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.
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