Health officials in the Roanoke, VA, area say the number of hepatitis A infections linked to three Famous Anthony’s restaurants has more than doubled, with 20 people requiring hospitalization.

The Roanoke City and Alleghany Health Districts report the patient count jumped from 14 to 35 cases since the most recent update, according to WFXR radio.

The case count on Sept. 28 was 14 with at least three people hospitalized, according to District Director Cynthia Morrow. She said earlier this week in an updat that additional cases beyond those now confirmed 35 are likely because of the long incubation time for the virus. It can take up to 50 days for symptoms to develop after exposure. 

Health officials first reported the outbreak on Sept. 24, saying that a person who worked at three different Famous Anthony’s locations tested positive for the highly contagious infection.

Morrow reports there has been a “handful” of secondary cases after people who were infected transmitted the virus to other people within their own households. However, there are no major clusters of such secondary infections.

Public health officials are encouraging anyone who visited any of the three implicated Famous Anthony’s restaurants between Aug. 10 and Aug. 26 to continue to monitor themselves for symptoms.

The three locations are: 

• 4913 Grandin Road
• 6499 Williamson Road
• 2221 Crystal Spring Avenue

There is a vaccine that prevents the highly contagious liver virus, but apparently, the restaurant worker had not been vaccinated. Employers generally do not require the vaccinations of food service workers. There is also a post-exposure vaccine, but it must be given within two weeks of exposure and the current outbreak was not identified until that opportunity had expired.

Anyone who ate or drank anything from any of the three restaurants and develops symptoms of hepatitis A should immediately seek medical attention and tell their health care providers about the potential exposure.

Symptoms include jaundice (yellowing of the skin or the eyes), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine or light-colored stools.