Hepatitis A cases found among workers at a Kroger in southwest Louisville and two Waffle House restaurants in the Ashland area

The outbreak of hepatitis A that the state identified in November and that escalated in Louisville last month continues, with new cases being traced to groceries and restaurants. The liver disease is thought to be spread primarily by failure to remove fecal material from the hands by washing them.

After an employee at the Kroger store at 4915 Dixie Highway in Louisville was diagnosed with the disease, the store said customers should throw away any produce bought at the store from Feb. 4 to Feb. 28, though the employee wore gloves while handling produce. Kroger told the Louisville Courier Journal that the employee did not continue working after being diagnosed.

This week, "An employee who worked at two Waffle House restaurants in Boyd County was diagnosed with Hepatitis A, according to the Ashland-Boyd County Health Department," Mike Stunson reports for the Lexington Herald-Leader. "The window of possible exposure for the worker was Feb. 12 to 28, the health department said. It can take up to 50 days from exposure to the illness for symptoms to develop, according to the Center for Disease Control and Prevention."

The restaurant and employees cooperated fully and will notify patrons of potential exposure, the health department said. Employees are receiving post-exposure vaccinations.

The state averages 10 cases of hepatitis A per year, but this year has identified 150 cases in a little over two months, 124 of them in Jefferson County. Besides Boyd, other counties with cases have been Anderson, Bullitt, Carter, Hopkins, Kenton, Leslie, Marion, McCracken, Russell, Spencer and Taylor.

"Hepatitis A is a liver disease caused by a virus, which hits adults the hardest, according to the health department. Symptoms include fatigue, sudden nausea and vomiting, abdominal pain or discomfort, loss of appetite, low-grade fever, dark urine, joint pain, yellowing of the skin and whites of your eyes and intense itching," Stunson reports. "People are at risk for the virus if they have been exposed to someone with it, have traveled to a country where the virus is common, if they are homeless or lack access to adequate restroom facilities, use illicit drugs or have had sexual contact with an infected person."