The U.S. Food and Drug Administration, the Centers for Disease Control and Prevention (CDC) and state and local officials are investigating an outbreak of hepatitis A illnesses linked to frozen strawberries in smoothies served at Tropical Smoothie Café locations.
- The FDA, CDC and state and local officials are investigating hepatitis A virus (HAV) infections linked to frozen strawberries in smoothies served in Tropical Smoothie Cafe restaurant locations.
- As of September 8, 2016, CDC reports 89 people with hepatitis A linked to this outbreak have been reported from 7 states (MD, NC, NY, OR, VA, WI and WV).
- Nearly all ill people interviewed report eating smoothies containing strawberries at Tropical Smoothie locations in a limited geographic area. Preliminary traceback information indicates that the frozen strawberries served in these Tropical Smoothie Café locations were imported from Egypt. Tropical Smoothie Café has stopped using these strawberries nationwide.
- If you think you’ve gotten sick from eating a smoothie containing strawberries from a Tropical Smoothie Café, contact your health care provider. At this time, we do not have information to suggest that there is an ongoing risk of hepatitis A virus infection at Tropical Smoothie Cafes. Illnesses are largely limited to Virginia and neighboring states.
What is the Problem and What is Being Done About It?
The U.S. Food and Drug Administration and the Centers for Disease Control and Prevention, state and local officials are investigating an outbreak of hepatitis A illnesses linked to frozen strawberries in smoothies served at Tropical Smoothie Café locations.
As of September 8, 2016 CDC reports 89 people with hepatitis A linked to this outbreak have been reported from 7 states (MD, NC, NY, OR, VA, WI and WV). Among people with available information, 39 people have been hospitalized. Nearly all ill people reported drinking a smoothie from Tropical Smoothie Café in the month before illness started. Of the 54 ill people who were interviewed about the type of smoothie, all reported eating a smoothie containing strawberries. These ill people purchased smoothies at cafés located in a limited geographical area, including Virginia and neighboring states. The ill person in Oregon had purchased smoothies containing strawberries from a Tropical Smoothie Café location in Virginia while traveling.
The FDA’s preliminary traceback investigation indicates that the strawberries served in Tropical Smoothie Café locations where ill people reported drinking smoothies were imported from Egypt. Tropical Smoothie Café reported that they stopped using Egyptian frozen strawberries in their locations in Virginia and neighboring states by August 8, 2016. Additionally, on August 19, 2016, the firm reported that they removed Egyptian frozen strawberries from all cafes nationwide.
The FDA’s investigation into the source and distribution of the strawberries is ongoing; and the agency has been in touch with the Egyptian International Health Regulations National Focal Point to discuss the investigation. FDA is working to identify other parts of the relevant supply chain and will take appropriate action as necessary. However, FDA is prohibited by law in most situations from releasing publicly certain confidential commercial information about supply chains.The FDA has initiated increased surveillance of imported strawberries and will provide more information as it becomes available.
Hepatitis A is a contagious liver disease that results from infection with the Hepatitis A virus (HAV). It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces of an infected person.
What are the Symptoms of Hepatitis A?
Illness occurs within 15 to 50 days of exposure and in adults includes fatigue, abdominal pain, jaundice, abnormal liver tests, dark urine and pale stool.
Hepatitis A, and especially the strain found in the clinical samples already tested, is a virus that originates in and is spread by people, rather than animals. Contamination can occur when an infected food handler prepares food without appropriate hand hygiene. Food (as is suspected in this outbreak) or water contaminated with HAV can also cause outbreaks of disease.
In rare cases, particularly in patients with pre-existing severe illness or who are immunocompromised, HAV infections can progress to liver failure and death.
People with hepatitis A may not have symptom until 15 to 50 days after consuming a contaminated food or drink. CDC expects to see more ill people reported in this outbreak because of this long incubation period.
In general, CDC recommends the following groups be vaccinated for hepatitis A:
- All children at age 1 year
- Travelers to countries that have high rates of hepatitis A
- Family members and caregivers of recent adoptees from countries where hepatitis A is common
- Men who have sexual contact with other men
- Users of injection and non-injection illegal drugs
- People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C
- People who are treated with clotting-factor concentrates
- People who work with Hepatitis A infected animals or in a hepatitis A research laboratory
What Do Restaurants and Retailers Need To Do?
The FDA investigation is focused on frozen strawberries imported from Egypt and distributed to Tropical Smoothie Café locations. At this time, we do not have information to suggest that there is an ongoing risk of hepatitis A virus infection at Tropical Smoothie Cafes. At this time, we are not aware of any other restaurants or retailers that may have received frozen strawberries linked to this outbreak.
In the event that retailers and/or other food service operators are found to have handled potentially contaminated food in their facilities, they should:
- Wash and sanitize display cases and refrigerators where potentially contaminated products were stored.
- Wash and sanitize cutting boards, surfaces, and utensils used to prepare, serve, or store potentially contaminated products.
- Wash hands with hot water and soap following the cleaning and sanitation process.
- Retailers, restaurants, and other food service operators who have processed and packaged any potentially contaminated products need to be concerned about cross contamination of cutting surfaces and utensils through contact with the potentially contaminated products.
At this time, we do not have information to suggest that there is an ongoing risk of hepatitis A virus infection at Tropical Smoothie Cafes. If you think you’ve gotten sick from eating a smoothie containing strawberries from a Tropical Smoothie Café, contact your health care provider.
Water, shellfish, fruit (berries) and salads are the most frequent foodborne sources of hepatitis A. Hepatitis A can be transmitted from person to person. Consumers should always practice safe food handling and preparation measures. Wash hands, utensils, and surfaces with hot, soapy water before and after handling food. Consumers should thoroughly wash their hands after using the bathroom and changing diapers to help protect themselves from hepatitis A, as well as other foodborne diseases.
Contact your healthcare provider if you think you may have become ill from eating frozen strawberries.
The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD Monday through Friday between 10 a.m. and 4 p.m. Eastern time, or to consult http://www.fda.gov.