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Hepatitis Blog

Surveillance & Analysis on Hepatitis News & Outbreaks

Hepatitis A Outbreak in Hawaii Hits 292

In 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.

Hawaii Sushi Hepatitis A Update

Since the last update, HDOH has identified 2 new cases of hepatitis A. Seventy-three (73) have required hospitalization.

Findings of the investigation suggest that the source of the outbreak is focused on Oahu. Eleven (11) individuals are residents of the islands of Hawaii, Kauai, or Maui, and seven visitors have returned to the mainland or overseas.

Although the 50-day maximum incubation period from the date of the scallops embargo has passed, HDOH continues to be alert for people who have had onset of illness earlier but may present late to a clinician, as well as possible secondary cases. Secondary cases have been rare in this outbreak and have been limited to household members of cases or close contacts of cases.

CONFIRMED CASES OF HEPATITIS A – 291
Onset of illness has ranged between 6/12/16 – 10/9/16.

Hepatitis A in Chehalis Washington

Lewis County Public Health & Social Services announced today that recent customers of the Shop’N Kart bakery in Chehalis, may have been exposed to hepatitis A.

“On October 6, 2016, a case of hepatitis A in a bakery worker was reported to the Health Department,” said Danette York, Lewis County Public Health & Social Services director. “To prevent illness, persons who have not been vaccinated against hepatitis A and ate decorated cakes or cupcakes from the bakery between September 22 and October 6, 2016 should contact their healthcare provider about treatment to prevent hepatitis A,” said York.

Persons who ate these foods between September 8 and 22 may also have been exposed, but it is now too late for treatment to prevent illness. If you ate decorated cakes or cupcakes from the bakery and develop symptoms of hepatitis A, contact your healthcare provider.

Shop’N Kart contacted public health as soon as they became aware of the infection and have taken every precaution to ensure the safety of their customers. No cases of hepatitis A associated with the bakery have been reported.

Hepatitis A is a viral disease of the liver. It is spread from person to person by the fecal-oral route, often by inadequate handwashing after using the toilet or changing diapers. Typical symptoms of hepatitis A include fatigue, fever, loss of appetite, abdominal pain, nausea, vomiting, diarrhea, and jaundice (yellowing of the skin or eyes). Symptoms usually develop 2–7 weeks after exposure. Some infections may be very mild or may not produce symptoms.

Hawaii Scallop Hepatitis A Outbreak Hits 271

As of September 14, 2016:

Since the last update, HDOH has identified 19 new cases of hepatitis A.  All cases have been in adults, 68 have required hospitalization.

Findings of the investigation suggest that the source of the outbreak is focused on Oahu. Ten (10) individuals are residents of the islands of Hawaii, Kauai, or Maui, and four visitors have returned to the mainland.

CONFIRMED CASES OF HEPATITIS A – 271
Onset of illness has ranged between 6/12/16 – 9/4/16.

An employee of the following food service business(es) has been diagnosed with hepatitis A. This list does not indicate these businesses are sources of this outbreak; at this time, no infections have been linked to exposure to these businesses. The likelihood that patrons of these businesses will become infected is very low. However, persons who have consumed food or drink products from these businesses during the identified dates of service should contact their healthcare provider for advice and possible preventive care.

Listed businesses will be removed from this list once 50 days have elapsed from the affected employee’s last service date while potentially infectious. Since the incubation period for hepatitis A is between 15 and 50 days, any customers who were potentially exposed at that business are no longer considered at risk for developing hepatitis A from that exposure after 50 days have passed.

  • Chili’s, Oahu, Kapolei (590 Farrington Highway), July 10, 12, 14, 15, 17, 18, 20, 21, 22, 23, 25, 26, and 27, 2016
  • Hokkaido Ramen Santouka, Oahu, Honolulu (801 Kaheka Street), July 21-23, 26-30, and August 2-6, 9-11, 2016
  • Papa John’s Waipahu, Oahu, Waipahu (94-1021 Waipahu Street), July 23-24, and August 2, 2016
  • New Lin Fong bakery, Oahu, Chinatown (1132 Maunakea Street), July 20, 22-23, 25, 27, 29-30, and August 1, 3, and 5-6, 2016
  • Hawaiian Airlines, July 31-August 1, August 10-12
  • Zippy’s Restaurant, Oahu, Kapolei (950 Kamokila Boulevard), August 14, 18–19, 21, 23, and 25–26
  • Harbor Restaurant at Pier 38, Oahu, Honolulu (1133 North Nimitz Highway), August 26 through September 12
  • Benjamin Parker Elementary School, Oahu, August 28 through August 30

123 with Hepatitis A in Arkansas, Maryland, New York, North Carolina, Oregon, Virginia, Wisconsin and West Virginia

Arkansas, Maryland, New York, North Carolina, Oregon, Virginia, Wisconsin, West Virginia and CDC, and the U.S. Food and Drug Administration (FDA) are continuing to investigate a multistate outbreak of foodborne hepatitis A. Information available at this time does not indicate an ongoing risk of acquiring hepatitis A virus infection at Tropical Smoothie Café’s, as the contaminated food product has been removed as of August 8. Symptoms of hepatitis A virus infection can take up to 50 days to appear.

As a result, CDC continues to identify cases of hepatitis A related to the initial contaminated product. As of September 14, 2016:

123 people with hepatitis A have been reported from eight states: Arkansas (1), Maryland (12), New York (3), North Carolina (1), Oregon (1), Virginia (98), West Virginia (6), and Wisconsin (1).

47 ill people have been hospitalized. No deaths have been reported.

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

Hawaii Hepatitis A Outbreak Update

The Source:

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.

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.

The Toll:

As of August 31, 2016:

Since the last update, HDOH has identified 13 new cases of hepatitis A.  All cases have been in adults, 64 have required hospitalization.

Findings of the investigation suggest that the source of the outbreak is focused on Oahu. Ten (10) individuals are residents of the islands of Hawaii, Kauai, or Maui, and four visitors have returned to the mainland.

CONFIRMED CASES OF HEPATITIS A – 241

Onset of illness has ranged between 6/12/16 – 8/25/16.

Tropical Smoothie Café Hepatitis A Outbreak Update

The CDC, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of foodborne hepatitis A.  70 people with hepatitis A have been reported from seven states: Maryland (6), New York (1), North Carolina (1), Oregon (1), Virginia (55), West Virginia (5), and Wisconsin (1).  32 ill people have been hospitalized. No deaths have been reported. Epidemiologic and traceback evidence indicate frozen strawberries imported from Egypt are the likely source of this outbreak.

On August 8, 2016, Tropical Smoothie Café reported that they removed the Egyptian frozen strawberries from their 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.

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

Tropical Smoothie Cafe Linked to 35 Hepatitis A Illnesses

The 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.

Tropical Smoothie Cafes in Virginia Link in Hepatitis A Outbreak

The 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.

Virginia Reports Hepatitis A Outbreak

The 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/.