Health Authorities Investigating Multistate Outbreak of Hepatitis A Linked to Frozen Strawberries

The Centers for Disease Control and Prevention (CDC) is collaborating with public health officials in several states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of foodborne hepatitis A.

The investigation began in early August when the Virginia Department of Health (VDH) identified an outbreak of hepatitis A cases potentially linked to smoothies from Tropical Smoothie Café restaurants in that state.

Since then, 70 people infected with hepatitis A linked to this outbreak have been reported from seven states: Maryland (6), New York (1), North Carolina (1), Oregon (1), Virginia (55), West Virginia (5), and Wisconsin (1). Among people with available information, 32 people have been hospitalized.

People with hepatitis A may not have symptoms until 15 to 50 days after consuming a contaminated food or drink. We expect to see more ill people reported in this outbreak because of this long incubation period.

Investigation of the Outbreak

Epidemiologic and traceback evidence available at this time indicate that frozen strawberries imported from Egypt are the likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the month before they became ill. Of the 70 ill people, 68 (97%) reported drinking a smoothie from Tropical Smoothie Café in the month before illness started. Of the 54 ill people who were interviewed about the type of smoothie, all (100%) reported drinking a smoothie containing strawberries. These ill people purchased smoothies at cafés located in a limited geographical area, including Virginia and neighboring states. The ill person in Oregon traveled to Virginia and while there, had purchased smoothies containing frozen strawberries from a Tropical Smoothie Café location.

Federal, state, and local officials are performing traceback investigations from the Tropical Smoothie Café locations where ill people reported drinking smoothies with frozen strawberries. The investigations currently indicate that the strawberries served in those locations were imported from Egypt. Investigators are working to determine which specific lots may have been contaminated with hepatitis A virus and to find out if the frozen strawberries were distributed to other U.S. customers. Frozen strawberries used at Tropical Smoothie Café locations were collected for testing. The FDA’s analysis is ongoing.

On Aug. 8, 2016, Tropical Smoothie Café reported that they removed the Egyptian frozen strawberries from restaurants in Maryland, North Carolina, Virginia, and West Virginia and switched to another supplier. Out of an abundance of caution, Tropical Smoothie Café has since switched to another supplier for all restaurants nationwide. At this time, the CDC does not have information to suggest that there is an ongoing risk of hepatitis A virus infection at Tropical Smoothie Cafes. The CDC is not yet aware of any other restaurants or retailers that may have received frozen strawberries linked to this outbreak. If this information changes, CDC will update the public immediately.

This investigation is ongoing. CDC and state and local public health partners are continuing to work to identify additional ill people and to interview those people about foods they ate before they got sick.

Advice to Consumers

Information available at this time does not indicate an ongoing risk of hepatitis A virus infection at Tropical Smoothie Cafes. The CDC is not yet aware of any other restaurants or retailers that may have received frozen strawberries linked to this outbreak. If this information changes, CDC will update the public immediately.
•Contact your doctor if you think you may have become ill from eating a smoothie containing strawberries from a Tropical Smoothie Café prior to August 8, 2016 in the following states: Virginia
West Virginia
Maryland
North Carolina

•It is important that food handlers and restaurant employees contact their doctor and stay home if they are infected with hepatitis A. This helps prevent the virus from spreading.
•Not everyone will experience symptoms from a hepatitis A virus infection. Some people may experience mild flu-like symptoms. Other symptoms of hepatitis A virus infection include:  Yellow eyes or skin
Abdominal pain
Pale stools
Dark urine

General Hepatitis A Prevention

Cases of hepatitis A have decreased dramatically over the last decade in large part due to successful vaccination programs and policies. Most new cases of hepatitis A are now related to international travel, and occasional foodborne outbreaks. Once a person becomes ill from hepatitis A, the virus can be easily transmitted to household or sexual partners. Thorough hand washing can help minimize transmission among close contacts.

The hepatitis A vaccine is recommended as part of routine childhood vaccinations and for adults at high risk. CDC recommends the following groups be vaccinated against 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 liver disease
•People who are treated with clotting-factor concentrates
•People who work with hepatitis A infected animals or in a hepatitis A research laboratory

Source: CDC