This is a summary of the Rock Island County Sheriff's Department report on its investigation of the June-July hepatitis A outbreak as prepared by Sgt. Steven Ven Huizen:

The Rock Island County Health Department learned of three hepatitis A cases July 10. Grace Schmalz of the health department called the two Rock Island County residents (the third lives in Mercer County) and learned that neither was in a sensitive occupation, such as food handler or day-care provider, that could have led to a spread of the disease.

A fourth case was also reported July 10, via a fax from Genesis Medical Center-West Central Park Avenue, Davenport. That person also lives in Mercer County.

Schmalz and other Rock Island County Health Department personnel were conducting follow-up investigations July 13, when she learned of still another person who had tested positive, in this instance on June 17. That report, from Metropolitan Laboratory in Moline, was received by mail June 26.

The report normally would have been given to Cheryl Dobereiner of the health department, but she was on vacation. Also, it was filled out on an incorrect form - for hepatitis B, C or D, diseases that are considered more serious than hepatitis A. The law states that hepatitis B, C and D cases may be reported within seven days, in contrast to the more immediate

24-hour requirement for hepatitis A.

Dobereiner returned to work at Rock Island County on July 13, having been on vacation since June 23. She noticed the incorrect form used by the Metropolitan Medical Lab and called the facility. A lab employee told Dobereiner that the person in question had been treated at the Trinity Medical Center-West Campus, Rock Island.

Metropolitan Lab did not have hepatitis A on its list of diseases that must be reported within 24 hours, according to the sheriff's department report. A representative from the lab was not available for comment Monday.

Dobereiner said she was told by a representative of Trinity's Disease Control Center that the hospital was not aware of the June 17 report in which a person was confirmed to have the infectious disease.

That subject was then interviewed and found to be an employee at the Milan, Ill., McDonald's restaurant, and county officials called the Illinois Department of Public Health for assistance.

According to Ven Huizen: "Dobereiner was advised of the four July 10 hepatitis A cases on July 13, after returning from an extended vacation. ... While receiving additional suspected cases from reporting entities, Dobereiner discovered an additional hepatitis A case that was not reported properly by a host of required reporting entities. Dobereiner immediately followed up with this case along with the additional cases."

County health officials then conducted hand-washing clinics and inspections of several area businesses, including the Milan McDonald's, the Hy-Vee Food Store in Milan and Just Kids Daycare, also in Milan. The McDonald's was ordered closed for deep cleaning, and the county oversaw deep cleaning at both the grocery store and the day-care center.