Multistate Outbreak of Hepatitis A Associated with Frozen Strawberries

A multistate outbreak of hepatitis A was traced to frozen strawberries processed at a single plant. Among 827 students and 60 teachers at an elementary school in Georgia during a 2-week period, 15 developed hepatitis A. Three months later, among 174 residents and 467 staff in an institution for the...

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Bibliographic Details
Published in:	The Journal of infectious diseases Vol. 166; no. 3; pp. 518 - 524
Main Authors:	Niu, Manette T., Polish, Louis B., Robertson, Betty H., Khanna, Bhawna K., Woodruff, Bradley A., Shapiro, Craig N., Miller, Mark A., Smith, J. David, Gedrose, Judith K., Alter, Miriam J., Margolis, Harold S.
Format:	Journal Article
Language:	English
Published:	Chicago, IL The University of Chicago Press 01-09-1992 University of Chicago Press
Subjects:	Adult Biological and medical sciences Diet Disease Outbreaks Epidemiology Faculty Feces - microbiology Female Food Contamination Foodborne Diseases - epidemiology Foodborne illnesses Fruit - microbiology Genomes Georgia - epidemiology Hepatitis Hepatitis A Hepatitis A - epidemiology Hepatitis A - etiology Hepatitis A virus Hepatovirus - genetics Hepatovirus - isolation & purification Human viral diseases Humans Infections Infectious diseases Major Articles Male Medical sciences Middle Aged Montana - epidemiology Notifiable diseases Nucleic acids Retrospective Studies Risk Factors RNA, Viral - genetics Viral diseases Viral hepatitis United States North America America Montana Georgia Human Hepatitis A virus Picornaviridae Hepatic disease Foodstuff Epidemiology Contamination Infection Virus Viral hepatitis A Etiology Viral disease Strawberry Digestive diseases Frozen product Transmission mode Public health
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Summary:	A multistate outbreak of hepatitis A was traced to frozen strawberries processed at a single plant. Among 827 students and 60 teachers at an elementary school in Georgia during a 2-week period, 15 developed hepatitis A. Three months later, among 174 residents and 467 staff in an institution for the developmentally disabled in Montana during a 3-week period, 13 developed hepatitis A. Primary attack rates were 10% in the school and 8% in the institution. Cohort analysis in the school implicated consumption of strawberry shortcake in hepatitis A virus (HAV) infection (relative risk, 7.6; 95% confidence interval, 1.04-55.6). In the institution, such analysis implicated desserts and uncooked strawberries as the most biologically plausible vehicle of HAV transmission. Molecular analysis of HAV from patients in the two outbreaks revealed that the viral genomes were genetically identical and distinct from other known US strains. Contamination of food products before retail distribution is rare but should be considered in investigating common-source outbreaks of hepatitis A.
Bibliography:	Reprints: Hepatitis Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control, 1600 Clifton Rd., Mailstop G-37, Atlanta, GA 30333. ark:/67375/HXZ-01BKNHXZ-X istex:9B701E613D4E0C8088DB9C9808506441468EFC01 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0022-1899 1537-6613
DOI:	10.1093/infdis/166.3.518