In the final analysis, the Milan McDonald’s Hepatitis A outbreak is not simply about who is lying or who is inept in this single instance. It is about whether the public health system for reporting and managing communicable diseases really works.
Like other states, Illinois requires all health care providers to notify local health authorities whenever they come across certain “reportable diseases”
In Illinois, the overall reporting requirements are found in Section 690.200 of the Public Health Code. Specific provisions for Hepatitis A are found in Section 690.450.
Interestingly, Hepatitis A cases must be reported “as soon as possible, within 24 hours.” Anyone with Hepatitis A “shall not work as food handlers or in sensitive occupations during the period when infection control precautions apply.”
In addition to a long list of health care providers who must report, under the Illinois code “any other person having knowledge of a known or suspected case or carrier of a reportable communicable disease or communicable disease death” is also legally obliged to report it.
How might these legal requirements apply to the facts on some key dates that are now critical to the Milan McDonald’s Hepatitis A outbreak?
June 16, 2009 – McDonald’s Employee Cheryl Schram learns from Trinity Medical Center in Rock Island, IL that she has tested positive for Hepatitis A.
June 25, 2009 – Cheryl Schram visits Milan McDonald’s and informs a manager known only as “Michelle” of her Hepatitis A status. This is confirmed by at least one witness.
July 10, 2009 – Multiple cases of Hepatitis A reported to both county and state health officials.
July 13, 2009 – McDonald’s franchise owner Kevin Murphy says he first learns of the Hepatitis A outbreak from the Rock Island County Health Department. The Illinois Department of Public Health first learns about the Cheryl Schram case, but does not know she was a food handler for McDonald’s until the next day.
July 15, 2009 – A second McDonald’s employee tests positive for Hepatitis A.
July 16, 2009 – There are 19 confirmed and two suspected cases of Hepatitis A, all involving people who ate at the Milan McDonald’s.
July 18,2009 – The Rock Island Health Department announces free Hepatitis A vaccination and immune globulin clinics for the following Monday and Tuesday for all those who dined at the Milan McDonalds from July 6-10 and July 13-14, 2009.
July 20-21,2009 – Of the estimated 10,000 who might have been exposed, about 4,000 take advantage of the vaccinations. The Milan McDonald’s is located just a couple blocks off the Interstate 280 beltway that goes around the Iowa-Illinois Quad Cities. Thousands who were exposed to Hepatitis A are far down the road by now.
There are obvious questions from all this that do not have answers at this point. Did Trinity Medical Center report within 24 hours on June 16th or 17th that Cheryl Schram had testing positive for Hepatitis A?
If Trinity did so, it probably used the Illinois National Electronic Disease Surveillance System (I-NEDSS), a web-based system.
When, if so, did the Rock Island County Health Department read the report? It would have included information on the Hep A patient and the attending physician. Finding out more would have required some investigation by the county health department.
Illinois law gives local health departments a lot of power to get investigations done. It requires businesses to cooperate and gives health officials emergency access to records. Finding out fast if someone with Hepatitis A is a food handler is clearly a major goal in the code.
How about the Milan McDonald’s manager who learned on June 25 that one of her employees, who she knew was recently released from the hospital, and now learns of the Hepatitis A diagnosis?
Illinois law obligates “any other person having knowledge of a known or suspected case… to contact local health officials that license restaurants to operate. The number is usually on the license on the wall by the phone.