Yvan J.F. Hutin, M.D., Vitali Pool, M.D., Elaine H. Cramer, M.D., Omana V. Nainan, Ph.D., Jo Weth, M.A., Ian T. Williams, Ph.D., Susan T. Goldstein, M.D., Kathleen F. Gensheimer, M.D., Beth P. Bell, M.D., Craig N. Shapiro, M.D., Miriam J. Alter, Ph.D., Harold S. Margolis, M.D., for The National Hepatitis A Investigation Team
Background We investigated a large, foodborne outbreak of hepatitisA that occurred in February and March 1997 in Michigan and thenextended the investigation to determine whether it was relatedto sporadic cases reported in other states among persons whohad consumed frozen strawberries, the food suspected of causingthe outbreak.
Methods The cases of hepatitis A were serologically confirmed.Epidemiologic studies were conducted in the two states withsufficient numbers of cases, Michigan and Maine. Hepatitis Avirus RNA detected in clinical specimens was sequenced to determinethe relatedness of the virus from outbreak-related cases andother cases.
Results A total of 213 cases of hepatitis A were reported from23 schools in Michigan and 29 cases from 13 schools in Maine,with the median rate of attack ranging from 0.2 to 14 percent.Hepatitis A was associated with the consumption of frozen strawberriesin a case–control study (odds ratio for the disease, 8.3;95 percent confidence interval, 2.1 to 33) and a cohort study(relative risk of infection, 7.5; 95 percent confidence interval,1.1 to 53) in Michigan and in a case–control study inMaine (odds ratio for infection, 3.4; 95 percent confidenceinterval, 1.0 to 14). The genetic sequences of viruses from126 patients in Michigan and Maine were identical to one anotherand to those from 5 patients in Wisconsin and 7 patients inArizona, all of whom attended schools where frozen strawberriesfrom the same processor had been served, and to those in 2 patientsfrom Louisiana, both of whom had consumed commercially preparedproducts containing frozen strawberries from the same processor.
Conclusions We describe a large outbreak of hepatitis A in Michiganthat was associated with the consumption of frozen strawberries.We found apparently sporadic cases in other states that couldbe linked to the same source by viral genetic analysis.
Source Information
From the Hepatitis Branch (Y.J.F.H., O.V.N., I.T.W., S.T.G., B.P.B., C.N.S., M.J.A., H.S.M.) and the Epidemiology Program Office (V.P., E.H.C.), Centers for Disease Control and Prevention, Atlanta; the Calhoun County Department of Health, Battle Creek, Mich. (J.W.); and the Maine State Bureau of Health, Augusta (K.F.G.).
Address reprint requests to Dr. Hutin at the Hepatitis Branch, Mailstop G37, Centers for Disease Control and Prevention, Atlanta, GA 30333, or at yah5{at}cdc.gov.
Rawsthorne, H., Phister, T. G., Jaykus, L.-A.
(2009). Development of a Fluorescent In Situ Method for Visualization of Enteric Viruses. Appl. Environ. Microbiol.
75: 7822-7827
[Abstract][Full Text]
Butot, S., Putallaz, T., Amoroso, R., Sanchez, G.
(2009). Inactivation of Enteric Viruses in Minimally Processed Berries and Herbs. Appl. Environ. Microbiol.
75: 4155-4161
[Abstract][Full Text]
Tallon, L. A., Love, D. C., Moore, Z. S., Sobsey, M. D.
(2008). Recovery and Sequence Analysis of Hepatitis A Virus from Springwater Implicated in an Outbreak of Acute Viral Hepatitis. Appl. Environ. Microbiol.
74: 6158-6160
[Abstract][Full Text]
Butot, S., Putallaz, T., Sanchez, G.
(2007). Procedure for Rapid Concentration and Detection of Enteric Viruses from Berries and Vegetables. Appl. Environ. Microbiol.
73: 186-192
[Abstract][Full Text]
Wasley, A., Fiore, A., Bell, B. P.
(2006). Hepatitis A in the Era of Vaccination. Epidemiol Rev
28: 101-111
[Abstract][Full Text]
Nainan, O. V., Xia, G., Vaughan, G., Margolis, H. S.
(2006). Diagnosis of Hepatitis A Virus Infection: a Molecular Approach. Clin. Microbiol. Rev.
19: 63-79
[Abstract][Full Text]
Shan, X. C., Wolffs, P., Griffiths, M. W.
(2005). Rapid and Quantitative Detection of Hepatitis A Virus from Green Onion and Strawberry Rinses by Use of Real-Time Reverse Transcription-PCR. Appl. Environ. Microbiol.
71: 5624-5626
[Abstract][Full Text]
Wheeler, C., Vogt, T. M., Armstrong, G. L., Vaughan, G., Weltman, A., Nainan, O. V., Dato, V., Xia, G., Waller, K., Amon, J., Lee, T. M., Highbaugh-Battle, A., Hembree, C., Evenson, S., Ruta, M. A., Williams, I. T., Fiore, A. E., Bell, B. P.
(2005). An Outbreak of Hepatitis A Associated with Green Onions. NEJM
353: 890-897
[Abstract][Full Text]
Di Giammarino, L., Dienstag, J. L.
(2005). Hepatitis A -- The Price of Progress. NEJM
353: 944-946
[Full Text]
Jothikumar, N., Cromeans, T. L., Sobsey, M. D., Robertson, B. H.
(2005). Development and Evaluation of a Broadly Reactive TaqMan Assay for Rapid Detection of Hepatitis A Virus. Appl. Environ. Microbiol.
71: 3359-3363
[Abstract][Full Text]
Lu, L., Ching, K. Z., de Paula, V. S., Nakano, T., Siegl, G., Weitz, M., Robertson, B. H.
(2004). Characterization of the complete genomic sequence of genotype II hepatitis A virus (CF53/Berne isolate). J. Gen. Virol.
85: 2943-2952
[Abstract][Full Text]
Mackiewicz, V., Dussaix, E., Le Petitcorps, M.-F., Roque-Afonso, A. M.
(2004). Detection of Hepatitis A Virus RNA in Saliva. J. Clin. Microbiol.
42: 4329-4331
[Abstract][Full Text]
Weinberg, M., Hopkins, J., Farrington, L., Gresham, L., Ginsberg, M., Bell, B. P.
(2004). Hepatitis A in Hispanic Children Who Live Along the United States-Mexico Border: The Role of International Travel and Food-Borne Exposures. Pediatrics
114: e68-e73
[Abstract][Full Text]
Chironna, M., Lopalco, P., Prato, R., Germinario, C., Barbuti, S., Quarto, M.
(2004). Outbreak of Infection with Hepatitis A Virus (HAV) Associated with a Foodhandler and Confirmed by Sequence Analysis Reveals a New HAV Genotype IB Variant. J. Clin. Microbiol.
42: 2825-2828
[Abstract][Full Text]
(2003). Hepatitis A Outbreak Associated With Green Onions at a Restaurant--Monaca, Pennsylvania, 2003. JAMA
290: 3187-3190
[Full Text]
Shieh, Y. C., Baric, R. S., Woods, J. W., Calci, K. R.
(2003). Molecular Surveillance of Enterovirus and Norwalk-Like Virus in Oysters Relocated to a Municipal-Sewage-Impacted Gulf Estuary. Appl. Environ. Microbiol.
69: 7130-7136
[Abstract][Full Text]
Sanchez, G., Pinto, R. M., Vanaclocha, H., Bosch, A.
(2002). Molecular Characterization of Hepatitis A Virus Isolates from a Transcontinental Shellfish-Borne Outbreak. J. Clin. Microbiol.
40: 4148-4155
[Abstract][Full Text]
Kingsley, D. H., Meade, G. K., Richards, G. P.
(2002). Detection of both Hepatitis A Virus and Norwalk-Like Virus in Imported Clams Associated with Food-Borne Illness. Appl. Environ. Microbiol.
68: 3914-3918
[Abstract][Full Text]
Oleszak, E. L., Lin, W. L., Legido, A., Melvin, J., Hardison, H., Hoffman, B. E., Katsetos, C. D., Platsoucas, C. D.
(2001). Presence of Oligoclonal T Cells in Cerebrospinal Fluid of a Child with Multiphasic Disseminated Encephalomyelitis following Hepatitis A Virus Infection. CVI
8: 984-992
[Abstract][Full Text]
Webster, G., Barnes, E., Dusheiko, G., Franklin, I.
(2001). Protecting travellers from hepatitis A. BMJ
322: 1194-1195
[Full Text]
Cuthbert, J. A.
(2001). Hepatitis A: Old and New. Clin. Microbiol. Rev.
14: 38-58
[Abstract][Full Text]
LEVINE, D F, BENDALL, R P, TEO, C G
(2000). Hepatitis E acquired in the UK. Gut
47: 740-740
[Full Text]
Bidawid, S., Farber, J. M., Sattar, S. A.
(2000). Contamination of Foods by Food Handlers: Experiments on Hepatitis A Virus Transfer to Food and Its Interruption. Appl. Environ. Microbiol.
66: 2759-2763
[Abstract][Full Text]
Schwab, K. J., Neill, F. H., Fankhauser, R. L., Daniels, N. A., Monroe, S. S., Bergmire-Sweat, D. A., Estes, M. K., Atmar, R. L.
(2000). Development of Methods To Detect "Norwalk-Like Viruses" (NLVs) and Hepatitis A Virus in Delicatessen Foods: Application to a Food-Borne NLV Outbreak. Appl. Environ. Microbiol.
66: 213-218
[Abstract][Full Text]
Sanders, T A B
(1999). Food production and food safety. BMJ
318: 1689-1693
[Full Text]
(1999). Molecular Epidemiology Links Hepatitis A to Frozen Strawberries. JWatch Infect. Diseases
1999: 19-19
[Full Text]
Koff, R. S.
(1999). The Case for Routine Childhood Vaccination against Hepatitis A. NEJM
340: 644-645
[Full Text]
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