestion, but it's "mostly food borne."

"There's a fecal-oral route," he said. If a person with hepatitis A and poor hygiene handled food, traces of infected fecal matter might contaminate the food.

McGovern also added that green onions have been linked to previous outbreaks of the disease, because "they're difficult to clean."

According to their Web site, Chi-Chi's has voluntarily removed green onions from all of their locations as of Nov. 12.

"Twelve workers had hepatitis A," McGarvey said. But "they got ill at the same time everyone else did," meaning that they were not likely to be the source of contamination.

The Department of Health is interviewing people who ate at the Chi-Chi's, McGarvey added, and "trying to cross-match the two" to find out exactly what food caused the outbreak.

However, he warned, "in about 40 percent of the hepatitis outbreaks that have happened, we aren't able to determine the source."

Infected food, rather than poor hygiene, leaves more room for the outbreak to spread, McGovern said.

"If it's foodstuff that may not have been delivered only to the Chi-Chi restaurant, but to other restaurants in Pennsylvania, then there's a chance" of the outbreak spreading beyond the Pittsburgh area, McGovern said.

However, he added, "it's premature to say whether it is or it is not going to spread because the investigation has not been completed."

According to McGarvey, the outbreak has not yet spread. "At this point, we have not seen other hepatitis cases in Pennsylvania," he said.

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