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Hepatitis A Spike in San Diego

Forty-two hepatitis A cases have been reported in the San Diego region since November 2016, more than four times the monthly average typically reported, the County Health and Human Services Agency announced today.

Thirty-six people were hospitalized and two died from the disease.  Twenty-three cases are men, and the cases range in age from 26 to 72 years, with an average age of 42 years.  Twenty-nine cases have a history of substance abuse, and 27 are homeless.  Five people became ill with hepatitis A after traveling outside the United States.  No common sources of infection have been identified, and investigations are still continuing.

“The County is working closely with the local health community to increase outreach to vulnerable populations to raise awareness and promote hepatitis A vaccination,” said Wilma Wooten, M.D., M.P.H., County public health officer.  “Those at risk are urged to talk to their health care providers and get vaccinated for hepatitis A.”

Hepatitis A is a vaccine-preventable disease. While the hepatitis A vaccine is recommended as part of the routine childhood vaccination schedule, most adults have not been vaccinated and may be susceptible to the hepatitis A virus.

Two doses of hepatitis A vaccine are recommended for:

  • All children (first dose of vaccine between 12 months and 23 months of age, and the second dose six to 18 months later)
  • Travelers to countries that have higher rates of hepatitis A (high-risk areas include parts of Africa and Asia, and moderate risk areas include Central and South America, Eastern Europe, and parts of Asia)
  • Men who have sex with men
  • Users of injection and non-injection illegal drugs
  • Homeless people who are living outdoors
  • Household or sexual contacts of hepatitis A patients
  • People with chronic liver diseases, such as cirrhosis, hepatitis B or hepatitis C
  • Family members or caregivers of a recent adoptee from countries where hepatitis A is common
  • People who are treated with clotting-factor concentrates

Symptoms of hepatitis A include jaundice (yellowing of the skin and eyes), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and light-colored stools.  Symptoms usually appear over a number of days and last less than two months.  However, some people can be ill for as long as six months. Hepatitis A can sometimes cause liver failure and death.

Hepatitis A Class Action Settled

The following release was issued today by The Notice Company, Inc.:

A Settlement has been reached in the lawsuit entitled Cody Werkmeister v. Hardee’s Restaurants, LLC, Case No. 2015-CP-42-3982, pending in the Court of Common Pleas in the Seventh Judicial Circuit Court of Spartanburg County, South Carolina, concerning alleged exposure to the Hepatitis A virus.

What is This Case About?

On September 18, 2015, the South Carolina Department of Health and Environmental Control (“Health Department”) announced that customers who ate at two Hardee’s Restaurants in Spartanburg County might have been exposed to the hepatitis A virus (“HAV”). One restaurant location was at 12209 Greenville Highway in Lyman, South Carolina, and the second location was at 1397 East Main Street in Duncan, South Carolina. The Health Department recommended that persons who ate at either the Hardee’s Restaurant in Duncan between September 4 and 13, 2015 or the Hardee’s Restaurant in Lyman between September 4 and 15, 2015, be vaccinated.  These time periods are referred to as the “Exposure Period”.

Who is Included in the Settlement?

Included in the Settlement are all persons who:

(1) consumed food or drink between September 4 and September 13, 2015, at the Hardee’s Restaurant located in Duncan, South Carolina, or between September 4 and September 15, 2015, at the Hardee’s Restaurant located in Lyman, South Carolina, and
(2) subsequently obtained a Hepatitis-A Virus (“HAV”) vaccination, an immune globulin (“IG”) shot, or HAV blood test within thirty days after eating at these Hardee’s Restaurant locations, but in no event later than October 15, 2015.

The South Carolina Department of Health and Environmental Control has not provided notice that any persons developed HAV infections after consuming food or drink at these Hardee’s Restaurant locations during these time periods; such persons, if any, are excluded from the class.  Employees of Hardee’s Restaurants are also excluded from the class.

What Does the Settlement Provide?

Each member of the Settlement Class who submits a timely, qualified claim will share equally in the aggregate Class Award of $500,000.00.

How Do You Make a Claim?

To make a claim, you must submit a Claim Form so that the Claims Administrator receives it no later than March 30, 2017. If you did not receive a Claim Form in the mail, you can obtain a Claim Form online at www.SpartanburgHepa.com, by calling 1-800-352-1270, or by writing to the Claims Administrator at:

Spartanburg Hep-A Class Action
c/o The Notice Company
P. O. Box 455
Hingham, MA 02043

Who Represents You?

The Court has appointed Marler Clark, LLP, PS, as the Class Counsel. Class Counsel will receive as attorneys’ fees 25% of the amount paid to the entire Settlement Class for general damages, or what is awarded by the Court, whichever is less. The defendant, Hardee’s Restaurants, LLC, will pay the determined Class Counsels’ fees and costs.  The Class Award of $500,000.00 will not be reduced by these attorneys’ fees and costs.

What Are Your Options?

Submit a Claim:  If you want to participate in the Settlement and receive a portion of the Class Award, you must make a claim as described above.

Exclude Yourself:  If you do not want to be legally bound by the Settlement, you must exclude yourself in writing by sending a written request for exclusion to the Claims Administrator so that it is postmarked by March 30, 2017, or you will not be able to sue, or continue to sue, Hardee’s Restaurants, LLC, about the legal claims in this case.  An exclusion request must include your name and address, state “I request exclusion from the Hardee’s HEP-A Settlement in Spartanburg County, SC”, be signed by you or your legal representative, and be mailed to:

Spartanburg Hep-A Class Exclusions
c/o The Notice Company
P. O. Box 455
Hingham, MA 02043

If you exclude yourself you may not submit a Claim Form and you will not be entitled to share in the Class Award.

Object:  If you stay in the Settlement Class, you may object to the Settlement by filing with the Court, with copies to Class Counsel and to counsel for Hardee’s Restaurants, LLC, a notice of intent to appear and/or object, no later than March 30, 2017.

Court Address:
The Court of Common Pleas of Spartanburg County
180 Magnolia Street
Spartanburg, SC 29306

Class Counsel Address:
William D. Marler, Esquire
MARLER CLARK, L.L.P., P.S.
1012 First Avenue, Fifth Floor
Seattle, WA 98104-1008

Defendant’s Counsel Address:
Kenneth W. Ward, Esq.
TRAMMELL, ADKINS & WARD, P.C.
P.O. Box 51450
Knoxville, TN 37950-1450

The Court of Common Pleas of Spartanburg County will hold a Final Approval Hearing at 10:00 a.m. on Monday, April 17, 2017, at 180 Magnolia Street, Spartanburg, SC 29306.  At the hearing, the Court will consider whether the proposed settlement should be granted final approval as fair, adequate, and reasonable, and in the best interests of the Settlement Class as a whole.  The Parties will request that the Court enter a Final Approval Order. You may attend this hearing if you wish, but you are not required to do so in order to participate in the Settlement.

This Notice is only a Summary. To obtain a copy of the detailed Notice of Settlement, you may visit www.SpartanburgHepa.com, call 1-800-352-1270 or write to the Claims Administrator at the above address.  You may also write to Class Counsel.

PLEASE DO NOT DIRECT QUESTIONS TO THE COURT

Genki Sushi Scallops Hepatitis A Outbreak in Hawaii

On August 15, 2016, the Hawaii Department of Health (HDOH) identified raw scallops served at Genki Sushi restaurants on Oahu and Kauai as a likely source of an ongoing hepatitis A outbreak. The product of concern was identified to be Sea Port Bay Scallops (Wild Harvest, Raw Frozen) that originated in the Philippines (states “Product of the Philippines” on the box) and were distributed by Koha Oriental Foods.

As a result, HDOH ordered this product embargoed (not to be sold, purchased, or consumed) throughout the state, and the temporary closure of all Genki Sushi restaurants on Oahu and Kauai.

As of November 30, 2016, HDOH has identified 292 cases of hepatitis A. Seventy-four have required hospitalization. Findings of the investigation suggest that the source of the outbreak is focused on Oahu. Eleven individuals are residents of the islands of Hawaii, Kauai, or Maui, and seven visitors have returned to the mainland or overseas. Onset of illness has ranged between June 12, 2016 and October 9, 2016.

The FDA and CDC are supporting the HDOH in the investigation of hepatitis A virus (HAV) infections linked to scallops supplied by Sea Port Products Corp. On August 17, 2016, the FDA, HDOH, CDC, and state partners informed Sea Port Products Corp. that epidemiological, laboratory, and traceback information indicated that their scallops are the likely source of illnesses. On August 18, 2016, Sea Port Products Corp. initiated a voluntary recall of three lots of frozen Bay Scallops produced on November 23 and 24, 2015. The lot numbers for the recalled scallops are 5885, 5886, and 5887. The products were distributed to California, Hawaii, and Nevada. According to Sea Port Products Corp., the recalled products are not intended for retail sale. The FDA is working with the recalling firm to ensure their recall is effective and that recalled product is removed from the market.

The FDA’s traceback investigation involved working with HDOH to trace the path of food eaten by those made ill back to a common source. The traceback investigation determined that Sea Port Products Corp. imported the scallops that were later supplied to certain Genki Sushi locations in Hawaii, where ill people reported eating.

On August 17, 2016, FDA laboratory analysis of two scallop samples, which were collected on August 11, 2016, were confirmed positive for hepatitis A. These samples were imported by Sea Port Products Corp. and were produced on November 23 and 24, 2015.

The Hepatitis A Virus

Exposure to hepatitis A virus (“HAV”) can cause an acute infection of the liver that is typically mild and resolves on its own.[1] The symptoms and duration of illness vary a great deal, with many persons showing no symptoms at all.[2] Fever and jaundice are two of the symptoms most commonly associated with HAV infection.[3]

Throughout history, hepatitis infections have plagued humans. The “earliest accounts of contagious jaundice are found in ancient China.”[4] According to the CDC:

The first descriptions of hepatitis (epidemic jaundice) are generally attributed to Hippocrates.  Outbreaks of jaundice, probably hepatitis A, were reported in the 17th and 18th centuries, particularly in association with military campaigns.  Hepatitis A (formerly called infectious hepatitis) was first differentiated epidemiologically from hepatitis B, which has a long incubation period, in the 1940s.  Development of serologic tests allowed definitive diagnosis of hepatitis B.  In the 1970s, identification of the virus, and development of serologic tests helped differentiate hepatitis A from other types of non-B hepatitis.[5]

Until 2004, HAV was the most frequently reported type of hepatitis in the United States. In the pre-vaccine era, the primary methods used for preventing HAV infections were hygienic measures and passive protection with immune globulin (IG). Hepatitis A vaccines were licensed in 1995 and 1999. These vaccines provide long-term protection against HAV infection.[6]

Hepatitis A is the only common vaccine-preventable foodborne disease in the United States.[7] This virus is one of five human hepatitis viruses that primarily infect the human liver and cause human illness.[8] Unlike hepatitis B and C, hepatitis A does not develop into chronic hepatitis or cirrhosis, which are both potentially fatal conditions.[9] Nonetheless, infection with the hepatitis A virus (HAV) can lead to acute liver failure and death.[10]

Where does Hepatitis A Come From?

Hepatitis A is a communicable (or contagious) disease that often spreads from person to person.[11] Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water.[12] Food-related outbreaks are usually associated with contamination of food during preparation by a HAV-infected food handler.[13] The food handler is generally not ill because the peak time of infectivity—that is, when the most virus is present in the stool of an infected individual—occurs two weeks before illness begins.[14]

Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A.[15] In 1997, frozen strawberries were the source of a hepatitis A outbreak in five states.[16] Six years later, in 2003, fresh green onions were identified as the source of a HAV outbreak traced to consumption of food at a Pennsylvania restaurant.[17] Other fruits and vegetables, such as blueberries and lettuce, have also been associated with HAV outbreaks in the U.S. as well as in other developed countries.[18] HAV is relatively stable and can survive for several hours on fingertips and hands and up to two months on dry surfaces.[19] The virus can be inactivated by heating to 185°F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of household bleach in tap water.[20] HAV can still be spread from cooked food if it is contaminated after cooking.[21]

Although ingestion of contaminated food is a common means of spread for HAV, it may also be spread by household contact among families or roommates, sexual contact, or by direct inoculation from persons sharing illicit drugs.[22] Children are often asymptomatic, or have unrecognized infections, and can pass the virus through ordinary play, unknown to their parents, who may later become infected from contact with their children.[23]

What are the Symptoms of Hepatitis A?

Hepatitis A may cause no symptoms at all when it is contracted, especially in children.[24] Asymptomatic individuals will only know they were infected (and have become immune, given that you can only get hepatitis A once) by getting a blood test later in life.[25] Approximately 10 to 12 days after exposure, HAV is present in blood and is excreted via the biliary system into the feces.[26] Although the virus is present in the blood, its concentration is much higher in feces.[27] HAV excretion begins to decline at the onset of clinical illness, and decreases significantly by 7 to 10 days after onset of symptoms.[28] Most infected persons no longer excrete virus in the feces by the third week of illness. Children may excrete HAV longer than adults.[29]

Seventy percent of HAV infections in children younger than six years of age are asymptomatic; in older children and adults, infection tends to be symptomatic with more than 70% of those infected developing jaundice.[30] Symptoms typically begin about 28 days after contracting HAV, but can begin as early as 15 days or as late as 50 days after exposure.[31] The symptoms include muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever, and malaise.[32]

After a few days of typical symptoms, jaundice (also termed “icterus”) sets in.[33] Jaundice is a yellowing of the skin, eyes, and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood.[34] The urine will also turn dark with bile and the stool light or clay-colored from lack of bile.[35] When jaundice sets in, initial symptoms such as fever and headache begin to subside.[36]

In general, symptoms usually last less than two months, although 10% to 15% of symptomatic persons have prolonged or relapsing disease for up to 6 months.[37] It is not unusual, however, for blood tests to remain abnormal for six months or more.[38] The jaundice so commonly associated with HAV can also linger for a prolonged period in some infected persons, sometimes as long as eight months or more.[39] Additionally, pruritus, or severe “itchiness” of the skin, can persist for several months after the onset of symptoms. These conditions are frequently accompanied by diarrhea, anorexia, and fatigue.[40]

Relapse is possible with hepatitis A, typically within three months of the initial onset of symptoms.[41] Although relapse is more common in children, it does occur with some regularity in adults.[42] The vast majority of persons who are infected with hepatitis A fully recover, and do not develop chronic hepatitis.[43] Persons do not carry HAV long-term as with hepatitis B and C.[44]

Fulminant Hepatitis A

Fulminant hepatitis A, or acute liver failure, is a rare but devastating complication of HAV infection.[45] As many as 50% of individuals with acute liver failure may die or require emergency liver transplantation.[46] Elderly patients and patients with chronic liver disease are at higher risk for fulminant hepatitis A.[47] In parallel with a declining incidence of acute HAV infection in the general population, however, the incidence of fulminant HAV appears to be decreasing.[48]

HAV infects the liver’s parenchymal cells (internal liver cells).[49] Once a cell has been penetrated by the viral particles, the hepatitis A releases its own toxins that cause, in essence, a hostile takeover of the host’s cellular system.[50] The cell then produces new viral components that are released into the bile capillaries or tubes that run between the liver’s parenchymal cells.[51] This process results in the death of liver cells, called hepatic necrosis.[52]

The fulminant form of hepatitis occurs when this necrotic process kills so many liver cells—upwards of three-quarters of the liver’s total cell count—that the liver can no longer perform its job.[53] Aside from the loss of liver function, fulminant hepatic failure can lead to encephalopathy and cerebral edema.[54] Encephalopathy is a brain disorder that causes central nervous system depression and abnormal neuromuscular function.[55] Cerebral edema is a swelling of the brain that can result in dangerous intracranial pressure.[56] Intracranial hypertensions leading to a brain stem death and sepsis with multiple organ failure are the leading causes of death in individuals with fulminant hepatic failure.[57]

Incidence of Hepatitis A Infection

Hepatitis A is much more common in countries with underdeveloped sanitation systems and, thus, is a risk in most of the world.[58] An increased transmission rate is seen in all countries other than the United States, Canada, Japan, Australia, New Zealand, and the countries of Western Europe.[59] Nevertheless, infections continue to occur in the United States, where approximately one-third of the population has been previously infected with HAV.[60]

Each year, approximately 30,000 to 50,000 cases of hepatitis A occur in the United States.[61] Historically, acute hepatitis A rates have varied cyclically, with nationwide increases every 10 to 15 years.[62] The national rate of HAV infections has declined steadily since the last peak in 1995.[63] Although the national incidence—1.0 case per 100,000 population—of hepatitis A was the lowest ever recorded in 2007, it is estimated that asymptomatic infections and underreporting kept the documented incidence-rate lower than it actually is. In fact, it is estimated that there were 25,000 new infections in 2007.[64]

In 2007, the CDC reported a total of 2,979 acute symptomatic cases of HAV.[65] Of these, information about food and water exposure was known for 1,047 cases, leading to an estimate that 6.5% of all infections were caused by exposure to contaminated water or food.[66] In 2,500 of the cases, no known risk factor was identified.[67]

 

Estimates of the annual costs (direct and indirect) of hepatitis A in the United States have ranged from $300 million to $488.8 million in 1997 dollars.[99] Nationwide, adults who become ill miss an average of 27 workdays per illness, and 11 to 22 percent of those infected are hospitalized.[100] All of these costs are entirely preventable given the effectiveness of a vaccination in providing immunity from infection.[101]

References (more…)

Egyptian Strawberry Hepatitis A Outbreak

Beginning in September 2016, several states, CDC, and the FDA investigated a multistate outbreak of foodborne hepatitis A. Epidemiologic and traceback evidence indicate that frozen strawberries imported from Egypt are the likely source of this outbreak. Although no discovery has been done to date to confirm how the Egyptian strawberries made it to consumers, we have learned that Tropical Smoothie had a bulk purchasing agreement with Patagonia. Patagonia bought from VLM Canada.  It is also our understanding that VLM Canada bought from ICAPP and that VLM USA was the importer.  It appears that the strawberries entered the US in Norfolk into VLM USA’s possession and then were transferred to Preferred Freezers Storage, Inc. in Chesapeake into Patagonia’s possession.  From there, ITI picked up the berries and delivered them to either Sysco Hampton Roads or Sysco VA.  Sysco delivered them to Tropical Smoothie franchisees.

Nearly all ill people interviewed reported drinking smoothies containing strawberries at Tropical Smoothie Café locations prior to August 8, in a limited geographical area, including Maryland, North Carolina, Virginia, and West Virginia, but there have been a small number of cases outside of that geographic area with no Tropical Smoothie Café exposure.

In total, 134 people with hepatitis A have been reported from nine states: Arkansas (1), California (1), Maryland (12), New York (3), North Carolina (1), Oregon (1), Virginia (107), West Virginia (7), and Wisconsin (1). Of these cases, 129 people reported eating a smoothie containing strawberries from Tropical Smoothie Café and 5 cases reported having no exposure to Tropical Smoothie Café. There have been no cases reporting illness from this same exposure since September 23, 2016. The latest illness onset date among these cases was October 1, 2016. The investigation into these cases is ongoing. Of the 134 cases, 52 ill people have been hospitalized and no deaths have been reported.

FDA traceback information indicated that the frozen strawberries served in the Tropical Smoothie Café locations were from the International Company for Agricultural Production & Processing (ICAPP), imported from Egypt. On August 8, 2016, Tropical Smoothie Café reported that they removed the Egyptian frozen strawberries from their restaurants in Maryland, North Carolina, Virginia, and West Virginia and switched to another supplier out of an abundance of caution. Information available at this time does not indicate an ongoing risk of hepatitis A virus infection at Tropical Smoothie Cafes.

On October 30, 2016, the International Company for Agricultural Production & Processing (ICAPP) recalled all of its frozen strawberries that were imported into the U.S. since January 1, 2016. The recalled products were distributed for sale to and use in food service establishments nationwide. The FDA reports that hepatitis A virus contamination was found in four samples of ICAPP frozen strawberries.

What is Hepatitis A?

Exposure to hepatitis A virus (“HAV”) can cause an acute infection of the liver that is typically mild and resolves on its own.[1] The symptoms and duration of illness vary a great deal, with many persons showing no symptoms at all.[2] Fever and jaundice are two of the symptoms most commonly associated with HAV infection.[3]

Throughout history, hepatitis infections have plagued humans. The “earliest accounts of contagious jaundice are found in ancient China.”[4] According to the CDC:

The first descriptions of hepatitis (epidemic jaundice) are generally attributed to Hippocrates.  Outbreaks of jaundice, probably hepatitis A, were reported in the 17th and 18th centuries, particularly in association with military campaigns.  Hepatitis A (formerly called infectious hepatitis) was first differentiated epidemiologically from hepatitis B, which has a long incubation period, in the 1940s.  Development of serologic tests allowed definitive diagnosis of hepatitis B.  In the 1970s, identification of the virus, and development of serologic tests helped differentiate hepatitis A from other types of non-B hepatitis.[5]

Until 2004, HAV was the most frequently reported type of hepatitis in the United States. In the pre-vaccine era, the primary methods used for preventing HAV infections were hygienic measures and passive protection with immune globulin (IG). Hepatitis A vaccines were licensed in 1995 and 1999. These vaccines provide long-term protection against HAV infection.[6]

Hepatitis A is the only common vaccine-preventable foodborne disease in the United States.[7] This virus is one of five human hepatitis viruses that primarily infect the human liver and cause human illness.[8] Unlike hepatitis B and C, hepatitis A does not develop into chronic hepatitis or cirrhosis, which are both potentially fatal conditions.[9] Nonetheless, infection with the hepatitis A virus (HAV) can lead to acute liver failure and death.[10]

Where does Hepatitis A Come From?

Hepatitis A is a communicable (or contagious) disease that often spreads from person to person.[11] Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water.[12] Food-related outbreaks are usually associated with contamination of food during preparation by a HAV-infected food handler.[13] The food handler is generally not ill because the peak time of infectivity—that is, when the most virus is present in the stool of an infected individual—occurs two weeks before illness begins.[14]

Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A.[15] In 1997, frozen strawberries were the source of a hepatitis A outbreak in five states.[16] Six years later, in 2003, fresh green onions were identified as the sourse of a HAV outbreak traced to consumption of food at a Pennsylvania restaurant.[17] Other fruits and vegetables, such as blueberries and lettuce, have also been associated with HAV outbreaks in the U.S. as well as in other developed countries.[18] HAV is relatively stable and can survive for several hours on fingertips and hands and up to two months on dry surfaces.[19] The virus can be inactivated by heating to 185°F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of household bleach in tap water.[20] HAV can still be spread from cooked food if it is contaminated after cooking.[21]

Although ingestion of contaminated food is a common means of spread for HAV, it may also be spread by household contact among families or roommates, sexual contact, or by direct inoculation from persons sharing illicit drugs.[22] Children are often asymptomatic, or have unrecognized infections, and can pass the virus through ordinary play, unknown to their parents, who may later become infected from contact with their children.[23]

What are the Symptoms of Hepatitis A?

Hepatitis A may cause no symptoms at all when it is contracted, especially in children.[24] Asymptomatic individuals will only know they were infected (and have become immune, given that you can only get hepatitis A once) by getting a blood test later in life.[25] Approximately 10 to 12 days after exposure, HAV is present in blood and is excreted via the biliary system into the feces.[26] Although the virus is present in the blood, its concentration is much higher in feces.[27] HAV excretion begins to decline at the onset of clinical illness, and decreases significantly by 7 to 10 days after onset of symptoms.[28] Most infected persons no longer excrete virus in the feces by the third week of illness. Children may excrete HAV longer than adults.[29]

Seventy percent of HAV infections in children younger than six years of age are asymptomatic; in older children and adults, infection tends to be symptomatic with more than 70% of those infected developing jaundice.[30] Symptoms typically begin about 28 days after contracting HAV, but can begin as early as 15 days or as late as 50 days after exposure.[31] The symptoms include muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever, and malaise.[32]

After a few days of typical symptoms, jaundice (also termed “icterus”) sets in.[33] Jaundice is a yellowing of the skin, eyes, and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood.[34] The urine will also turn dark with bile and the stool light or clay-colored from lack of bile.[35] When jaundice sets in, initial symptoms such as fever and headache begin to subside.[36]

In general, symptoms usually last less than two months, although 10% to 15% of symptomatic persons have prolonged or relapsing disease for up to 6 months.[37] It is not unusual, however, for blood tests to remain abnormal for six months or more.[38] The jaundice so commonly associated with HAV can also linger for a prolonged period in some infected persons, sometimes as long as eight months or more.[39] Additionally, pruritus, or severe “itchiness” of the skin, can persist for several months after the onset of symptoms. These conditions are frequently accompanied by diarrhea, anorexia, and fatigue.[40]

Relapse is possible with hepatitis A, typically within three months of the initial onset of symptoms.[41] Although relapse is more common in children, it does occur with some regularity in adults.[42] The vast majority of persons who are infected with hepatitis A fully recover, and do not develop chronic hepatitis.[43] Persons do not carry HAV long-term as with hepatitis B and C.[44]

Fulminant Hepatitis A

Fulminant hepatitis A, or acute liver failure, is a rare but devastating complication of HAV infection.[45] As many as 50% of individuals with acute liver failure may die or require emergency liver transplantation.[46] Elderly patients and patients with chronic liver disease are at higher risk for fulminant hepatitis A.[47] In parallel with a declining incidence of acute HAV infection in the general population, however, the incidence of fulminant HAV appears to be decreasing.[48]

HAV infects the liver’s parenchymal cells (internal liver cells).[49] Once a cell has been penetrated by the viral particles, the hepatitis A releases its own toxins that cause, in essence, a hostile takeover of the host’s cellular system.[50] The cell then produces new viral components that are released into the bile capillaries or tubes that run between the liver’s parenchymal cells.[51] This process results in the death of liver cells, called hepatic necrosis.[52]

The fulminant form of hepatitis occurs when this necrotic process kills so many liver cells—upwards of three-quarters of the liver’s total cell count—that the liver can no longer perform its job.[53] Aside from the loss of liver function, fulminant hepatic failure can lead to encephalopathy and cerebral edema.[54] Encephalopathy is a brain disorder that causes central nervous system depression and abnormal neuromuscular function.[55] Cerebral edema is a swelling of the brain that can result in dangerous intracranial pressure.[56] Intracranial hypertensions leading to a brain stem death and sepsis with multiple organ failure are the leading causes of death in individuals with fulminant hepatic failure.[57]

Incidence of Hepatitis A Infection

Hepatitis A is much more common in countries with underdeveloped sanitation systems and, thus, is a risk in most of the world.[58] An increased transmission rate is seen in all countries other than the United States, Canada, Japan, Australia, New Zealand, and the countries of Western Europe.[59] Nevertheless, infections continue to occur in the United States, where approximately one-third of the population has been previously infected with HAV.[60]

Each year, approximately 30,000 to 50,000 cases of hepatitis A occur in the United States.[61] Historically, acute hepatitis A rates have varied cyclically, with nationwide increases every 10 to 15 years.[62] The national rate of HAV infections has declined steadily since the last peak in 1995.[63] Although the national incidence—1.0 case per 100,000 population—of hepatitis A was the lowest ever recorded in 2007, it is estimated that asymptomatic infections and underreporting kept the documented incidence-rate lower than it actually is. In fact, it is estimated that there were 25,000 new infections in 2007.[64]

In 2007, the CDC reported a total of 2,979 acute symptomatic cases of HAV.[65] Of these, information about food and water exposure was known for 1,047 cases, leading to an estimate that 6.5% of all infections were caused by exposure to contaminated water or food.[66] In 2,500 of the cases, no known risk factor was identified.[67]

Estimates of the annual costs (direct and indirect) of hepatitis A in the United States have ranged from $300 million to $488.8 million in 1997 dollars.[97] In one study conducted in Spokane, Washington, the combined direct and indirect costs for each case of hepatitis A from all sources ranged from $2,892 to $3,837.[98] In a 2007 Ohio study, each case of HAV infection attributable to contaminated food was estimated to cost at least $10,000, including medical and other non-economic costs.[99] Nationwide, adults who become ill miss an average of 27 workdays per illness, and 11 to 22 percent of those infected are hospitalized.[100] All of these costs are entirely preventable given the effectiveness of a vaccination in providing immunity from infection.[101]

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Calling All New Sea Hawaii Victims: Settlement reached in 2013 Bronx Hepatitis A Lawsuit

Successful class action lawsuit seeks beneficiaries of $200,000 settlement

A settlement has been reached in the class action lawsuit against New Hawaii Sea Restaurant, formerly of the Bronx, New York. Approximately 3,000 people received Hepatitis A vaccinations after being exposed to the illness by the restaurant in September 2013 and all are included in the class-action lawsuit.

The deadline for applying to receive a portion of the $200,000 settlement is December 16th, 2016.  Those interested in benefiting from the class action settlement should visit www.NewHawaiiHepA.com for more information.

According to the settlement, potential class members who may benefit by this settlement include anyone who ate or drank food from the New Hawaii Sea Restaurant from September 7-19, 2013, or were exposed to someone who did, and obtained a blood test and immune globulin (IG) or Hepatitis A vaccination shot within 30 days of eating at the restaurant. Those who actually developed Hepatitis A infections after eating at the restaurant are not included in this settlement.

Bill Marler of Marler Clark LLP, an expert on Hepatitis outbreaks, is available for comment on the outcome of the case. Marler is the nation’s premiere legal expert on foodborne illness and has represented victims of various foodborne illnesses. If you would like to speak with Mr. Marler, please contact Colleen McMahon (colleen@quinnbrein.com), Samantha Jones (sam@quinnbrein.com), or call (206) 842-8922.

Marler Clark, LLC has been an advocate for victims of foodborne illnesses for decades, and have represented thousands of victims of Hepatitis A and other foodborne illnesses.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Marler Clark attorneys have litigated Hepatitis A cases stemming from outbreaks traced to a variety of foods. The firm has brought lawsuits against companies such as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

If you would like more information regarding the New Sea Hawaii outbreak and settlement, or would like to schedule an interview with an expert from Marler Clark, please contact Colleen McMahon (colleen@quinnbrein.com), Samantha Jones (Sam@quinnbrein.com) or call (206) 842-8922.

Indiana Department of Health Joins Chorus Announcing Where Hepatitis A Tainted Egyptian Strawberries Sold

150522130633-strawberries-medium-plus-169The Indiana State Department of Health joins a small but growing chorus of health departments slowly announcing the retail locations of where hepatitis A tainted frozen strawberries from Egypt may have been sold.

To date, eight restaurants in Marion, Hamilton and Hendricks counties have confirmed they served products containing the recalled strawberries in the last two weeks. Those include El Rey Del Taco at 3925 N. high School Rd. and Don Marcos Ice Cream and Restaurant at 4779 N. Post Rd. in Marion County.

More counties could be identified as the investigation continues.

Anyone who consumed a food item that contained strawberries at a restaurant in those counties since Nov. 1 should contact these local health departments for more information.

The Marion county Public Health Department established a hotline to answer questions and concerns at (317) 221-5503 starting Wednesday, Nov. 16, from 8 a.m. – 5 p.m. Hendricks County residents can call (317) 745-9222 between 8 a.m. and 4 p.m. on weekdays.

No Indiana schools or nursing homes have been affected.

Hepatitis A is caused by a virus that inflames the liver. Signs and symptoms of infection include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Abdominal pain
  • Fever
  • Jaundice (yellowing of the skin or eyes)

Symptoms can take up to 50 days to appear after exposure. Not everyone infected with the virus will exhibit symptoms, but all infected individuals can transmit the disease to others through contact with stool or unwashed hands.

State health officials ask healthcare providers to ask patients who exhibit symptoms of hepatitis A about recent strawberry consumption as part of their investigation into the multistate outbreak. So far, they have traced the outbreak to frozen strawberries imported from Egypt and food items containing these strawberries.

Individuals who may have been exposed to hepatitis A within the last two weeks can receive either a vaccine or immunoglobulin, depending on their age, to help prevent infection by contacting their health care provider or local health department. Those whose potential exposure occurred prior to Nov. 1 should contact their healthcare provider to determine whether testing for hepatitis A is appropriate, especially if symptoms develop.

Hepatitis A:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food.  The law firm has brought Hepatitis A lawsuits against such companies as Costco, Subway, McDonald’s, Red Robin, Chipotle, Quiznos and Carl’s Jr.  We proudly represented the family of Donald Rockwell, who died after consuming hepatitis A tainted food and Richard Miller, wo required a liver transplant after eating food at a Chi-Chi’s restaurant.

If you or a family member became ill with a Hepatitis A infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Hepatitis A attorneys for a free case evaluation.

Latest on Tropical Smoothie Cafe Hepatitis A Outbreak

Several states, CDC, and the FDA investigated a multistate outbreak of foodborne hepatitis A. Epidemiologic and traceback evidence indicate frozen strawberries imported from Egypt are the likely source of this outbreak.

In interviews, nearly all ill people interviewed reported drinking smoothies containing strawberries at Tropical Smoothie Café locations prior to August 8 in a limited geographical area, including Maryland, North Carolina, Virginia, and West Virginia, but there have been a small number of cases outside of that geographic area with no Tropical Smoothie Café exposure.

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134 people with hepatitis A have been reported from nine states: Arkansas (1), California (1), Maryland (12), New York (3), North Carolina (1), Oregon (1), Virginia (107), West Virginia (7), and Wisconsin (1). 129 of these cases reported eating a smoothie containing strawberries from Tropical Smoothie Café. There have been no cases reporting illness from this same exposure since September 23, 2016. 5 cases had no exposure to Tropical smoothie café. The latest illness onset date among these cases was October 1, 2016.  The investigation into these cases is ongoing. 52 ill people have been hospitalized. No deaths have been reported.

FDA traceback information indicated that the frozen strawberries served in the Tropical Smoothie Café locations were from the International Company for Agricultural Production & Processing (ICAPP), imported from Egypt. On August 8, 2016, Tropical Smoothie Café reported that they removed the Egyptian frozen strawberries from their restaurants in Maryland, North Carolina, Virginia, and West Virginia and switched to another supplier out of an abundance of caution. Information available at this time does not indicate an ongoing risk of hepatitis A virus infection at Tropical Smoothie Cafes.

On October 30, 2016, the International Company for Agricultural Production & Processing (ICAPP) recalled all of its frozen strawberries that were imported into the U.S. since January 1, 2016. The recalled products were distributed for sale to and use in food service establishments nationwide. The FDA reports that hepatitis A virus contamination was found in four samples of ICAPP frozen strawberries.

Hepatitis A:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food.  The law firm has brought Hepatitis A lawsuits against such companies as Costco, Subway, McDonald’s, Red Robin, Chipotle, Quiznos and Carl’s Jr.  We proudly represented the family of Donald Rockwell, who died after consuming hepatitis A tainted food and Richard Miller, wo required a liver transplant after eating food at a Chi-Chi’s restaurant.

If you or a family member became ill with a Hepatitis A infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Hepatitis A attorneys for a free case evaluation.

Latest Update on Hawaii Scallops Hepatitis A Outbreak

On August 15, 2016, the Hawaii Department of Health (HDOH) identified raw scallops served at Genki Sushi restaurants on Oahu and Kauai as a likely source of the ongoing outbreak. The product of concern is Sea Port Bay Scallops (Wild Harvest, Raw Frozen) that originated in the Philippines (states “Product of the Philippines” on the box), distributed by Koha Oriental Foods.  As a result, HDOH ordered this product embargoed (not to be sold, purchased, or consumed) throughout the state, and the temporary closure of all Genki Sushi restaurants on Oahu and Kauai.

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HDOH has identified 292 cases of hepatitis A. Seventy-four (74) have required hospitalization. Findings of the investigation suggest that the source of the outbreak is focused on Oahu. Eleven (11) individuals are residents of the islands of Hawaii, Kauai, or Maui, and seven visitors have returned to the mainland or overseas. Onset of illness has ranged between 6/12/16 – 10/9/16.

The FDA and CDC are supporting the Hawaii Department of Health (DOH) in an investigation of hepatitis A virus (HAV) infections linked to scallops supplied by Sea Port Products Corp. On August 17, 2016, the FDA, Hawaii DOH, CDC and state partners informed Sea Port Products Corp that epidemiological, laboratory and traceback information indicates their scallops are the likely source of illnesses. On August 18, 2016, Sea Port Products Corp initiated a voluntary recall of three lots of frozen Bay Scallops produced on November 23, 2015 and 24, 2015. The lot numbers are 5885, 5886, and 5887. The products were distributed to California, Hawaii, and Nevada. According to Sea Port Products Corp, the recalled products are not intended for retail sale. The FDA is working with the recalling firm to ensure their recall is effective and that recalled product is removed from the market.

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The FDA’s traceback investigation involved working with Hawaii DOH to trace the path of food eaten by those made ill back to a common source. The traceback investigation determined that Sea Port Products Corp imported the scallops that were later supplied to certain Genki Sushi locations in Hawaii, where ill people reported eating.

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On August 17, 2016, FDA laboratory analysis of two scallop samples, which were collected on August 11, 2016, were confirmed positive for hepatitis A. These samples were imported by Sea Port Products Corp and were produced on November 23, 2015 and 24, 2015.

Hepatitis A:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food.  The law firm has brought Hepatitis A lawsuits against such companies as Costco, Subway, McDonald’s, Red Robin, Chipotle, Quiznos and Carl’s Jr.  We proudly represented the family of Donald Rockwell, who died after consuming hepatitis A tainted food and Richard Miller, wo required a liver transplant after eating food at a Chi-Chi’s restaurant.

If you or a family member became ill with a Hepatitis A infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Hepatitis A attorneys for a free case evaluation.

Colorado’s Weld County Adds to the Hepatitis A Warning

Several states, the Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of foodborne hepatitis A. Evidence indicates frozen strawberries imported from Egypt are the likely source of this outbreak. The recall affects all frozen strawberries and frozen strawberry products imported into the United States by the International Company for Agricultural Production & Processing (ICAPP) since January 1, 2016. The products were NOT offered for sale in retail stores such as grocery stores or food warehouses (e.g. Costco or Sam’s Club). The frozen strawberries were distributed to restaurants. Most of the outbreak-related human infections have occurred on the East coast. There are currently no hepatitis A cases in Colorado associated with this outbreak.

At this time, two establishments in Weld County served affected frozen strawberry products within the past 14 days:

  •  Fat Alberts restaurant (Greeley) served strawberries on top of dessert items, last served October 24, 2016.
  •  Red Rooster restaurant (Longmont) served strawberries on top of breakfast items, last served by October 28, 2016.

Hepatitis A is a contagious liver infection that results from exposure to the hepatitis A virus. Illness from hepatitis A generally begins around 28 days after exposure (a range of 15–50 days) and symptoms include:

  •  Fatigue
  •  Stomach pain
  •  Yellowing of the skin and eye (jaundice)
  •  Dark urine
  •  Clay-colored stool

Hepatitis A can range from a mild illness lasting a few weeks to a serious illness lasting several months. In rare cases, the infection can lead to liver failure, particularly in individuals who have a pre-existing liver disease or weakened immune systems.

“If you have been exposed to hepatitis A, you can prevent infection by having a hepatitis A vaccine or immunoglobulin therapy within two weeks of exposure,” said Mark E. Wallace, MD, MPH, Executive Director of the Weld County Department of Public Health and Environment. “If it has been more than 14 days since you have eaten these berries, the vaccine won’t be effective in preventing infection.”

If you ate items containing strawberries from the above listed locations, contact your health care provider to discuss your options. Certain pharmacies also may offer hepatitis A vaccine. Visit vaccinefinder.org for locations near you. If you have been vaccinated for hepatitis A, you do not need to be vaccinated again, even if you ate the affected strawberries.

Vaccinations are also available at the Weld County Health Department main office (1555 North 17th Avenue, Greeley) and the Southwest Weld County Health Department satellite office (4209 County Road 241⁄2 Road, Longmont— I-25 and Hwy 119) during normal business hours. Call 970-400-2703 for an appointment.

For more information, Weld County residents may contact COHelp at 1-877-462-2911 or 303-389-1687. COHelp is available 9 a.m. to 10 p.m. Monday – Friday and 9 a.m. to 5 p.m. on weekends.

FDA Weighs in on Hepatitis A Egyptian Strawberry Problem

150522130633-strawberries-medium-plus-169Update 11/3/2016: The FDA has learned that frozen strawberry products subject to recall by The International Company for Agricultural Production and Processing (ICAPP), including but not limited to whole, sliced and sugared, and diced strawberries, may have been served in food service operations as recently as October 27, 2016.

The FDA recommends that institutions and food service operations supplied by any of the five companies identified below immediately reach out to their suppliers and determine if they received frozen strawberry product recalled by ICAPP. Then, if needed, institutions and food service operations that find they served any recalled product within the last two weeks should contact their local health department and communicate to their customers regarding possible exposure to hepatitis A virus and the potential benefit of post exposure prophylaxis.

The FDA and CDC are not currently aware of any illnesses related to any recalled products other than whole frozen strawberries. However, because hepatitis A can have serious health consequences, CDC advises post exposure prophylaxis (PEP) for unvaccinated persons who have consumed any of the recalled frozen strawberry products in the last 2 weeks. PEP offers no preventive benefit to persons whose exposure occurred more than 2 weeks ago.

The five consignees who received recalled frozen strawberry products from ICAPP are:

C.H. Belt of Lake Forest, Ca. (sold under CH World Brand)

Jetro/Restaurant Depot of College Point, N.Y. (sold under James Farm brand and unbranded “Bits & Pieces”)

Sysco Corporation of Houston, Tex. (sold under Sysco brand)

Patagonia Foods of San Luis Obispo, Ca. (sold under Patagonia brand)

Reddy Raw of Woodridge, N.J. (sold under Regal brand).

The FDA is working with these firms to help identify further downstream customers who may have received the recalled frozen strawberry products. More product information in table below.

The FDA, CDC and state and local officials are investigating hepatitis A virus (HAV) infections linked to frozen whole strawberries in smoothies served in Tropical Smoothie Cafe restaurant locations.

On October 19, 2016 the FDA placed frozen strawberries from ICAPP on Import Alert 99-35 after multiple positive samples confirmed hepatitis A in the product.

As of October 20, 2016, CDC reports 134 people with hepatitis A linked to this outbreak have been reported from 9 states (AR, CA, MD, NC, NY, OR, VA, WI and WV).

129 of these cases reported eating a smoothie containing strawberries from Tropical Smoothie Café. There have been no cases reporting illness from this same exposure since September 23, 2016.

5 cases had no exposure to Tropical smoothie café. The latest illness onset date among these cases was 10/1/2016.

The investigation into these cases is ongoing.

According to the CDC, information available at this time does not indicate an ongoing risk of acquiring hepatitis A virus infection at Tropical Smoothie Café’s.  Tropical Smoothie Café reported that they removed these strawberries from their Cafés nationwide on August 19.

On October 25, 2016, ICAPP recalled all frozen strawberries and frozen strawberry products that it has imported into the United States since January 1, 2016. These include whole, sliced and sugared, and diced frozen strawberries.