Another patient has been added to the case count in a deadly hepatitis A outbreak in Virginia where public health officials continue to investigate other potential cases linked to a local restaurant chain in the Roanoke area.

Now 50 people have been confirmed infected and three have died, according to Dr. Cynthia Morrow, health district director. There are also two people who are considered “secondary cases” because they were infected by patients who ate at one of the three implicated restaurants. Of those sick, 31 have required hospitalization. Morrow did not report whether any of those patients have been released to go home.

The health district director also reported that the agency is investigating “a handful” of other patients who might be part of the outbreak.

“Not surprisingly our numbers have really held steady now that the incubation period is over,” Morrow said Tuesday afternoon during an online news conference. Hepatitis A symptoms generally appear within 50 days of exposure to the liver virus.

The health department has determined that the source of the outbreak was an employee of the Famous Anthony’s restaurant chain. The employee worked at three of the chain’s restaurants while contagious but was not exhibiting any symptoms of being ill, according to public health officials in Roanoke, VA. No details about the employee have been released, including whether hospitalization was required.

Morrow said she does not believe there is an ongoing threat to the public based on the health of other Famous Anthony’s employees.

Public health officials said in late October that the patients were ranging from their 30s to their 70s.

The agency continues to give people the same advice as it has been, which is to monitor themselves for symptoms if they ate at any of the restaurants implicated in the outbreak or have been in close contact with anyone who has been diagnosed as being infected.

Anyone who visited any of the following Famous Anthony’s locations — 4913 Grandin Road, 6499 Williamson Road, or 2221 Crystal Spring Ave. — from Aug. 10 through 27, is urged to seek medical attention if they have developed any of the following symptoms:

• jaundice: yellowing of the skin or the eyes
• fever
• fatigue
• loss of appetite
• nausea
• vomiting
• abdominal pain
• dark urine
• light-colored stools

Hepatitis A is a vaccine-preventable disease. The hepatitis A vaccine is specifically recommended for children, for travelers to certain countries, and for people at high risk for infection with the virus, however, since Virginia is experiencing multi-year widespread outbreaks of hepatitis A, vaccination is recommended for everyone.

Anyone who is not vaccinated against hepatitis A is encouraged to get the vaccine, which is currently available from many healthcare providers and local pharmacies.