Wake County health officials are still investigating the cause of a sudden outbreak of sickness at Evoo, a Mediterranean restaurant in Raleigh’s Five Points.

At least 18 diners were struck with symptoms that included nausea, vomiting and diarrhea in a very quick onset of symptoms shortly before 10 p.m. April 17, prompting frantic calls to the Raleigh-Wake 911 Center. (Hear the recordings.) Multiple paramedic teams and other emergency vehicles responded to the restaurant on Fairview Road and to a house nearby where two people who had eaten at Evoo earlier in the evening were ill. Rescuers treated victims at the two scenes and took an unknown number of patients to two hospitals.

County, state and federal investigators are awaiting test results from a federal Food and Drug Administration lab, said André Pierce, director of the environmental health and safety division of the county’s environmental services department.

All of the affected patrons have fully recovered, Pierce said, and after a thorough disinfection, the restaurant was cleared to resume business the following day.

“The risk of this incident was over almost as soon as it happened,” said Pierce, whose department is responsible for inspecting the 1,800 licensed restaurants in Wake County. “All the cases reported quickly and there is no ongoing concern for the community.”

Food-borne illnesses vary greatly, and the onset of symptoms can take anywhere from a few minutes to several days, Pierce said. Because of the rapidity of the Evoo cases, investigators believe some type of chemical or toxin was involved, but they won’t know more until test results come back in another week or so, Pierce said.

Meanwhile, Evoo’s owners are assuring the dining public the danger has passed.

“Hopefully, we’re about to get an all-clear from the health department,” partner Robert Duffy said Monday. “We did everything the health department asked us to do; we’ve complied with everything.”

County health officials have studied various menu items and collected data from the scene to compare the cases, Pierce said, and his department will eventually issue a detailed report about the incident.

Investigators also collected samples of tuna from the restaurant, according to Duffy, who contends that the incident is “not food-related.”

Evoo’s past inspection reports on file with the county (read them at wake.digitalhealthdepartment.com) show that the restaurantwhile maintaining “A” ratings from the health departmenthas been cited for multiple violations involving food storage practices and cleanliness in the last two years.

The most recent report, dated March 20, noted two “critical violation risk factors”: unsanitary food contact surfaces, including dirty utensils, and improper holding temperatures for cold foods.

Statewide health regulations list 18 factors that are given highest priority in inspections, Pierce said.

“These are those items we know are more likely to contribute to food-borne illnesses,” he said.

Evoo received a score of 92.5 out of 100 possible points in last month’s inspection, despite the deductions for the two critical violations.

On Nov. 20, 2008, inspectors cited one critical violation pertaining to food storage; raw oysters were being kept over ready-to-eat items in the walk-in cooler.

Two months earlier, on Sept. 4, 2008, the restaurant was cited for the same two categories of critical violations as the March 2009 report.

Evoo received a 94.5 score in both the September and November inspections.

Duffy maintains that the inspection reports show the restaurant is in good standing.

“I don’t think there’s anything in those reports that you wouldn’t find everywhere else in this industry,” he said. “We’ve maintained A ratings consistently, which is very hard to do in Wake County.”

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