Officials Respond to Hepatitis Threat at 18 L.A. Schools

As many as 9,000 students and school employees across Los Angeles may have been exposed to the highly contagious but seldom fatal hepatitis A virus last week when they ate frozen desserts containing sliced strawberries that may have been illegally sold to a federal surplus food program, officials disclosed Tuesday.

The Los Angeles Unified School District said that by Friday it would set up an unprecedented inoculation program at the 18 public schools where the fruit was served. An injection of immune serum globulin is nearly always effective against hepatitis A, if administered within two weeks of exposure.

“It’s not a panic situation,” Dr. Shirley Fannin, Los Angeles County’s director of infectious disease control, said at a press conference at district headquarters. Noting that there is a 14-day incubation period, Fannin added, “We’re here within a week of consumption. We have another week to plan.”

The four-ounce frozen strawberry-blueberry fruit cups were served March 25 through March 28 in 13 elementary, two middle and three high schools. The strawberries they contained already have been implicated in three hepatitis outbreaks in Michigan, which also obtained the fruit as part of the United States Department of Agriculture’s surplus program. Berries from the same source also were shipped to Arizona, Florida, Tennessee, Iowa and Illinois, federal officials said.

All the strawberries were grown and frozen in Mexico, and transported to Andrew & Williamson, a processor and packer of foods in San Diego. On three separate days last year, April 19 and May 7 and 8, the San Diego packer sent the frozen fruit to Michigan, Arizona, Florida and Southern California for bulk distribution as part of a USDA-sponsored school lunch programs.

USDA officials plan to launch an investigation into the affair, because the department is legally required to buy only U.S.-grown commodities for the school lunch program. Processors must certify in writing that the products they use come from the United States.

“A false statement to federal officials is a criminal offense,” said Tom Amontree, a USDA spokesman. Offenders can be sent to prison for as long as five years, assessed civil penalties and stripped of their license to participate in the USDA program.

USDA investigators will interview officials at Andrew & Williamson, who reportedly told representatives of the federal Centers for Disease Control and Prevention in Atlanta that the company had procured the berries from Mexico.

“We have investigators working on it right now to determine whether these are Mexican strawberries. If so, it’s a serious offense,” Amontree said.

Los Angeles’ public schools have yet to report any cases of hepatitis A, which could incubate for another week before causing symptoms. If any students or employees have contracted the virus, officials warned, they can transmit it even though they are symptom-free. Symptoms include fatigue, abdominal discomfort, vomiting, fever, dark urine and jaundice. The virus can be transmitted either orally or through human waste on the hands of food workers with poor personal hygiene, through undercooked shellfish from infected waters or through tainted water or ice.

“Even though [children] would probably not have very severe symptoms, they are good carriers,” said Sara Anne Coughlin, assistant district superintendent for student health. “Kids do not wash their hands enough and it spreads to other family members really quickly.”

Whether they have health insurance or not, all students and staff are eligible for free shots through the clinics the district plans to begin opening at schools as early as Thursday. Those clinics, operated in conjunction with the county health department, will run just through Tuesday, because gamma globulin is only effective if administered within two weeks of exposure to the virus.

Notifications drafted with the help of county health officials are going out to parents today in five languages--English, Spanish, Korean, Chinese and Armenian.

The disclosure of the contamination by the district and county public health officials outraged political leaders and frightened parents who jammed telephone lines at the nation’s second-largest school district shortly after word of the potential outbreak was broadcast, as schools were letting out.

School officials said they were alerted to the possible contamination after 5 p.m. Thursday, and ordered that the fruit cups be removed from the freezers of 46 schools the next day. However, by the time the order was received at schools on Friday, some already had served the desserts to students and staff for breakfast.

Late Friday, health officials say, they confirmed that the cases in Michigan were linked to the tainted strawberries. It was determined Saturday that some of the same shipment of fruit had come to the school district. But no formal announcement was made at that time, school officials said, because they wanted to confer with the county health department over the best method of notifying parents.

“It’s important to emphasize that these students and adults may--I emphasize may--have been exposed to this hepatitis virus,” Deputy Supt. Ruben Zacarias told reporters. “Unfortunately, it is practically impossible to test for the presence of this virus in food. So there’s no way to know, for sure, whether these food items were, in fact, contaminated.”

Parents with access to private medical assistance were urged to have their children immunized, Zacarias said. For those who do not, he said, the school district and the county Department of Health Services are setting up immunization centers at the affected schools.

“I think it’s important to note that as many as 30% of adults are already immune to this disease, and the infection in children is usually mild,” he added.

Dr. James Cherry, chief of pediatric infectious diseases at UCLA Medical Center, agreed with Zacarias’ assessment. At the same time, Cherry noted that the steps being taken by county health officials suggested that the potential health threat is serious.

“I believe in our health department and I don’t think they would overreact,” Cherry said. “If they are recommending the gamma globulin, then I think the risk of infection is substantial.”

Bob Howard, a spokesman for the federal CDC’s National Center for Infectious Diseases in Atlanta, said the continuing investigation into the Calhoun County, Michigan, outbreak in which 153 students fell ill “strongly implicated” a single batch of strawberries. “The CDC has only been called in on one outbreak,” he said.

Iowa officials warned Tuesday that the questionable strawberries may have been shipped to 300 schools there in January and served as recently as last week.

Even as Los Angeles school and county officials sought to quell anxiety about the discovery, political leaders expressed outrage that the public notification was so long in coming.

At the county Hall of Administration, Health Services Director Mark Finucane came under fire by supervisors when he raised the issue during the board’s regular Tuesday meeting.

Finucane admitted that he only learned of the potential health crisis Monday, but said some employees in his office knew about it earlier. That prompted Board Chairman Zev Yaroslavsky and Supervisor Gloria Molina to chastise the health director.

“I hope you’re going to kick some serious butt over this,” an angry Molina told Finucane.

“I plan to, supervisor,” Finucane responded.

After classes ended, the staff at Lenicia B. Weemes Elementary School on West 36th Place near USC watched the televised district press conference about the hepatitis threat. The reaction was concern but not panic, as many teachers recalled the jam-like dessert that left purplish stains on their pupils’ mouths and hands.

“It was a memorable lunch because it left a mess,” said Weemes Principal Annette Kessler, who estimated that about 950 lunches were served on Friday.

Some teachers seemed resigned that they would have to receive the inoculation because they either sampled the fruit concoction or came into close contact with the children who did.

“I ate part of it and it wasn’t very good,” said kindergarten teacher Barbara Erdman. She said she expected to get the shot “just for my own protection.”

At Mount Vernon Middle School, where 746 students and 22 adults ate the strawberry dish for breakfast, parents were upset.

“I’ve told my daughter don’t eat here. I prefer to pack her lunch. She has gotten sick eating food here twice,” said Linda Faye Rogers of her 12-year-old daughter, LaToya Thompson.

Parent Almarie Ford said she would have her sixth-grader seen by a doctor. “It bothers me that you can’t trust the food. It is discouraging news.” she said.

Immediately after the press conference, the district’s Communicable Disease Control Center in Reseda was swamped with calls from parents. Eight nurses answered more than 200 calls within the first two hours after the broadcast.

Officials at local schools and at district headquarters downtown also said they received calls from parents complaining that they could not get through to the nursing office. Many of the initial callers were trying to find out which schools were affected. One call came from a mother in San Marino, which is not even within the Los Angeles city district.

The Los Angeles district was the only one in California to receive the USDA strawberries, which were deemed surplus by the federal government. Once the district took possession, the frozen strawberries were shipped to a plant in the San Joaquin Valley--Wawona Food Services in Clovis--for packaging. Once that was done, the frozen strawberry cups were sent back to the Los Angeles district, which distributed them to the local schools.

Health officials do not know the source of the contamination. It could have been in Mexico, the packer in San Diego or the processing plant in Clovis.

Warren Lund, head of the district’s food services, said surplus food makes up about 18% of the estimated $70 million the district spends each year on acquiring food. Other surplus foods acquired in substantial quantities by the U.S. Department of Agriculture include ground beef, cheese and some fruits, including strawberries.

“As a general rule, we don’t have concerns about surplus food from the USDA,” Lund said.

At the California Strawberry Commission in Watsonville, spokeswoman Teresa Thorne said the California industry hopes that consumers will understand that the berries in question “were frozen strawberries from Mexico grown last year.”

She said that California has stringent field sanitation laws and that the industry this year implemented a quality assurance program, one aspect of which is field sanitation.

Times staff writers Josh Meyer, Amy Pyle, Larry Gordon, Bob Pool and librarian Peter Johnson contributed to this story.

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Hepatitis A Fact Sheet

SYMPTOMS: Muscle weakness, fatigue, loss of appetite, diarrhea, vomiting, chills and high fever.

TREATMENT: Globulin inoculation within two weeks of exposure is usually effective in warding off illness.

RECOVERY: Most patients begin to recover within three weeks and are fully recovered within six to 12 months.

CHILDREN: Far less likely to develop full- blown symptoms- many show none at all.

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INFORMATION: Parents may call L.A. Unified nursing services at (818) 997-2625.

INFORMACION: Los padres de familia pueden llamar a los servicios de enfermeria del Distrito Unificado de L.A. al (818) 997-2625.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Trouble Spots

Here are the schools where strawberry and blueberry frozen fruit cups possibly contaminated with hepatitis A were served:

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School Number Served Day Alta Loma Elementary 476 students March 26-27 Bell High 945 students, 10-15 adults March 27 Coldwater Canyon Elementary 191 students, 1 adult March 26 Dayton Heights Elementary 136 total March 25 Fremont High 461 students March 28 Garfield High 1,900 total March 26 Haddon Elementary 95 students, 1 adult March 27 Hazeltine Elementary 1 or 2 adults (1 cup) March 25 Holmes Elementary 8 students March 26 Magnolia Elementary 1,104 total March 26 Mt. Vernon Middle School 746 students, 22 adults March 28 Plummer Elementary 93 students, 3 adults March 26 Ramona Elementary 140 students, 1 adult March 27 Strathern Elementary 51 students March 26 Trinity Elementary 1,047 students, 14 adults March 27 Virgil Middle School 384 students March 27 Weemes Elementary 978 total March 28 Wilton Place Elementary 192 total March 27 TOTAL 9,006

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Source: Los Angeles Unified School District