August 2016

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According to press reports and the CDC, Hepatitis A cases linked to Tropical Smoothie Café have been identified in five other states besides Virginia, bringing the total number of cases to 66.

Maryland and West Virginia are now reporting four cases each; North Carolina, Oregon and Wisconsin are each reporting one case.

55 Virginia residents who had tested positive for hepatitis A (28 in Northern, 9 in Northwest, 12 in Eastern, 6 in Central, 0 in southwest) reported consuming a smoothie at Tropical Smoothie Café prior to becoming ill.

Approximately 46% of the residents, for whom information is available, have been hospitalized for their illness. The 55 ill residents range in age from 14-68. Onsets of illness for the 55 cases range from early May through August.

 

tsc_header_2016The number of people sickened in a Hepatitis A outbreak linked to frozen strawberries from Egypt served by Tropical Smoothie Cafe increased Friday to 35 as the timing of the public warning remain perplexing.

Virginia’s Department of Health issued a public warning August 19. However, the Health Department has not provided the date that the state received test results showing the victims are infected with the same strain of Hepatitis A isolated in strawberries from Egypt.

In a YouTube video posted last Sunday, Tropical Smoothie Cafe CEO Mike Rotondo apologized to customers and said the Virginia health department notified the chain August 5 about the possible link between the Egyptian strawberries and the outbreak. He said the chain immediately removed the frozen berries from all of its stores.  He did not explain why he did not then alert the public of the risk of illness.

As of Friday, the lag time between August 5 when the restaurant chain was apparently notified and August 19 when the public warning was issued remains unexplained by the Virginia health department or Tropical Smoothie Cafe.

The timing is crucial because of the narrow window of opportunity for post-exposure vaccination. The post-exposure vaccine or immune globulin (IG) injections must be administered within 14 days of exposure or they are not effective, according to the Centers for Disease Control and Prevention and the Virginia department.

This is going to get interesting.

hepatitisa11According to the Virginia Department of Health, there have been 28 confirmed cases of hepatitis A linked to frozen strawberries used at Tropical Smoothie Cafes across Virginia.

This includes five cases in Central Virginia.

There are ten in Northern Virginia, five in Northwest Virginia, and eight in the eastern region on the state.

Throughout the week, confirmed cases of hepatitis A have increased. Tuesday, August 23, there were 17 confirmed cases, but by Wednesday, Aug. 24, that number had risen to 23. Five new confirmed cases were reported Thursday.

 Outbreak
The Hawaii Department of Health (HDOH) is investigating an outbreak of hepatitis A in its state. For the latest case count and investigation findings, visit the HDOH outbreak investigation website. On August 15, 2016, HDOH identified raw scallops served at Genki Sushi restaurants on the islands of Oahu and Kauai as a likely source of the ongoing outbreak.

CDC and the U.S. Food and Drug Administration (FDA) are assisting HDOH with its investigation. At this time, CDC is not aware of any hepatitis A virus infections in other states linked to the Hawaii outbreak. CDC continues to monitor for illnesses in other states.

Recall

On August 18, 2016, Sea Port Products Corp. recalled three lots of frozen bay scallops produced on November 23-24, 2015 in the Philippines. The lot numbers are 5885, 5886, and 5887. The products were distributed to California, Hawaii, and Nevada. The recalled products were not sold directly to consumers by Sea Port.

Advice to Consumers, Restaurants, and Retailers

Residents of Hawaii and Recent Travelers to Hawaii

If you live in Hawaii, or have recently traveled to Hawaii and ate scallops at a Genki Sushi restaurant, HDOH has specific advice on its website for you.

Advice to Restaurants and Retailers

  • Restaurants and retailers should not serve or sell recalled scallops.
    • The recalled scallops were produced on November 23-24, 2015 in the Philippines.
    • Recalled lot numbers are 5885, 5886, and 5887
  • The products were distributed to California, Hawaii, and Nevada. Restaurants and retailers should check their freezers and inventory for recalled scallops and return them to their distributor.

Advice to Consumers

  • Before you eat raw or cooked scallops in a restaurant, ask the restaurant who supplied the scallops and if they were recalled. If they were recalled or the restaurant doesn’t know the origin of the scallops, don’t eat them.
  • If you think you’ve gotten sick from eating contaminated scallops, contact your health care provider.
    • Some symptoms of hepatitis A virus infection include:
      • Yellow eyes or skin
      • Abdominal pain
      • Pale stools
      • Dark urine

General Hepatitis A Prevention

  • CDC recommends the following groups be vaccinated for hepatitis A:
    • All children at age 1 year
    • Travelers to countries that have high rates of hepatitis A
    • Family members and caregivers of recent adoptees from countries where hepatitis A is common
    • Men who have sexual contact with other men
    • Users of injection and non-injection illegal drugs
    • People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C
    • People who are treated with clotting-factor concentrates
    • People who work with Hepatitis A infected animals or in a Hepatitis A research laboratory

Additional Resources

tropical-smoothie-cafe_1471641149449_5578065_ver1.0-300x225Virginia health officials say they have confirmed 17 cases of hepatitis A are linked to frozen strawberries used by Tropical Smoothie Cafe.

The Virginia Department of Health says testing indicates frozen strawberries from Egypt used at the smoothie chain may be to blame for the illnesses.

The 17 hepatitis cases are from across Virginia: five in the eastern region (which includes Hampton Roads), four in the northern region, four in the northwestern region, and four in the central region.

Tropical Smoothie Cafe says it stopped using the strawberries from Egypt at all of its stores, including those outside Virginia, after learning about the potential issue. The smoothie chain says the cafes and their food handling practices “have not been implicated in any way.”

Health officials are encouraging anyone who consumed a smoothie with frozen strawberries at a restaurant in the last 50 days to watch for symptoms of hepatitis A. Those include jaundice, fever, fatigue, loss of appetite and nausea.

Not surprisingly BPI, the maker of Lean Finely Textured Beef (LFTB), a.k.a.”Pink Slime,” per the New York Times 2009, dismissed my clients, two former USDA scientists from a lawsuit that has been pending since 2012.  I had suggested the same shortly after the lawsuit was filed – but, hell, who ever listens to me? My thoughts on the merits of the entire lawsuit are best summarized here in a post I did several years ago:

dude_its_Beef_Tshirt_pic-300x247What if you were the CEO of a multimillion dollar, privately held food manufacturing company and awoke one morning to find that the name of your best selling product (you previously had painstakingly crafted the name to sound so appetizing) was now known to the public as “Blue Barf,” “Green Goop,” “Purple Puke,” “Red Rubbish,” or “Yellow Yuck?”

What if you had come from nothing and had worked your adult life to create a product used widely by consumers only to find that those same consumers (despite all your donations to charity) had turned against you?

Now, instead of consumers happily (perhaps unknowingly) eating millions of pounds of your product yearly in homes, schools and restaurants, many of those consumers are “twittering” and “facebooking” that your product is now pure evil.  Thousands of formerly ignorant consumers are now signing petitions asking for the product to be banned or at least labeled.  Bloggers (those damn bloggers) are recycling news articles of years past that cited emails from former government employees that raised questions about the chemicals in your product and coined the terms “Blue Barf,” “Green Goop,” “Purple Puke,” “Red Rubbish,” or “Yellow Yuck.”  Now the “lame stream” media, “faux” news and the 24-hour news channels are piling on.  And, to pour salt into your wounds, the comedians pounce – making your product the butt end of every late night joke.

Consumers have reacted and pressured grocery stores, schools and restaurants to pull your product.  For the first time in decades sales have dropped.  Your plants are temporarily closed and the specter of unemployed workers weighs heavily on the now isolated CEO.

Sitting in the boardroom (it feels more like a bunker) with family, friends, and a pile of consultants (all of them paid handsomely) the CEO feels more than slightly paranoid, and for good reason.  People are actually out to get him.  He turns to his circle of family, friends and consultants and asks: “Why is this happening?”  “How can we rebuild public trust and sales?”

“Why is this happening?”

Although many food companies and their government minders feel that consumers, like mushrooms, are best left in the dark, today where information, accurate or not, is accessed on smartphones, the old rules simply do not apply.

“Why is this happening?”  It is happening because the CEO did not trust consumers with the truth.  Pre-the easily accessible Internet, companies and governments simply made decisions and assumed the public did not care or did not need to know what was in their food.  That is neither no longer possible nor the case.

Not openly explaining how the food product was made and what all the additives and ingredients are was a foundational mistake for this CEO.  Of course, even 10 years ago it was possible to have an idea for a food additive (err, processing aide), to get a college professor hungry for research dollars to give it high marks, and to get a government bureaucrat yearning for a post-public sector job, to approve its quiet introduction into commerce.   Those days are done.

It was also a bad idea to ignore dissenting expert opinions that made it into memos and emails.  Documents, especially electronic ones, now exist forever, and, if there exists something negative about your product it cannot and should not be ignored.

“How can we rebuild public trust and sales?”

First, there are a couple of things not to do.

Do not shoot the messenger.  Blaming what is now happening on the media or the moms who are concerned about their kids health never works.  Had you not built the foundation of your business in part by deciding the public did not need to know something – even something that you believed was good for them – the explosion of negativism you are now experiencing would have been a passing storm instead of a hurricane.

Do not threaten legal action against anyone.  There are too many good lawyers (this one included) who would gladly take up their defense – pro bono.

For goodness sakes, do not play the political card.  Sure, you have given hundreds of thousands of dollars (perhaps millions) to politicians (hopefully from both parties – Republicans and Democrats will equally prostitute themselves), but do not make them dance in support of your product as they try to explain that the money you threw at them has no bearing on their willingness to dance.  And, please do not make them eat your product or say how safe it is in front of the national media.  No one will believe people that you paid to endorse your product.  Remember, politicians are considered only slightly more trustworthy than lawyers, however, both are in single digits.

So, how can you rebuild sales when what consumers see and hear are “Blue Barf,” “Green Goop,” “Purple Puke,” “Red Rubbish,” or “Yellow Yuck?”

Simple, just tell the truth.

Why not say it was a mistake to hide from the public all ingredients and additives that are in the product?  Tell the consumer what they already know – they have a right to know.

Why not tell the public how the product is made and what is in it?  If you are proud of your product, explain in honest and clear terms why you are.

Tell the consumer what the real benefit of the product is.  Does it taste good?  Is it healthful?  Does it save on energy?  Is it sustainable?  Does it create good jobs?  Is it good for the environment?

Is the product itself, what is added to it, and the process to make it, safe?  What have been and are your lab test results?  Why not post them online?  If you are proud of the safety of your product, prove it.

Invite the public, not politicians, to your plant for a tour and a taste test.

Bottom line:  If you have nothing to hide then hide nothing.

Humans have a great capacity to forgive when they are told the facts.  Perhaps someday “Blue Barf,” “Green Goop,” “Purple Puke,” “Red Rubbish,” or “Yellow Yuck” will be forgotten and the name you so painstakingly crafted to sound so appetizing will be remembered – Dude.

hepatitisa11Sea Port Products Corp is voluntarily recalling a batch of its scallops after at least 206 people became sick with hepatitis A, prompting an investigation by the US Food and Drug Administration and Centers for Disease control and Prevention.

The federal agencies are assisting the Hawaii Department of Health, which reported the cases on August 17.

The cases are linked to raw scallops. Of those who contracted hepatitis A, 51 were hospitalized. All the cases involve adults.

Hepatitis A is a liver disease that can cause severe stomach pains, dark jaundice and fatigue. If someone has a weak immune system it can also cause liver failure and death.

People typically get hepatitis A after eating food that has been contaminated with fecal matter from a person who has the infection. Symptoms can show up in 15 to 50 days.

The scallops were not for sale in stores. They were supplied to restaurants and other commercial groups by Sea Port Products Corp. The company voluntarily recalled the scallops that were distributed to Hawaii, Nevada and California. The FDA is working with the company to make sure the products are pulled off shelves, according to the FDA website.

The scallops were produced on November 23 and 24, 2015.

On August 17 the federal agencies and the Hawaiian Department of Health told Sea Port Products that tests confirmed their product was positive for hepatitis A and that they were the likely source of the outbreak.

The FDA suggests customers who would like to eat scallops in the states where the recall is in effect should ask the restaurant where the scallops come from.

web1_20160818_sea_port_scallops-300x188The Hawaii Department of Health (HDOH) is continuing to investigate a cluster of hepatitis A infections in the state.

On August 15, 2016, HDOH identified raw scallops served at Genki Sushi restaurants on Oahu and Kauai as a likely source of the ongoing outbreak. The product of concern is Sea Port Bay Scallops (Wild Harvest, Raw Frozen) that originated in the Philippines (states “Product of the Philippines” on the box), distributed by Koha Oriental Foods and True World Foods. As a result, HDOH ordered this product embargoed (not to be sold, purchased, or consumed) throughout the state, and the temporary closure of all Genki Sushi restaurants on Oahu and Kauai. The scallops received by True World Foods have not been distributed to any restaurants in the state, and were embargoed at their warehouse. The scallops served at Genki locations on the Big Island and Maui originated from a different supplier and have not been associated with the outbreak.

The outbreak investigation is ongoing.   It continues to be challenging because of the long incubation period of the disease (15 to 50 days) and the difficulty patients have in accurately recalling the foods consumed and locations visited during the period when infection could have taken place.

FDA reported suspect scallops tested positive for hepatitis A.

Healthcare providers have been informed and are asked to notify HDOH immediately if they have a patient they suspect may be infected.

HDOH encourages Hawaii residents to consider getting vaccinated for hepatitis A.

Hawaii residents are also advised that the demand for the vaccine during the outbreak has led to varied supply levels around the state, so it is recommended that they call ahead to assure the vaccine is available at a particular clinic or pharmacy before going there.

As of August 17, 2016:

Since the last update, HDOH has identified 38 new cases of hepatitis A.  All cases have been in adults, 51 have required hospitalization.

Findings of the investigation suggest that the source of the outbreak is focused on Oahu. Nine (9) individuals are residents of the islands of Hawaii, Kauai, or Maui, and one visitor has returned to the mainland.

CONFIRMED CASES OF HEPATITIS A – 206

Onset of illness has ranged between 6/12/16 – 8/9/16.

tsc_header_2016The Virginia Department of Health (VDH) is investigating a cluster of hepatitis A cases and has identified a potential association with smoothies from Tropical Smoothie Cafe restaurants in Virginia. Genetic testing shows the illnesses were caused by a strain of hepatitis A that has been associated with past outbreaks due to frozen strawberries from Egypt. Upon learning of the potential link to strawberries, Tropical Smoothie Cafe immediately conducted a voluntary product withdrawal of all strawberries sourced from Egypt and found an alternate supply.

Individuals who consumed a smoothie from a Tropical Smoothie Cafe in Virginia that contained frozen strawberries, on August 5, 6, 7 or 8, 2016, may still benefit from vaccine or immune globulin to prevent hepatitis A. (Vaccine or immune globulin administered within two weeks of exposure to hepatitis A virus is effective at preventing the disease.) If you have had hepatitis A or have been vaccinated for hepatitis A, you are already immune and therefore not at risk for getting the disease. Anyone who consumed a smoothie after the frozen strawberries were removed from restaurants is not thought to be at risk for hepatitis A.

Other restaurants, and firms that supply restaurants, may also have received the frozen strawberries imported from Egypt. VDH continues to investigate cases and work with state and federal partners, including the Virginia Department of Agriculture and Consumer Services, the U.S. Food and Drug Administration, and the Centers for Disease Control and Prevention, to identify additional locations where the product may have been distributed.

Anyone who consumed a smoothie with frozen strawberries at a restaurant within the last 50 days is encouraged to watch for symptoms of hepatitis A. If illness occurs, seek medical care and take steps to protect others from the infection.

Hepatitis A is an inflammation of the liver caused by the hepatitis A virus.  The classic symptom of hepatitis A is jaundice, which is a yellowing of the skin or the eyes.  Other symptoms of hepatitis A include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stools. Symptoms develop 15-50 days after exposure to the virus, which can occur through direct contact with another person who has the infection or by consuming food or drink that has been contaminated with the virus.

Frequent handwashing with soap and warm water after using the bathroom, changing a diaper, or before preparing food can help prevent the spread of hepatitis A.

It is very important for people who have symptoms of hepatitis A to stay home from work, especially if they work in food service.

Routine vaccination against hepatitis A has reduced the risk of this disease in the past decade.  Vaccination is available to anyone, but specifically recommended for all children, for travelers to certain countries, and for people at high risk for infection with the virus.  Hepatitis A vaccine is available from health care providers (including some pharmacies and travel clinics) to protect against this disease.

Individuals can contact their local health department with any questions concerning this investigation. For more information, visit http://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/hepatitis-a/.

sushiThe Hawaii State Department of Health has ordered all Oahu and Kauai Genki Sushi Restaurants to close for business immediately.  The Department of Health has determined the Hepatitis A outbreak on Oahu is likely due to imported frozen scallops served raw at Genki Sushi Restaurants on Oahu and Kauai. The restaurants have been closed tonight to prevent any further illness and protect the public.

As of Wednesday, the Hawaii Department of Health (HDOH) has identified 33 new cases of Hepatitis A, bringing the total to 168.

All cases have been adults with 46 requiring hospitalization.

Findings of the investigation suggest that the source of the outbreak is focused on Oahu.

Eight individuals now live on the islands of Hawaii, Kauai, and Maui, and one visitor has returned to the mainland.

Onset of illness has ranged between June 12th to August 1st.