The DuPage County Illinois Health Department has reported that four more cases of shigellosis were confirmed Friday, bringing the total number of confirmed cases caused by the outbreak at the Subway restaurant in Lombard to 12. Of those 12 cases, seven have required hospitalization. Six of those who were hospitalized have been released. The restaurant at 1009 E. Roosevelt Road in Lombard remains closed as investigators try to determine the cause of the outbreak.

In mid-October of 1999, an unusually high number of hepatitis A cases were reported among individuals residing in Northeast Seattle and Snohomish County, Washington. Public health officials conducted an epidemiologic survey that included questions about whether case-patients had eaten at fast food restaurants and grocery stores prevalent in the North Seattle area. By November 5, 1999, 18 of 21 persons confirmed positive with hepatitis A in King County after October 15, 1999 were found to have eaten at one of two Subway Sandwich outlets during the two to six week period prior to the onset of symptoms. During this same time period, the SHD determined that at least six persons with hepatitis A had eaten at one of the two implicated Subway outlets.

An environmental investigation resulted in the finding that neither of the implicated Subway outlets had a written hand washing policy, and that employees were not required to document their knowledge of proper hand washing technique. Having confirmed that the Subway outlets were, in fact, the outbreak’s common source, health department officials issued a press release that stated, in part, that: “An ongoing investigation by Public Health suggests that many [hepatitis A] infections are associated with consuming food from one of two Subway Salads and Sandwiches outlets during the month of September. . . .”

It is estimated that over 40 persons became ill as a result of eating contaminated food sold at the two Subway outlets implicated in the September 1999 hepatitis A outbreak. One child developed acute liver failure and required a transplant; many others were hospitalized with severe symptoms.