As of June 12, 2023, a total of 9 outbreak-associated cases of hepatitis A have been reported from 3 states – Washington, Oregon and California.

Illnesses started on dates ranging from November 24, 2022, to April 12, 2023. Ill people range in age from 38 to 64 years, with a median age of 56 years. Thirty-three percent of ill people are female. Of 9 people with available information, 3 (33%) have been hospitalized. No deaths have been reported.

Epidemiologic and traceback evidence indicate that frozen organic strawberries, imported fresh from certain farms located in Baja California, Mexico in 2022, are the likely source of this outbreak. The hepatitis A virus strain causing illnesses in this outbreak is genetically identical to the strain that caused a foodborne hepatitis A outbreak in 2022, which was linked to fresh organic strawberries imported from Baja California, Mexico, and sold at various retailers.

In interviews, ill people answered questions about the foods they ate and other exposures in the 2 to 7 weeks before they became ill. Of people who were interviewed, 9/9 (100%) reported eating frozen organic strawberries. This proportion was significantly higher than results from a survey of healthy people in which 24% reported eating frozen berries in the week before they were interviewed.

In response to this investigation, California Splendor, Inc. of San Diego, California voluntarily recalled certain lots of 4-lb. bags of Kirkland Signature Frozen Organic Whole Strawberries that were sold at Costco stores in Los Angeles, California; Hawaii; and two San Diego, California business centers. The lots subject to this recall include: 140962-08, 142222-23, 142792-54, 142862-57, 142912-59, 142162-20, 142202-21, 142782-53, 142852-56, 142902-58, 142212-22, 142232-24, 142842-55.

In response to this investigation, Scenic Fruit Company of Gresham, Oregon voluntarily recalled frozen organic strawberries, sold to Costco, Trader Joe’s, Aldi, KeHE, Vital Choice Seafood, and PCC Community Markets in certain states. Products subject to this recall include:

Brand Name	Product Name	Net Wt.	UPC	Best By Date, Best If Use Date, Best Before Date	Distributed in States
Simply Nature	Organic Strawberries	24 oz.	4099100256222	6/14/2024	Arizona, Arkansas, California, Illinois, Iowa, Michigan, Minnesota, Missouri, North Dakota, Ohio, South Dakota, Wisconsin
Vital Choice	Organic Strawberries	16 oz.	834297005024	5/20/2024	Washington
Kirkland Signature	Organic Strawberries	4 lbs.	96619140404	10/8/2024	Alaska, Idaho, Montana, Oregon, Utah, Washington
Made With	Organic Strawberries	10 oz.	814343021390	11/20/2024	Illinois, Maryland
PCC Community Markets	Organic Strawberries	32 oz.	22827109469	29/10/2024	Washington
Trader Joe’s	Organic Tropical Fruit Blend Pineapple, Bananas, Strawberries & Mango	16 oz.	00511919	04/25/24, 05/12/24, 05/23/24, 05/30/24, 06/07/24	Nationwide

On March 17, 2023, a retailer, Meijer, also issued press to voluntarily recall Made-With brand frozen organic strawberries from certain market store locations.

In response to this investigation, on June 7, 2023, Wawona Frozen Foods of Clovis, California, initiated a voluntary recallof year-old packages of Wawona brand Organic DayBreak Blend 4-lb. bags that were distributed to Costco Wholesale stores in Arizona, California, Colorado, Utah, and Washington from April 15, 2022, to June 26, 2022, with “Use By” dates of 9/23/2023, 9/29/2023, 9/30/2023, and 10/18/2023:

Best If Used By 09/23/2023	Best If Used By 09/29/2023	Best If Used By 09/30/2023	Best If Used By 10/18/2023
Affected Lot Codes:	Affected Lot Codes:	Affected Lot Codes:	Affected Lot Codes:
20082D04	20088D04	20089D09	20108D04
20082D05	20088D05	20089D10	20108D05
20082D06	20088D06	20089D11	20108D06
20082D07	20088D07	20089D12	20108D07
20082D08	20088D08		20108D08
	20088D09
	20088D10
	20088D11
	20088D12

FDA’s investigation is ongoing; additional products might be included in the future.

The Roanoke Times reports: The victims of a hepatitis A outbreak at a Roanoke restaurant — which killed four people and sickened more than 40 — were allowed Thursday to broaden their legal claims.

When the illness first struck customers of Famous Anthony’s late last summer, it was believed that an infected employee inadvertently spread the virus to food they ate at the restaurant’s Grandin Road Extension and Williamson Road locations.

Further investigation has determined that in addition to contaminating the food, the employee also touched surfaces such as doorknobs, tables and menus. Some customers who later came into contact with those surfaces were likely infected, according to Bill Marler, a Seattle attorney who represents many of them.

“There is as much evidence that this was surface contamination as it was food contamination,” Marler said during a hearing Thursday in Roanoke’s federal court.

At the request of the plaintiffs’ attorneys — and over the objections of Famous Anthony’s insurance carrier, Cincinnati Insurance Co. — Judge Michael Urbanski allowed the victims to amend their earlier complaints to include both sources of the illness.

Cincinnati, which had earlier agreed to cover claims of food contamination, argued that the plaintiffs’ request to broaden the scope was “a theory in search of evidence.”

But in granting a motion made by Marler and other attorneys to amend the complaints, Urbanski said it may never be known how each diner at the restaurants came down with hepatitis A.

“This case needs to go forward,” he said. “It needs to be resolved. And I intend to do that.”

People who were sickened, and the family members of those who died, have filed about 40 lawsuits against Famous Anthony’s in state court. Those legal claims were put on hold in January, when the restaurant filed for bankruptcy.

In all likelihood, the lawsuits will not be decided by a judge or jury. Instead, a medical claims evaluator appointed by the bankruptcy court will determine how much each person should receive from a pool of insurance money.

When a dispute surfaced over whether the coverage limit is $7 million as Cincinnati contends, or $14 million as the plaintiffs argue, that question was removed to U.S. District Court in Roanoke.

Urbanski must now decide whether the policy allows for $7 million in total, or whether that amount should apply to each of the two restaurants where the outbreak occurred. Once that question is resolved, the matter will be returned to bankruptcy court for the distribution of money to the victims.

Cincinnati agreed early this year to pay $7 million to settle the case, according to the company’s attorney, James Humphreys. But that offer was rejected by the plaintiffs.

Since then, the case has been complicated further by a dispute over whether the claims should be limited to food contamination, or include surface contamination or a combination of the two.

The insurance company argues that expanding the case beyond food as the source of the illness raises questions about liability and coverage that it cannot determine at this point.

But the victims are also in the dark about the outbreak, Marler said, because they have not been able to acquire information from the legal process of discovery since their lawsuits were stayed by the bankruptcy proceedings.

The Virginia Heath Department’s Roanoke office has said the virus was spread, beginning in late summer 2021, by an employee who worked at three Famous Anthony’s locations. Patrons became sick at the Grandin and Williamson road eateries, but not at the third.

At the time, the unidentified worker did not know that he or she had hepatitis A, which generally does not produce symptoms for the first two weeks, which is also the period in which it is most contagious.

Microscopic amounts of fecal matter from the employee, who is suspected of inadequate hand-washing after using the bathroom, was spread to food and restaurant surfaces and then to customers.

The employee had multiple duties, which included working as a cook, waiting on tables and greeting customers as they came into the restaurants.

Hepatitis A causes liver inflammation. At least two Famous Anthony’s customers became so ill that they required liver transplants.

“It has been a year since this tragic outbreak,” Marler said. “Many of my clients were either getting out of the hospital or burying loved ones at this time a year ago.”

When hearing about hepatitis A, many people think about contaminated food and water. However, in the United States, hepatitis A is more commonly spread from person to person. Since March 2017, CDC’s Division of Viral Hepatitis (DVH) has been assisting multiple state and local health departments with hepatitis A outbreaks, spread through person-to-person contact.

The hepatitis A vaccine is the best way to prevent hepatitis A virus (HAV) infection 

• The following groups are at highest risk for acquiring HAV infection or developing serious complications from HAV infection in these outbreaks and should be offered the hepatitis A vaccine in order to prevent or control an outbreak:
  • People who use drugs (injection or non-injection)
  • People experiencing unstable housing or homelessness 
  • Men who have sex with men (MSM)
  • People who are currently or were recently incarcerated 
  • People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C
• One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A.^1,2
• Pre-vaccination serologic testing is not required to administer hepatitis A vaccine. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable.

CDC has provided outbreak-specific considerations for hepatitis A vaccine administration and has updated its overall recommendations on the prevention of hepatitis A virus infection in the United States.

The Long Beach Post reports that health officials in Long Beach notified recipients of Meals on Wheels that they may have been exposed to hepatitis A, a highly contagious liver infection, in late May and June.

The nonprofit delivers meals five times a week to about 400 people in Long Beach who can’t shop for themselves and live alone, most of them elderly. The Long Beach Health Department sent letters to those who consumed food delivered by the agency on May 23, May 31, June 6 and June 13, warning them of the possible exposure.

The individuals “were notified as standard public health practice, but the risk of developing Hepatitis A infection is low,” the Health Department said in a statement Thursday. “Meals on Wheels has cooperated fully and there is no ongoing risk to eating Meals on Wheels food.”

Meals on Wheels Executive Director Bill Cruikshank said the incident stemmed from a volunteer who was helping package food, but couldn’t provide further details due to privacy laws.

“This was a very low-risk exposure,” he said.

The Health Department advised those who were notified to get vaccinated for hepatitis A if they haven’t already, and to monitor any symptoms of the illness, which include diarrhea, stomach pain, dark-colored urine, fever, jaundice, nausea, vomiting, loss of appetite and muscle pain.

There is no treatment for the virus, which typically goes away on its own.

The virus is spread through contact with someone who is positive, or by ingesting food or water that has been contaminated with feces from an infected person.