‘My three weeks of hell’

Tired and with yellowing eyes, Peter* was in hospital undergoing several tests when he read the news reports of a Hepatitis A outbreak linked to a food outlet.

Shockingly, he realised that the symptoms described in the reports were similar to what he had been experiencing for the previous two-and-a-half weeks.

Speaking to MaltaToday from his hospital bed two days after being admitted, Peter was on the mend but still stuck to his drip as doctors monitored his liver count.

Blood tests confirmed that Peter had contracted Hepatitis A, a viral infection that affects the liver. Symptoms may include fever, tiredness, loss of appetite, nausea, vomiting, abdominal discomfort, diarrhoea, dark urine, pale stools and yellowing of the skin or eyes.

On 5 August, the health authorities issued the public warning of a hepatitis cluster linked to the food outlet Deli & Co. in Qormi. By then four cases had been traced back to the same establishment. Peter was not yet one of the confirmed cases. But two days later, the Superintendence for Public Health told MaltaToday that the cases had risen to seven and investigations were still ongoing.

“These were almost three weeks of hell, not knowing what I had; unexplained tiredness, fever, low blood pressure and a general feeling of unwellness,” he said. “It gets to you not understanding what is happening.”

Peter had ordered food from the outlet on 18 June but it was only when he read the health authorities’ notice while at hospital that he realised what might have happened to him.

The authorities had issued a warning for people who consumed food from Deli & Co. between 17 and 25 June to remain alert for symptoms of Hepatitis A until 14 August. The infection has a lengthy incubation period.

“It started with a fever on 20 July, a month after I consumed the food,” Peter said. “I was extremely tired but at the time I blamed it on the heatwave and the fact that I had gone on my usual morning run.”

Peter continued to feel weak and fatigued even though the fever left him four days later. “I then started experiencing low blood pressure, passing it off as heat related until I visited the doctor on 27 July because of stomach discomfort and a general feeling of unwellness.”

However, the doctor, who was not Peter’s usual GP, diagnosed it as an intestinal problem and prescribed medicine. With his symptoms not improving and now noticing dark yellow urine, Peter became worried.

“It was concerning; I felt tired and something felt off, which is when I decided to visit my GP, who immediately noticed a slight yellowing of my eyes and ordered blood tests,” Peter recounts. “That is when I started to worry for real.”

He had brushed off earlier warnings from his wife, who had noticed a yellow tinge to his skin.

On 4 August, Peter received his blood test results and the doctor immediately referred him to Mater Dei Hospital since the liver count was 25 times above the normal limit. At hospital, Peter was admitted to a ward and immediately placed on a drip to support liver recovery. The Hepatitis A infection was eventually confirmed through further tests.

“Doctors put my mind at rest that the infection will eventually pass on its own but my wife was in a state of panic, bursting into tears every time a nurse or doctor came to take blood samples,” Peter said. “I was also worried because of my two young children but thankfully they are vaccinated.”

His liver count has since improved immensely and was discharged from hospital but still required to carry out follow-up tests.

Hepatitis A is mainly transmitted through the faecal-oral route, including through food or water contaminated with the virus or through close contact with an infected person. Good hand hygiene, particularly after using the toilet and before preparing or eating food, is important in preventing transmission.

Seven diagnosed with Hep A

Meanwhile, in replies to MaltaToday, the health authorities confirmed that after the 5 August announcement, they received several calls from members of the public. As a result, another three people were diagnosed with Hepatitis A, bringing the total until Friday, to seven.

“All cases were linked to the cluster, having consumed food from the establishment during the period when a food handler was infectious and working at the establishment,” the authorities said.

On the day the public health warning was issued, Deli & Co. released a statement confirming that an employee of theirs was diagnosed with Hepatitis A on 4 July. The company said the employee did not return to work until he was cleared to do so by the health authorities. The company said “all measures were taken in line with public health guidelines”. It did not specify what these measures were.

But the company also accused the health authorities of basing their warning on “suppositions” and “unsubstantiated allegations”.

The company added: “We are surprised and disappointed that, despite the issue going back to the start of July, the public advice was only issued now, more than a month after the event.”

However, unwittingly, the company also confirmed that the person’s last working day before going abroad was 25 June, which places the infected employee squarely within the incubation period for the infection and at the workplace in the period identified by the public health authorities.

Symptoms usually develop around four weeks after infection, although the incubation period can range from approximately 15 to 50 days.

Persons who consumed food from the establishment between 17 and 25 June and develop symptoms are advised to contact the Infectious Disease Prevention and Control Unit within the Health Promotion and Disease Prevention Directorate on 23266161, 23266104, 23266119 between 8am and 3:30pm.

*The name has been changed to protect the person’s privacy.