Red Book Online Outbreaks: Hepatitis A Outbreak Linked to Frozen Organic Strawberries

Overview

As of September 4, 2023, this investigation is over.

As of July 18, 2023, a total of 10 outbreak-associated cases of hepatitis A linked to frozen organic strawberries have been reported from 4 states. (Multistate Outbreak of Hepatitis A Virus Infections Linked to Frozen Organic Strawberries | CDC)

CDC, state public health and regulatory officials, and FDA are investigating an outbreak of hepatitis A linked to frozen organic strawberries imported from certain farms located in Baja California, Mexico, by a common supplier. Frozen organic strawberries may be sold to a variety of retailers under multiple brand labels. Specific details on the voluntary recall of products can be found on CDC and FDA outbreak pages.

Clinical Guidance

• Presentation: Symptomatic hepatitis A virus (HAV) infection occurs in approximately 30% of infected children younger than 6 years of age, but few of these children will have jaundice. Among older children and adults, infection usually is symptomatic, with jaundice occurring in 70% or more of cases. Symptoms usually occur abruptly and can include the following:
  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Diarrhea
  • Clay-colored stool
  • Joint pain
  • Jaundice
• Who is at highest risk/complications: Recognized risk groups for HAV infection include people who have close personal contact with a person infected with HAV, people with chronic liver disease, people with clotting factor disorders, people with human immunodeficiency virus (HIV) infection, men who have sex with men, people who use injection and noninjection drugs, people who experience homelessness, people traveling to or working in countries that have highly or intermediately endemic HAV, people who anticipate close contact with an adoptee from a country of high or intermediate endemic HAV during the first 60 days following arrival, and people who work with HAV-infected primates or with HAV in a research laboratory setting. Foodborne outbreaks often involve raw produce (including vegetables and fruits), oysters, or muscles, though other foods can be involved.
• Diagnosis: Serologic tests for HAV-specific total antibody (ie, immunoglobulin [Ig] G plus IgM), IgG-only anti-HAV, and IgM-only anti-HAV are available commercially, primarily in enzyme immunoassay format. A single total or IgG anti-HAV test does not have diagnostic value for acute infection. The presence of serum IgM anti-HAV indicates current or recent infection, although false-positive results may occur, particularly if the person is asymptomatic. IgM anti-HAV generally is included in most acute hepatitis serologic test panels offered by hospital or reference laboratories. See Red Book Hepatitis A diagnostic tests for more information.
• Risk Mitigation: Contact precautions should be practiced in addition to standard precautions for diapered and incontinent patients for at least 1 week after onset of symptoms. The major methods of prevention of HAV infections are improved sanitation (eg, in food preparation and of water sources) and personal hygiene (eg, hand hygiene after toilet use and diaper changes in child care settings). A two-dose series of Hepatitis A (HepA) vaccine is part of the routinely recommended immunization schedule and is highly effective for prevention of hepatitis A infection.  For individuals who have not received Hepatitis A (HepA) vaccine and have been exposed to hepatitis A, postexposure prophylaxis with either HepA vaccine or Immune Globulin (IG) is effective in preventing infection when administered within 14 days of last exposure.  See Red Book Hepatitis A for recommendations for postexposure prophylaxis and recommended vaccine doses and schedules.
• Treatment: Supportive and management of complications.
• Reporting: Suspected cases should be reported to the local department of public health.

Resources

• For more information see the Red Book chapter on: Hepatitis A