In December, South Carolina health department workers began receiving reports of hepatitis A infections that were associated with eating at a Taco Bell in Fruitland Park, Florida. The Florida health department was notified and investigated the outbreak with assistance from South Carolina's health department. Twenty-three cases of hepatitis A ultimately met the outbreak case definition. The analysis of food histories and the environmental health investigation showed that green onions held the strongest association with illness. The green onions were not cooked. Concurrent with the cluster of cases in Florida and South Carolina, outbreaks of hepatitis A were discovered and were also linked to Taco Bell restaurants in Kentucky (6 cases) and Nevada (1 case). Green onion consumption again showed the strongest link with illness. The same supplier distributed the green onions to the outlets in Florida and Kentucky. Food handlers at the Florida outlet were tested for hepatitis A. One food handler had hepatitis A, but this illness occurred at the same time as the illnesses in the patrons, thus was not the index case that caused the outbreak. Serum samples from case patients from the various states showed that the hepatitis A virus was the same strain.