The North Dakota Department of Health (NDDoH) is providing information regarding an outbreak of hepatitis A cases in the United States associated with fresh, organic strawberries. One case linked to this outbreak has been reported in North Dakota. The individual was hospitalized and has since recovered.
The FDA, along with CDC, the Public Health Agency of Canada and the Canadian Food Inspection Agency, state, and local partners are investigating a multistate outbreak of hepatitis A infections in the United States and Canada potentially linked to fresh, organic strawberries. Currently, the potentially affected product is past its shelf life. People who purchased FreshKampo and HEB fresh organic strawberries between March 5, 2022, and April 25, 2022, and then froze those strawberries for later consumption should not eat them. These products were sold nationwide at the following retailers, including, but not limited to:
- Sprouts Farmers Market
- Trader Joe’s
- Weis Markets
- WinCo Foods
“If you are unsure of what brand you purchased, when you purchased your strawberries, or where you purchased them from prior to freezing them, the strawberries should be thrown away,” said Molly Howell, immunization director at the NDDoH.
If consumers purchased fresh organic strawberries branded as FreshKampo or HEB between March 5, 2022, and April 25, 2022, ate those berries in the last two weeks, and have not been vaccinated against hepatitis A, they should immediately consult with their healthcare professional to determine whether post exposure prophylaxis (PEP) is needed. PEP is recommended for unvaccinated people who have been exposed to hepatitis A virus in the last two weeks because vaccination can prevent a hepatitis A infection if given within 14 days of exposure. Those with evidence of previous hepatitis A vaccination or previous hepatitis A infection do not require PEP.
Hepatitis A is an infection of the liver caused by the hepatitis A virus. Adults and teens are more likely to have symptoms compared to children. Symptoms may include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, pale stools or jaundice (i.e., yellowing of skin or whites of eyes). Children younger than 6 often have few or no symptoms. Individuals experiencing symptoms of hepatitis A should see a health care provider. Hepatitis A symptoms generally last less than two months. It can take from 15 to 50 days to get sick after being exposed to the hepatitis A virus. The average is about one month. A person infected with hepatitis A is most likely to spread the disease during the two weeks before symptoms begin. Most people stop being contagious one week after their symptoms start. Young children can be shedding the virus in their stool for up to three months after infection. The hepatitis A virus is usually found in the stools (feces) of infected people. Unlike other hepatitis viruses, hepatitis A virus is usually not spread by blood.
“Hepatitis A vaccine has been routinely recommended for children ages 12-23 months since 2006, therefore, most children have been vaccinated,” said Howell. “Most adults are likely unvaccinated for hepatitis A, unless they were vaccinated for travel, employment, or because they were high-risk.
Recommendations for Health Care Providers
Healthcare providers are encouraged to remain vigilant for patients presenting with symptoms suggestive of hepatitis A. Symptoms may be mild or severe and can include:
- Yellow eyes
- Abdominal pain
- Patients may also note light colored stool and dark urine.
Diagnosis is made by testing for IgM antibody to the hepatitis A virus (i.e., anti-HAV IgM) in serum in symptomatic patients. Lab testing should not be conducted if the patient is asymptomatic, as false positives can occur. The NDDoH Laboratory Services Section does offer anti-HAV IgM testing.
To report cases of hepatitis, please call 701-328-2378 or 1-800-472-2180.