In September 1999, at least 32 customers in Seattle contracted hepatitis A after eating food contaminated with the virus at two Subway outlets.[86] The virus, which is spread by eating or drinking food or water contaminated with infected feces, infects the liver causing nausea, vomiting, diarrhea, fatigue, and fever.[87] Subsequent investigations found that staff failed to adhere to thorough hand washing and the use of plastic gloves during food preparation.[88] A class-action lawsuit on behalf of 31 victims was resolved for $1.6 million.[89][90] The most seriously affected victim—a 6-year-old boy—suffered acute liver failure and required a liver transplant.