The Beaver County hepatitis A outbreak, already one of the largest in history, claimed its third victim yesterday as the number of confirmed cases climbed to 490.

John Spratt, 46, of Aliquippa, died in an intensive care unit at UPMC Montefiore, where he had been treated since Nov. 5, said his brother, Joseph Spratt, of Patterson Township.

Since state Department of Health investigators were first alerted to the outbreak two weeks ago, more than 9,600 people have been screened at state-run clinics, of which 8,914 have received precautionary injections of immune globulin. Of the 490 confirmed cases to date, 330 of the people reside in Beaver County and 60 are from other states.

In a telephone conference with reporters yesterday, Dr. Calvin Johnson, state secretary of health, said there's no evidence yet of infections spreading beyond those people who were exposed through the Chi-Chi's restaurant at the Beaver Valley Mall.

Twenty-six employees of various restaurants, including 11 at Chi-Chi's, have been confirmed with hepatitis A, said Jay Pagni, spokesman for the state Health Department. The 15 restaurant workers who aren't employed at Chi-Chi's had eaten at the restaurant. He said there is no evidence that the infection has spread beyond Chi-Chi's, however, and patrons of the restaurants where the other infected employees work are not at risk.

State and federal health officials say they still have not found a source of the contamination. They have not eliminated the possibility that an infected employee with poor hygiene may have caused the outbreak, but, given the size of the outbreak and the genetic characteristics of the virus involved, they also are considering that green onions or some other food might have been contaminated before being delivered to Chi-Chi's.

"We're not discounting food service workers, [but] based on where we're at now, we're focused more on the food, " said Joel Hersh, director of epidemiology at the state Health Department. "The data seems to be more suggestive that that may have been the route."

Green onions are suspected in recent outbreaks in Georgia, North Carolina and Tennessee.

Donna Garren, vice president of scientific and technical affairs for the United Fresh Fruit and Vegetable Association, said the trade association is aware of the outbreak and is working with the Food and Drug Administration, as well as monitoring the situation on behalf of its members.

Following the report of the latest death, Bill Zavertnick, chief operating officer for the Louisville, Ky.-based restaurant chain, said company officials are working tirelessly with health authorities investigating the outbreak.

"We're deeply saddened by the untimely loss of life and extend our sympathies to the immediate family and friends," he said.

The families of the victims also are struggling to figure out how a dinner out at a favorite restaurant could have such catastrophic consequences.

On Oct. 5, John Spratt and his 17-year-old daughter shared chicken fajitas at Chi-Chi's.

If his wife, Robin, and other daughter were busy, the two would "sneak off to Chi-Chi's," as his brother Joseph Spratt put it. "That was their favorite spot," he said.

The teenager had some flu-like symptoms later that month, but wasn't sick enough to need any treatment. But John Spratt felt ill for weeks.

"It wasn't like he got sick and then got worse every day," his brother said. "He would get better, then get sick again. He thought he had a recurring bout of the flu."

The third time, Spratt became so ill he couldn't keep anything down. His doctor thought it was the flu, too, but sent him to the Medical Center, Beaver, for intravenous fluid treatment of dehydration.

"And then he unexpectedly went into liver failure," Joseph Spratt said. "That's when the domino effect took over."

John Spratt was flown by an air ambulance to UPMC Montefiore. His kidneys failed and his pancreas became inflamed. Surgeons evaluated him for a liver transplant, but concluded that he was too medically unstable to withstand the rigors of the operation.

But Spratt's prognosis was not consistently bleak.

"There were times when he appeared to have turned the corner," his brother said. "That gives you some hope for recovery. Then the hopes would fade. It's been a little rough."

Spratt worked for about two decades at ADP, a payroll company in Robinson. He was a devout man who regularly attended a Pentecostal church in Aliquippa called the Wildwood Chapel, where he was a lay minister and taught Bible school.

Fewer than 1 percent of patients with hepatitis A die of the infection. The risk is greater for people who already have a liver condition or other chronic disease. But prior to getting hepatitis A, Spratt was healthy, his brother said.

"That's the big mystery," Joseph Spratt said. "Everybody who has the disease has to proceed with caution and not be deceived by being asymptomatic for a brief period of time. From my experience, things can turn around in a hurry."

Dineen Wieczorek, 52, died Wednesday while waiting for a liver transplant at the Cleveland Clinic, a week after she was diagnosed with the infection. She and her husband ate at Chi-Chi's on Oct. 6 to celebrate their 32nd wedding anniversary. Wieczorek had a history of diabetes.

The outbreak's first victim was Aliquippa resident Jeffrey Cook, 38, who died on Nov. 7.

Cook, his wife Christine, and their two daughters ate at the Chi-Chi's restaurant last month, said Charles Bowers, a lawyer who is representing the Cook family and several others affected by the outbreak.

The Cooks' 10-year-old girl became infected with hepatitis and is doing well.

In recent years, Cook was an at-home dad. He put his wife through nursing school by working as an auto detailer. He was so talented, Bowers said, that one of the cars he worked on was pictured on the cover of a national magazine.

Cook went to Sewickley Valley Hospital when he first became ill and was then transferred to UPMC Presbyterian, where he later died after a liver transplant failed to save him.

Rumors that he had an underlying liver disease and was already on the transplant list are not true, the lawyer said.

"To the best of his family's knowledge, there was no preexisting [medical] condition," Bowers said. "At least, there was never one that manifested itself or required any treatment."

Deaths from hepatitis A are rare, state health officials emphasized.

"It is unusual for it to cause death or result in death," Johnson said. "However, it is possible."

The deaths may be unusual, but they are consistent with findings from an investigation of an earlier outbreak in Tennessee.

Dr. Bradford Waters, of the University of Tennessee in Memphis, was part of a research team that analyzed 256 people who were hospitalized with hepatitis A during 1994 and 1995 in the outbreak in two Tennessee counties.

Five patients died and 20 patients had complications in organs other than the liver. Three of the 52 patients who were 40 or older died, while only two of 203 patients younger than 40 did.

"When it comes to hepatitis A, other studies have shown that being over 40 seems to be a risk factor," Waters said. Several of the patients who died or suffered severe complications had been healthy.

Some studies indicate that elderly Americans have natural immunity to hepatitis A, likely because they were exposed to the virus as youngsters when sanitation systems were less effective. Children often have no symptoms or mild disease.

"I think the biggest risk is having adults without immunity," Waters said. "And if you have big outbreaks, you're going to have serious complications."

During the Tennessee outbreak, doctors were told by federal infectious disease experts that they were not dealing with a more virulent strain of the hepatitis A virus, as some had feared.

Unlike the current situation, that outbreak did not stem from one source but may have spread to susceptible parents and caregivers through the diaper changes of asymptomatic, infected children in daycare centers, Waters said.

"Some physicians and members of the public take it very lightly, but ... they've never seen hundreds of cases and seen how horrible this thing can be," he said. "Believe me, in cities that have had an epidemic, the physicians respect this illness."