hepatits Jack in the Box

Health officials are reporting five new hepatitis A cases in Franklin County in the past three days, bringing the total to 30 since January.

Public Health Supervisor Tony Buel said in addition to investigating new cases, last Friday and Saturday, June 21 and 22, county and state health staff administered 720 vaccines to 665 adults and 55 children, who believed they may have been exposed to the virus while visiting a Union fast-food restaurant over three separate weekends.

County health officials have administered 848 hepatitis A vaccines thus far in June and 1,260 since Jan. 10 after the first case was diagnosed.

On Thursday, June 20, health officials temporarily shut down the Jack in the Box in Union after an employee there was diagnosed with hepatitis A.

The restaurant was only closed for a matter of hours and Buel confirmed all 16 employees of the restaurant have been vaccinated and are back to work, including the individual who was originally diagnosed.

“Jack in the Box corporate headquarters in California contacted us to assure the health department they have boosted their sanitization and cleaning products and procedures,” Buel said. “The Jack in the Box restaurant was not the source of the outbreak, and it was one of four eating or drinking facilities in the county where an employee has been diagnosed with hepatitis A.”

Buel could not reveal the other establishments, but said they are smaller and all of their employees have been vaccinated, per protocols.

The names of the establishments can’t be released since the number of employees are low and they could be easily identified, which could violate patient privacy laws.


Buel said the health department does not believe the five new cases this week stem from anyone who visited Jack in the Box, but they are tied to original cases reported in January.

“It looks like they are all connected to the outbreak,” Buel said. “Most of the cases have acquired it through drug use, others, like family members, have had contact with drug users.”

As of now, the original source of the hepatitis outbreak is not known, but it was believed to be contracted by a drug user outside of Franklin County in early 2019.

Since then, all of the cases reported here are linked to one another in some way.

“The average age is 37. The oldest person infected is 64 and the youngest is 14,” Buel said. “There are 19 males and 11 females.”

The scope of the county is widening as well with the virus reaching all areas of the county.

Currently there are hepatitis A cases reported in Washington, St. Clair, Union, Sullivan, Stanton, Beaufort, Lonedell, Catawissa, Villa Ridge, Pacific, Gerald and Leslie.

Moving Forward

Franklin County has a supply of vaccines, which has been supplemented by the Missouri Department of Health and Senior Services (DHSS) at no cost.

Although the vaccines have been supplied for free, the outbreak is costing Franklin County money in overtime for health department employees. 

“We are still vaccinating at the health department and nurses at the jail are as well,” Buel said.   

Before this year, Franklin County only had one reported case of hepatitis A in the past decade.

Buel explained it is hard to track the origin because of the 15- to 50-day incubation period of the virus, which is different in every individual.

Thus far, there have been no deaths related to hepatitis A in Franklin County, but two people have died in Missouri this year from the virus.


Hepatitis A is a viral infection of the liver that can cause loss of appetite, nausea, tiredness, fever, stomach pain, brown-colored urine and light-colored stools.