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 We contacted ICNs at other area hospitals as well as neighboring health departments, asking about additional cases and requested that we be notified by phone if any were detected. While reports of hepatitis A were not uncommon in this area, they were sporadic. Multiple case reports generally involved persons from the same household. The large number of cases (8) from a single geographic area suggested
    that we were either dealing with an outbreak of hepatitis A or there had been some sort of laboratory error. Clinical information from the ICN indicated that several persons had histories of illness consistent with hepatitis A and ruled out the possibility of a laboratory error. The focal nature of this report suggested a single source. This was substantiated by telephone calls to other health departments and ICNs at other area hospitals who reported no unusual hepatitis A activity at that time. These calls also served to alert the surveillance network of a potential problem and essentially switched it from a condition green involving written reporting to a condition yellow involving immediate telephone reporting. This is a common practice when dealing with potentially large outbreaks.

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