The Division of Public Health announced Friday that hepatitis "A" virus warnings have been expanded to include Buffalo Wild Wings in Bear and the Stone Balloon in Newark, in addition to the warning for Buffalo Wild Wings in Middletown announced Thursday.

UPDATE: Friday, April 12 at 5:38 p.m.

The Delaware Division of Public Health announced Friday afternoon that two more restaurants have been added to the warning about potential hepatitis "A" virus exposure first announced Thursday.

The first restaurant DPH warned about was the Buffalo Wild Wings in Middletown.

"As part of its ongoing investigation, DPH has also determined that exposure to the hepatitis 'A' virus may have also occurred at a second Buffalo Wild Wings location in Bear, as well as the Stone Balloon Ale House in Newark," said Jen Brestel, chief of community relations in the Office of Health and Risk Communication for the Delaware Department of Health and Social Services.

Also, new information indicates that potential exposures began earlier at the Middletown Buffalo Wild Wings than previously reported, and so the timeframe for which DPH is providing guidance to restaurant staff and diners has been updated.

Here are the latest DPH reports about potential hepatitis "A" exposure at the three restaurants:

Stone Balloon, 115 E. Main St., Newark – Potential exposures began on March 20, 2019 and ended with a cleaning of the facility on April 3, 2019. The timing of the cleaning at this facility was not related to the potential exposures, but would have ended the exposure window.

Buffalo Wild Wings, 1887 Pulaski Highway, Bear – Potential exposures began on March 21, 2019 and ended with the voluntary closure and cleaning of the facility on April 12, 2019.

Buffalo Wild Wings, 540 W. Main St., Middletown – New information indicates that potential exposures began earlier than previously reported. Potential exposures began on March 28, 2019 and ended with the voluntary closure and cleaning on April 10, 2019.

DIVISION OF PUBLIC HEALTH RECOMMENDATIONS

Diners who ate at these food establishments during the indicated timeframes and who fall into a high-risk category should contact their primary health care provider for further risk assessment and guidance.

Though the risk of diners contracting hepatitis "A" while dining at the establishments is low, post-exposure treatment may be considered for high-risk individuals in these categories:

• People with chronic liver disease, including cirrhosis, hepatitis "B" or hepatitis "C."

• People who are immunocompromised,

• Women who are pregnant,

• Anyone with jaundice or symptoms compatible with hepatitis "A,"

• People who use drugs (injection or non-injection),

• People experiencing homelessness,

• Men who have sex with men,

• People who are, or were recently, incarcerated.

“We understand that this information may be concerning to individuals who dined or worked at any of the restaurants during this timeframe,” said DPH Medical Director Dr. Rick Hong. “However, we want to stress that the risk of transmission of the virus to those who dined at these restaurant locations is low. Because DPH’s mission is to protect and promote the health of all people in Delaware, we are recommending those who visited these restaurants during the exposure timeframe, contact their health care provider to discuss their individual risk factors.”

DPH’s Office of Food Protection and Office of Infectious Disease Epidemiology continues to work with restaurant management on the investigation to ensure staff at these locations are aware of the recommendations to receive post-exposure prophylaxis, which may include the hepatitis "A" vaccine or a shot of immune globulin to prevent severe illness.

Those with health insurance who have concerns, need a risk assessment, and do not have a primary health care provider should visit a local walk-in medical center (not an emergency room) or call the DPH Office of Infectious Disease Epidemiology at 302-744-4990 or 1-888-295-5156.

Those who are uninsured or underinsured should contact one of the following DPH health clinics at:

• Porter State Service Center, 509 W. 8th St., Wilmington, DE 19801 302-777-2860,

• Hudson State Service Center, 501 Ogletown Road, Newark, DE 19711 302-283-7587, option 2,

• Kent County Health Unit, River Road, Dover, DE 19901, 302-857-5140,

• Sussex County Health Unit, 544. S. Bedford St., Georgetown, DE 19947, 302-515-3220.

ABOUT HEPATITIS "A" AND SYMPTOMS

Hepatitis "A" is a viral infection of the liver and usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. The virus can spread when an infected person does not wash his/her hands adequately after using the toilet, prepares food or shares utensils with others while eating, or engages in other behaviors that increase risk of infection.

Symptoms may include:

•Loss of appetite,

• Nausea,

• Tiredness,

• Fever,

• Stomach pain,

• Brown-colored urine and light-colored stools,

• Yellowing of the skin of eyes.

Symptoms can appear up to 15 to 50 days after exposure to the virus. If anyone develops these symptoms, they should stay at home and contact their health care provider immediately. There is no specific treatment for hepatitis "A" infection. Generally, rest, fluids, and good nutrition are all that is needed. Those with hepatitis "A" should avoid drugs and alcohol.

Careful hand washing, including under the fingernails, with soap and water, is an important tool to prevent the spread of this disease.

For more information about hepatitis "A," visit www.cdc.gov/hepatitis, https://www.dhss.delaware.gov/dhss/dph/dpc/hepa.html or call the DPH Office of Infectious Disease Epidemiology at 302-744-4990 or 1-800-282-8672.

FIRST REPORT: Friday, April 12 at 11:40 a.m.

The Division of Public Health (DPH) announced April 11 that employees and patrons of Buffalo Wild Wings at 540 W. Main St., Middletown, may have been exposed to the hepatitis "A" virus between March 31 and April 10, 2019.

When notified April 9 about the possible exposures, the restaurant voluntarily closed for cleaning and sanitization April 10 prior to reopening to the public April 11.

"Due to privacy restrictions under HIPAA, we cannot identify the source of the infection or their status," said Jen Brestel, chief of community relations in the Office of Health and Risk Communication for the Delaware Department of Health and Social Services.

While it is relatively rare for restaurant patrons to become infected with hepatitis "A" virus from a food establishment due to standard sanitation practices, DPH is taking steps to protect anyone who might have been exposed to the virus.

Anyone who consumed food or drink at this restaurant between March 31 and April 10 should consider contacting their health care provider for further guidance regarding the potential exposure, especially those with symptoms, with chronic medical conditions or women who may be pregnant.

Staff of the restaurant should contact their health care provider to receive post-exposure prophylaxis, which may include the hepatitis A vaccine or a shot of immune globulin to prevent severe illness.

Those who do not have a primary health care provider should visit a local walk-in medical center (not an emergency room), and those who are uninsured or underinsured should contact one of the following DPH health clinics at:

• Porter State Service Center, 509 W. 8th St., Wilmington, DE 19801 302-777-2860,

• Hudson State Service Center, 501 Ogletown Road, Newark, DE 19711 302-283-7587, option 2,

• Kent County Health Unit, River Road, Dover, DE 19901, 302-857-5140,

• Sussex County Health Unit, 544. S. Bedford St., Georgetown, DE 19947, 302-515-3220.

About hepatitis and symptoms

Hepatitis "A" is a viral infection of the liver and usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. The virus can spread when an infected person does not wash his/her hands adequately after using the toilet, prepares food or shares utensils with others while eating, or engages in other behaviors that increase risk of infection.

Symptoms may include:

•Loss of appetite,

• Nausea,

• Tiredness,

• Fever,

• Stomach pain,

• Brown-colored urine and light-colored stools,

• Yellowing of the skin of eyes.

Symptoms can appear up to 15 to 50 days after exposure to the virus. If anyone develops these symptoms, they should stay at home and contact their health care provider immediately. There is no specific treatment for hepatitis "A" infection. Generally, rest, fluids, and good nutrition are all that is needed. Those with hepatitis "A" should avoid drugs and alcohol.

Careful hand washing, including under the fingernails, with soap and water, is an important tool to prevent the spread of this disease.

For more information about hepatitis "A," visit www.cdc.gov/hepatitis, https://www.dhss.delaware.gov/dhss/dph/dpc/hepa.html or call the DPH Office of Infectious Disease Epidemiology at 302-744-4990 or 1-800-282-8672.