As of November 20, 2019, a total of 11 outbreak-associated cases of hepatitis A were reported from 3 states – Indiana (2), Wisconsin (3) and Nebraska (6)

Illnesses started on dates ranging from October 15, 2019, to November 5, 2019. Ill people range in age from 14 to 73 years, with a median age of 35. Seventy-three percent of ill people are female. Of 11 people with available information, 6 (55%) were hospitalized. No deaths have been reported.

Illnesses might not yet be reported due to the time it takes for symptoms to appear after exposure (average 4 weeks) and the time it takes between when someone becomes ill and when the illness is reported.

Epidemiologic and traceback evidence are being collected and analyzed. A single, common supplier of fresh blackberries has not been identified.

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, 11/11 (100%) reported eating fresh blackberries; of 9 people with known fresh blackberry purchase location information, 9/9 (100%) purchased fresh blackberries from Fresh Thyme Farmers Market. This proportion was significantly higher than results from a survey of healthy people in which 7% reported eating fresh blackberries in the week before they were interviewed.

The FDA and regulatory officials in several states have collected records from grocery stores where ill people reported buying fresh blackberries and are conducting traceback investigations to try to identify a specific source of the fresh blackberries.

This outbreak investigation is ongoing, and CDC will update the public when more information becomes available.