There are now 16 dead with 292 sickened with hepatitis A in San Diego – mostly in the ignored homeless population. And, the numbers of people with this preventable disease is spiking in Colorado (57 ill with 1 death), Michigan (319 ill with 14 deaths), New York (46 ill) and other states and cities (Los Angeles has at least 10 sick, Salt Lake City 21).  Lately, we have also seen the spread to food service workers, potentially exposing hundreds of unsuspecting consumers.

This is all preventable.

In 2006, health officials recommended routine hepatitis A vaccination for all children ages 12-23 months, that hepatitis A vaccination be integrated into the routine childhood vaccination schedule, and that children not vaccinated by two years of age be vaccinated subsequently. The vaccine is also recommended for the following persons:

  • Travelers to areas with increased rates of hepatitis A
  • Men who have sex with men
  • Injecting and non-injecting drug users
  • Persons with clotting factor disorders
  • Persons with chronic liver disease
  • Persons with occupational risk of infection
  • Children living in regions of the U.S. with increased rates of hepatitis A
  • Household members and other close personal contacts

The vaccine may also help protect household contacts of those persons infected with hepatitis A. Although generally not a legal requirement at this time, vaccination of food handlers would be expected to substantially diminish the incidence of hepatitis A outbreaks.

Although outbreaks continue to occur in the United States, no one should ever get infected if other preventive measures are taken. For example, food handlers must always wash their hands with soap and water after using the bathroom, changing a diaper, and certainly before preparing food. Food handlers should always wear gloves when handling or preparing ready-to-eat foods, although gloves are not a substitute for good hand washing. Ill food-handlers should be excluded from work.

Hepatitis A is a communicable (or contagious) disease that often spreads from person to person. Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water. Food-related outbreaks are usually associated with contamination of food during preparation by a HAV-infected food handler. The food handler is generally not ill because the peak time of infectivity—that is, when the most virus is present in the stool of an infected individual—occurs two weeks before illness begins.

Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A. In 1997, frozen strawberries were the source of a hepatitis A outbreak in five states. Six years later, in 2003, fresh green onions were identified as the source of a hepatitis A outbreak traced to consumption of food at a Pennsylvania restaurant. Other produce, such as blueberries and lettuce, has been associated with hepatitis A outbreaks in the U.S. as well as other developed countries.

HAV is relatively stable and can survive for several hours on fingertips and hands and up to two months on dry surfaces. The virus can be inactivated by heating to 185°F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (household bleach) in tap water. It must be noted, however, that HAV can still be spread from cooked food if it is contaminated after cooking.

So, for Goodness Sake, Vaccinate Against Hepatitis A

Thanks to HepMag.com for a great summary of ongoing hepatitis A outbreaks going on in the US.

California

Public health officials first detected the hepatitis A outbreak in November 2016 and as of July 21, 2017, 251 cases and 5 deaths have been reported in San Diego. Those affected have largely been homeless individuals, which has made public health efforts more challenging to implement, particularly in reaching individuals with vaccinations and improving hygiene practices. Local officials and community organizations have been working to raise awareness of hepatitis A vaccination, distribute “Hepatitis A Prevention Kits” (containing sanitary supplies), and plans are underway to install hand-washing stations in areas frequented by homeless persons to help stop the spread. Since the outbreak began, the county has administered over 4,000 hepatitis A vaccinations, and more work is planned to expand those efforts. With this combined approach, San Diego is hoping to end the outbreak, the largest in California in nearly 20 years.

Colorado

Between January and early July 2017, 43 cases of hepatitis A were reported in Colorado, a significant increase from 2016 where 23 cases were reported for the full year. Half of these cases resulted in hospitalization and one person has died. Unlike many hepatitis A outbreaks, there is no apparent common link to a restaurant or food item. 74% of hepatitis A cases are men and at least half are men who have sex with men (MSM). Local public health agencies are working to battle the epidemic by targeting MSM with outreach and offering vaccination at a variety of sites.

Michigan

Between August 2016 and June 2017 in southeast Michigan, almost 200 people have been diagnosed with hepatitis A infection, 90% of those infected have required hospitalization, and 10 people have died. Public health officials believe the outbreak to be unrelated to water or food contamination, but rather person-to-person spread through use of illicit drugs, sexual contact, and close proximity. Nearly 50% of those infected report a history of substance use disorders and 20% are also infected with hepatitis C.

Vaccinations urged for all people not immune.

According to the San Diego County Health and Human Services Agency, 228 cases of hepatitis A have been reported in 2017, with 161 people hospitalized during the outbreak.  There have been 5 deaths. Public health investigators continue to evaluate cases, but most of those who have become ill are either homeless and/or illicit drug users. Hepatitis A is most commonly spread person-to-person through the fecal-oral route. The disease can be prevented by getting vaccinated. So far, officials said no common food, drink or drug source has been identified as the cause.

In addition, the number of hepatitis A cases over last year in Macomb, Oakland, Wayne and St. Clair counties has increased tenfold, spawning a Michigan Department of Health and Human Services investigation. 190 cases have been reported between August 1, 2016 and June 26, 2017, which has resulted in 10 deaths so far. Officials said it represents a significant health threat, with links to either illicit drug use, sexual activity or close contact among household members.

Symptoms of hepatitis A include jaundice, fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stools. Symptoms usually appear over several days and last less than two months. However, some people can be ill for as long as six months. Hepatitis A can also sometimes cause liver failure and death.

hepatitisDr. Sherlita Amler, Westchester County’s Health Commissioner, is encouraging people who consumed beverages at Monteverde at Oldstone, a restaurant and event space at 28 Bear Mountain Bridge Road in Cortlandt Manor, to protect themselves against Hepatitis A following confirmation that an employee with the disease worked at the restaurant while infectious.

Hepatitis A is a viral liver disease transmitted by ingesting contaminated food or water or through direct contact with an infectious person. “The key to prevention is a quick response,” said Westchester County Executive Robert P. Astorino.

Patrons who consumed beverages at Monteverde between May 31 and June 10 are being urged to contact the Westchester County Health Department, which will offer free Hepatitis A treatment on Thursday, June 15, from 11 a.m. to 3 p.m. at Monteverde at Oldstone and on Friday, June 16, from 9 a.m. to 3 p.m. at the Westchester County Health Department clinic at 134 Court Street in White Plains.

No appointments are needed, but individuals interested in attending a clinic are encouraged to pre-register online or call the Health Department at (914) 995-7499.

The Health Department has been contacting all individuals who dined at Monteverde between May 31 and June 10 to alert them to their potential exposure.  The treatment is a Hepatitis A vaccine or immune globulin. Anyone age 18 or younger must be accompanied by a parent. Pregnant women who may have been exposed should contact their prenatal care provider about treatment. Preventive treatment is only effective if given within two weeks of potential exposure.

Hepatitis A is generally a mild illness that affects the liver. Symptoms include fatigue, fever, poor appetite, abdominal pain, diarrhea, dark urine and yellowing of the skin and eyes, and can develop from two weeks to two months after exposure

“Anyone who believes they may have symptoms of Hepatitis A should consult with their regular physician, inform their physician of the potential exposure and notify the Westchester County Department of Health,” Dr. Amler said.

As soon as the Health Department learned where the employee worked, its staff began a comprehensive investigation, with the full cooperation of the owner and in consultation with the New York State Department of Health.

On May 16, Hilo Fish Company notified the FDA that it had submitted samples of additional shipments held in its cold storage facility in Hawaii to a private laboratory for testing and received additional positive results for the hepatitis A virus. Imported tuna products from this facility were sourced from Sustainable Seafood Company and Santa Cruz Seafood and were distributed to restaurants and other retail locations in CA, NY, OK, and TX. The New York State Department of Health and the FDA verified that product shipped to New York was not sold to the public. The FDA’s investigation in connection with these firms is ongoing.

  • On May 18, Hilo Fish Company began recalling tuna sourced from Sustainable Seafood Company and Santa Cruz Seafood, Inc. that tested positive for the hepatitis A virus.
  • While the CDC is not currently aware of any illnesses linked to these products, it is advising post exposure prophylaxis (PEP)for unvaccinated persons who may have consumed the potentially contaminated tuna within the past two weeks.
  • The FDA is providing a list of establishmentsin TX, OK, and CA that may currently have potentially contaminated tuna in commerce to help alert consumers that may be at risk of the hepatitis A virus. Contact your health care professional if you believe you have been exposed to contaminated tuna.
  • The current recall resulted from follow-up after the Hawaii Department of Health notified the FDA of a frozen tuna sample, sourced from PT Deho Canning Co.,which tested positive for hepatitis A on May 1, 2017. The initially recalled product has been removed from circulation and the newly recalled frozen tuna lots were not shipped to Hawaii, but were shipped to the mainland U.S.

Consumers may be at risk of contracting a hepatitis A infection due to the consumption of potentially contaminated frozen tuna distributed by Hilo Fish Company and sourced from Sustainable Seafood Company (Lots F5-6 Soui Dau Industrial Zone, Can Lam Khanh Hoa Province, Vietnam) and Santa Cruz Seafood, Inc. (General Santos Fishport Complex Tambler, General Santos City, 9500, Philippines). The CDC reports no illnesses to date.

The FDA is collecting additional frozen tuna samples and increasing its screening measures and testing for imported seafood for these companies.

In addition, the agency has prepared a list of restaurants and other retail locations that received the recalled frozen tuna. The agency will continue to update this list as its investigation continues. To protect the health of consumers who may have eaten contaminated tuna and require post-exposure prophylaxis, the FDA has determined that it is necessary to make public the names of these businesses as part of the recall.

Hepatitis A is a contagious liver disease that results from infection with the hepatitis A virus . It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A can be spread when a person ingests the virus from contaminated food or water. The virus can also be easily passed from an infected person to other unvaccinated family members, sexual partners, and close contacts.

Symptoms in adults include fatigue, abdominal pain, jaundice, abnormal liver tests, dark urine, and pale stool. People with hepatitis A may not have symptoms until 15 to 50 days after consuming a contaminated food or drink. CDC reports that while the hepatitis A vaccine is recommended for all children, vaccination rates are lower than for other recommended childhood vaccines. Unvaccinated children can become ill and not have symptoms.

The product, imported from Indonesia, was used to prepare poke sold between April 27 and May 1 by food establishments on Oahu.

The Department of Health says Tropic Fish Hawaii discovered 200 tainted 15-pound cases of frozen ahi cubes; 140 of those cases were recovered and never got sold.

The imported frozen fish was used to prepare poke or food served or sold at:

  • Times Supermarket and Shima’s
    • Aiea
    • Kailua
    • Kaneohe
    • Kunia
    • Liliha
    • Mililani
    • Waipahu
    • Waimanalo
  • GP Hawaiian Food Catering
  • Crab Shack Kapolei (also known as Maile Sunset Bar & Grill in Kapolei)

Hawaii News Now also reported that the U.S. Food and Drug Administration issued a warning letter last July to the Honolulu-based seafood processor that distributed ahi that may have been tainted with Hepatitis A to local stores and eateries.

warning letter sent to Tropic Fish Hawaii, LLC, scolded the company for “unsanitary conditions” and noted an FDA inspector had found ahi tuna on the company’s warehouse concrete floor. At the time of the inspection, an employee was also seen dragging ahi tuna across the floor onto a pallet.

Finally, according to the Pacific Business Journal:

“Times Supermarket and Tropic Fish notified the department as soon as they learned of the test results on the imported fish,” said Peter Oshiro, chief of the state Department of Health Food Safety Program. “All of the product is being traced, collected and held by the distributor. Fortunately, in this case, Tropic Fish Hawaii kept excellent records and has been contacting all retailers and pulling the product quickly.”

Tropic Fish Hawaii, a wholesale food distributor and subsidiary of CMU and Associates on the Big Island, voluntarily recalled the shipment of contaminated cubed tuna, and has notified all customers after it found out on Monday.

“Our normal procedure is to receive the test results prior to distribution, but unfortunately, that did not happen with this particular shipment,” said Shawn Tanoue, president of Tropic Fish Hawaii. “We have corrected our procedures to ensure this will not happen again. I want to personally apologize to our customers and the public.

One of the great things about being a lawyer is that you can, if you want, continue to learn every day, even if you have been doing the same or similar thing for over 20 years.  I also get to reach out to the best experts in the world to ask for help in educating myself.  Thanks to to very good food safety people at NC State for updating the risk of Hepatitis A in shellfish.  Importers, be forewarned.

Hepatitis A outbreaks associated with shellfish, worldwide, from 1956 to 2016.  Adapted and expanded from Richards et al., 1985, Portnoy et al., 1975, and Fiore et al., 2004.  Outbreaks that were poorly investigated or had fewer than 30 cases were omitted.  Italics indicate the seafood was locally sourced with respect to the cases.  Asterisks denote outbreaks of “infectious hepatitis” before hepatitis A virus was specifically identified, and may have not been caused by hepatitis A virus.

Year # Cases Implicated food Location of cases Source of implicated food Suspected cause of contamination Reference
1956 629 Oysters Sweden Havstenssund Harbor, Sweden Oysters stored in polluted water Roos, 1956*; Pintó et al., 2009; Portnoy et al., 1975
1961 80

 

Oysters Mississippi, Alabama Pascagoula River, Mississippi Polluted harvesting areas Mason and McLean, 1962*
1961 459 Clams New Jersey Raritan Bay, New Jersey Polluted harvesting areas Dougherty and Altman, 1962*
1964 123 Clams Connecticut Multiple US sources, primarily Rhode Island Unknown Ruddy et al., 1969*
1973 281 Oysters Texas, Georgia, Louisiana Louisiana Stormwater runoff; investigated possible illegal harvesting Mackowiak et al., 1976; Portnoy et al., 1976
1980 312 Oysters Singapore Philippines Suspect contaminated harvesting waters Lee et al., 2011; Goh, 1981
1981 132 Cockles, whelks, mussels, prawns Southeast England United Kingdom Sewage discharge near harvesting beds, insufficient processing O’Mahoney et al., 1983
1982 225 Oysters Hondo City, Japan Ariake Bay, Japan Unknown Fujiyama et al., 1985
1984 75 Mussels and clams Livorno, Italy Livorno, Italy; Venice, Italy Sewage discharge near harvesting beds, improper handling at point of sale Mele et al., 1989
1988 61 Oysters Alabama, Georgia, Florida, Tennessee, Hawaii Florida Untreated sewage from residents and boats, possible illegal harvesting Descenclos et al., 1991
1988 292,301 Clams Shanghai, China Qi-Dong, China Untreated sewage Halliday et al., 1991
1992 800 Raw shellfish Western France Loire-Atlantique and Morbihan, France Unknown Apaire-Marchais et al., 1995
1996, 1997 5673,

5382

Mussels and clams Puglia, Italy Italy Unknown Chironna et al., 2002
1997 444

 

Oysters New South Wales, Australia Wallis Lake, Australia Untreated sewage; stormwater runoff Conaty et al., 2000
1999 184 Coquina clams Valencia, Spain Peru Unknown Sanchez et al., 2002; Bosch et al., 2001
1999 32 Raw shellfish Bretagne, France Bay of Pampiol, France Unknown, harvesting sites near a busy tourist port Costa-Mattioli et al., 2000
2004 882 Mussels and clams Campania, Italy Primarily Campania, also other areas of Italy, Turkey Illegal storage of shellfish in contaminated seawater at point of purchase Pontrelli et al., 2008
2005 39 Oysters Alabama, Florida, South Carolina, Tennessee Louisiana Untreated sewage, possibly from recreational and other boats Bialek et al., 2007; Shieh et al., 2007
2007 111 Oysters Côtes d’Armor, France Côtes d’Armor, France Suspect contaminated water in tanks used on a shellfish farm, nearby untreated sewage Guillois-Bécel et al., 2009
2008 100 Coquina clams Spain Peru Unknown Pintó et al., 2009; Polo et al., 2010
2013 117 Suspect raw foods, especially seafood Taiwan Unknown Unknown Lung and Kay, 2013
2014 30 Raw bivalves: oysters, clams Taiwan Unknown Unknown Taiwan CDC, 2014
2016 292 Scallops Hawaii Philippines Unknown CDC, 2016; HI DOH, 2016

 

References

Apaire-Marchais, V., Robertson, B. H., Aubineau-Ferre, V., Le Roux, M. G., Leveque, F., Schwartzbrod, L., & Billaudel, S. (1995). Direct sequencing of hepatitis A virus strains isolated during an epidemic in France. Applied and environmental microbiology, 61(11): 3977-3980.

Bialek, S. R., George, P.A., Xia, G. L., Glatzer, M. B., Motes, M. L., et al. (2007) Use of molecular epidemiology to confirm a multistate outbreak of hepatitis A caused by consumption of oysters. Clin Infect Dis, 44: 838–840.

Bosch, A., Sánchez, G., Le Guyader, F., Vanaclocha, H., Haugarreau, L., Pintó, R. M. (2001). Human enteric viruses in Coquina clams associated with a large hepatitis A outbreak. Water Science and Technology, 43(12): 61–65.

Centers for Disease Control and Prevention (CDC). (2016). Outbreak of hepatitis A in Hawaii linked to raw scallops. Press Release. Published August 19, 2016. Available at http://www.cdc.gov/hepatitis/outbreaks/2016/hav-hawaii.htm

Chironna, M., Germinario, C., De Medici, D., et al. (2002). Detection of hepatitis A virus in mussels from different sources marketed in Puglia region (South Italy). Int J Food Microbiol, 75: 11–18.

Conaty, S., Bird, P., Bell, G., Kraa, E., Grohmann, G., McAnulty, J. M., et al. (2000). Hepatitis A in New South Wales, Australia from consumption of oysters: the first reported outbreak. Epidemiol Infect, 124: 121–130.

Costa-Mattioli, M., Monpoeho, S., Schvoerer, C., Besse, B., Aleman, M. H., Billaudel, S., et al. (2001). Genetic analysis of hepatitis A virus outbreak in France confirms the co-circulation of subgenotypes Ia, Ib and reveals a new genetic lineage. J Med Virol, 65(2): 233-40.

Desenclos, J. C., Klontz, K. C., Wilder, M. H., Nainan, O. V., Margolis, H. S., Gunn, R. A. (1991). A multistate outbreak of hepatitis A caused by the consumption of raw oysters. Am J Public Health, 81: 1268–1272.

Dougherty, W. J., and Altman, R. (1962). Viral hepatitis in New Jersey 1960–1961. Am J Med, 32: 704–716.

Fiore, A. E. (2004). Hepatitis A transmitted by food. Clinical Infectious Diseases, 38(5): 705-715.

Fujiyama, S., Akahoshi, M., Sagara, K., Sato, T., Tsurusaki, R. (1985). An epidemic of hepatitis A related to ingestion of raw oysters. Gastroenterol Jpn, 20: 6-13.

Goh, K. T. (1981). Epidemiological studies of hepatitis A in Singapore. Ann Acad Med Singapore, 10: 25-33.

Guillois-Bécel, Y., Couturier, E., Le Saux, J. C., Roque-Afonso, A. M., Le Guyader, F. S., Le Goas, A., et al. (2009). An oyster-associated hepatitis A outbreak in France in 2007. Eurosurveillance, 14(10): 1-6.

Halliday, M. L., Kang, L.-Y., Zhou, T.-K., Hu, M.-D., Pan, Q.-C., Fu, T.-Y., et al. (1991). An epidemic of hepatitis A attributable to the ingestion of raw clams in Shanghai, China. J Infect Dis, 164: 852–859.

Hawaii Department of Health (HI DOH). (2016). Hepatitis A Outbreak 2016. Available at http://health.hawaii.gov/docd/hepatitis-a-outbreak-2016/

Lee, H. C., Ang, L. W., Chiew, P. K., James, L., & Goh, K. T. (2011). Changing epidemiological patterns of hepatitis A infection in Singapore. Ann Acad Med Singapore, 40(10): 439.

Lung, R.-Y. & Kay, L. (2013). CDC cautions against raw food as hepatitis A cases hit 4-year high. News Article. Published October 15, 2013. Focus Taiwan News Channel, The Central News Agency. Accessed online at http://focustaiwan.tw/news/asoc/201310150033.aspx

Mackowiak, P. A., Caraway, C. T., Portnoy, B.L. (1976). Oyster-associated hepatitis: lessons from the Louisiana experience. Am J Epidemiol, 103: 181–191.

Mason, J. O., & McLean, W. R. (1962). Infectious hepatitis traced to the consumption of raw oysters. Am J Hyg, 75: 90–111.

Mele, A., Rastelli, M. G., Gill, O. N., di Bisceglie, D., Rosmini, F., Pardelli, G., Valtriani, C. & Patriarchi, P. (1989). Recurrent epidemic hepatitis A associated with consumption of raw shellfish, probably controlled through public health measures. Am J Epidemiol, 130: 540–546.

O’Mahoney, M. C., Gooch, C. D., Smyth, D. A., Thrussell, A. J., Bartlett, C.L.R., Noah, N. D. (1983). Epidemic hepatitis A from cockles. Lancet, 1: 518–20.

Pintó, R. M., Costafreda, M. I., Bosch, A. (2009). Risk assessment in shellfish-borne outbreaks of hepatitis A. Appl Environ Micro, 75(23): 7350-7355.

Polo, D., Vilariño, M. L., Manso, C.F., Romalde, J. L. (2010). Imported Mollusks and Dissemination of Human Enteric Viruses. Letters to the Editor. Emerg Infect Dis, 16(6): 1036-1037. Accessed online at http://wwwnc.cdc.gov/eid/article/16/6/09-1748_article

Pontrelli, G., Boccia, D., Di Renzi, M., Massari, M., Giugliano, F., Celentano, L. P., … & Rapicetta, M. (2008). Epidemiological and virological characterization of a large community-wide outbreak of hepatitis A in southern Italy. Epidemiology and infection, 136(08): 1027-1034.

Portnoy, B. L., Mackowiak, P. A., Caraway, C. T., Walker, J. A., McKinley, T. W., Klein, C. A. (1975). Oyster-associated hepatitis: failure of shellfish certification programs to prevent outbreaks. JAMA, 233: 1065–1068.

Richards, G.P. 1985. Outbreaks of enteric virus illness in the United States: requisite for development of viral guidelines. J Food Prot, 48: 815-832.

Roos, B. (1956). Hepatitis epidemic transmitted by oysters. Sven Lakartidn, 53: 989–1003.

Ruddy, S. J., Johnson, R. F., Mosley, J. W., Atwater, J. B., Rossetti, M. A., Hart, J. C. (1969). An epidemic of clam-associated hepatitis. JAMA, 208: 649-655.

Sanchez, G., Pintó, R. M., Vanaclocha, H., Bosch, A. (2002). Molecular characterization of hepatitis A virus isolates from a transcontinental shellfish-borne outbreak. J Clin Microbiol, 40: 4148–4155.

Shieh, Y. C., Khudyakov, Y. E., Xia, G., Ganova-Raeva, L. M., Khambaty, F. M., et al. (2007) Molecular confirmation of oysters as the vector for hepatitis A in a 2005 multistate outbreak. J Food Prot, 70: 145–150.

Taiwan Centers for Disease Control. (2014). As Taiwan CDC confirms cluster of hepatitis A cases due to consumption of raw bivalves using genetic sequencing for the first time, public urged to pay attention to food safety. Press Release. Published December 8, 2014. Available at http://www.cdc.gov.tw/english/info.aspx?treeid=bc2d4e89b154059b&nowtreeid=ee0a2987cfba3222&tid=BA36E519A4A2F338 Also available on ProMED Mail at http://www.promedmail.org/post/3021721

Frozen-strawberriesMonterey County Health Officials have identified seven food service establishments in Monterey County at which the recalled product were served recently.  These locations include:

  • Black Bear Diner, 2450 Fremont Street, Monterey
  • Farm Fresh Deli and Café, 145 Main Street, Salinas
  • Fish Hopper Restaurant, 700 Cannery Row, Monterey
  • La Plaza Bakery, 107 Bardin Road, Salinas
  • La Plaza Bakery, 20A North Sanborn Road B, Salinas
  • Turn 12 Bar and Grill, 400 Tyler Street, Monterey
  • Yogurt Heaven, 157 The Crossroads, Carmel

If you consumed strawberries at Black Bear Diner (2450 Fremont St, Monterey), Farm Fresh Deli (145 Main Street, Salinas), Fish Hopper Restaurant (700 Cannery Row, Monterey), La Plaza Bakery (107 Bardin Road, Salinas), La Plaza Bakery (20A North Sanborn Road B, Salinas) or Turn 12 Bar and Grill (400 Tyler Street, Monterey) in the two weeks prior to November 3, 2016, OR if you consumed strawberries at Yogurt Heaven (157 The Crossroads, Carmel) in the two weeks prior to November 10th, Health Officials recommend that you:

Check your immunization record to see if you have been previously vaccinated for hepatitis A.If you have been vaccinated or have had hepatitis A disease in the past, no further action is recommended.

If you have not been immunized against hepatitis A or had hepatitis A disease in the past, contact your healthcare provider. The CDC recommends post-exposure prophylaxis (PEP) for unvaccinated people who ate the recalled strawberries in the last two weeks.  PEP consists of:Hepatitis A vaccine for people between the ages of 1 and 40 years.

Hepatitis A virus-specific immunoglobulin (IG) for people outside of this age range, but the hepatitis A vaccine can be substituted if IG is not available.

Those with evidence of previous vaccination do not require PEP.

PEP is not effective in people who ate the recalled strawberries more than 2 weeks ago.

Watch for signs and symptoms of hepatitis A infection for the next 6 weeks.

Contact your medical provider if you experience vomiting, abdominal pain, fever, nausea, dark urine, and/or yellowing of the skin or eyes.

If you ate the recalled product at one of the above locations in the time frame indicated and do not have a medical provider, please contact the following clinics offering hepatitis A vaccination:

  • Alisal Health Center, 559 East Alisal Street #201, Salinas, (831) 769-8800
  • Seaside Family Health Center, 1150 Fremont Street, Seaside, (831) 899-8100
  • Visiting Nurses Association and Hospice, (831) 372-6668
  • Hepatitis A vaccinations may also be available at your local pharmacy. Check with your insurance company about coverage.  Prices may vary by location and coverage.

Symptoms of hepatitis A can include vomiting, abdominal pain, yellowing of the skin and eyes, fever, fatigue, and nausea. Symptoms develop two to six weeks after consuming contaminated food or drink and can last from one week to several months. Most people recover completely, but sometimes hepatitis A can lead to hospitalization and severe illness. Hepatitis A can be passed from person-to-person when hands are not thoroughly washed after using the restroom.

The U.S. Food and Drug Administration, the Centers for Disease Control and Prevention (CDC), and state and local Health Officials are investigating an outbreak of hepatitis A illnesses linked to frozen strawberries. Epidemiologic and traceback evidence indicate frozen strawberries imported from Egypt are the likely source of this outbreak. The recalled product was distributed by the International Company for Agricultural Production & Processing (ICAPP) and imported from Egypt. On October 30, 2016, ICAPP recalled all of its frozen strawberries that were imported into the United States since January 1, 2016. The recalled products were distributed for sale to and use in food service establishments nationwide. As of October 17, 2016, 134 people with hepatitis A have been linked to the outbreak and reported from nine states: Arkansas (1), California (1), Maryland (12), New York (3), North Carolina (1), Oregon (1), Virginia (107), West Virginia (7), and Wisconsin (1).

raw-scallopsIn its weekly update Wednesday, the Hawaii Department of Health reported no new confirmed cases from Nov. 3 through 9. It recorded one new case the previous week, bringing the total number of sick people to 292. About a fourth of the outbreak victims have had symptoms so severe that they required hospitalization. At least one death, a 68-year-old woman, is attributed to the outbreak that was traced to frozen scallops imported from the Philippines and served raw by the Genki Sushi fast food chain. Another outbreak victim died, but was terminally ill and in hospice care so health officials are not attributing that death to Hepatitis A. All but 18 of the victims have been residents of Oahu. Seven victims are visitors who have returned to the mainland or overseas. Eleven outbreak victims live on the islands of Hawaii, Kauai or Maui. Only Genki Sushi locations on Oahu and Kauai served the implicated scallops.

seaweedMore than two dozen people in Hawaii have been infected by Salmonella bacteria in an outbreak that is tentatively linked to seaweed (limu or ogo) from an unnamed farm on Oahu. The 14 infected people include children and adults, with four victims have such severe symptoms that they required hospitalization, according to the Hawaii Department of Health. Although encouraging public awareness, the state health department did not release the name of the Oahu farm. The department ordered the farm “to halt operations and advise its customers to remove product from sale immediately.” All of the infected people developed diarrheal illnesses from mid- to late October. Preliminary investigations identified consumption of raw fish, specifically poke that contained limu, as a common factor among the sick people.

statemapSo far only California and Michigan health authorities have been forthcoming.  Why the silence from other health officials and the companies involved?

According to the recent CDC announcement, 134 people with hepatitis A have been reported from nine states: Arkansas (1), California (1), Maryland (12), New York (3), North Carolina (1), Oregon (1), Virginia (107), West Virginia (7), and Wisconsin (1).  129 of these cases reported eating a smoothie containing strawberries from Tropical Smoothie Café.  5 cases had no exposure to Tropical Smoothie café – which indicates a probable broader exposure to hepatitis A tainted strawberries. The latest illness onset date among these cases was October 1.  The first illnesses were in April.  We are representing nearly 80 of these people – mainly from Virginia.  There are also cases in Texas that have gone unreported.

FDA traceback information indicated that the frozen strawberries served in the Tropical Smoothie Café locations were from the International Company for Agricultural Production & Processing (ICAPP), imported from Egypt.

On October 30, ICAPP recalled all of its frozen strawberries that were imported into the U.S. since January 1, 2016. The recalled products were distributed for sale to and use in food service establishments nationwide.  The FDA reported that hepatitis A virus contamination was found in four samples of ICAPP frozen strawberries.

On November 3, the FDA also announced the five consignees who received recalled frozen strawberry products from ICAPP are:

  • H. Belt of Lake Forest, Ca. (sold under CH World Brand)
  • Jetro/Restaurant Depot of College Point, N.Y. (sold under James Farm brand and unbranded “Bits & Pieces”)
  • Sysco Corporation of Houston, Tex. (sold under Sysco brand)
  • Patagonia Foods of San Luis Obispo, Ca. (sold under Patagonia brand)
  • Reddy Raw of Woodridge, N.J. (sold under Regal brand).

However, the FDA did not release where the above consignees then sold the recall strawberries.  Thus far, only two states, California and Michigan have informed the public where the tainted strawberries may have been purchased by consumers.

A few questions for readers (press, health officials and companies involved):

  1.  Are there other reported hepatitis A illnesses linked to these strawberries in other states dating back to January 2016?
  2.  Why have only California and Michigan health authorities announced where the strawberries were sold at a consumer level?
  3. Why has ICAPP and the consignees been silent about where consumers would have come in contact with the strawberries?