Melissa G Collier1, Yury E Khudyakov2, David Selvage3, Meg Adams-Cameron3, Erin Epson4, Alicia Cronquist5, Rachel H Jervis5, Katherine Lamba6, Akiko C Kimura6, Rick Sowadsky7, Rashida Hassan8, Sarah Y Park9, Eric Garza10, Aleisha J Elliott11, David S Rotstein12, Jennifer Beal12, Thomas Kuntz12, Susan E Lance13, Rebecca Dreisch12, Matthew E Wise14, Noele P Nelson2, Anil Suryaprasad2, Jan Drobeniuc2, Scott D Holmberg2, Fujie Xu2. 1. Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: mgcollier@cdc.gov. 2. Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. 3. New Mexico Department of Health, Santa Fe, NM, USA. 4. Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Colorado Department of Public Health and Environment, Denver, CO, USA. 5. Colorado Department of Public Health and Environment, Denver, CO, USA. 6. California Department of Public Health, Sacramento, CA, USA. 7. Nevada Division of Public and Behavioral Health, Carson City, NV, USA. 8. Arizona Department of Health Services, Phoenix, AZ, USA. 9. Hawaii State Department of Health, Honolulu, HI, USA. 10. Texas Department of State Health Services, Austin, TX, USA. 11. Food and Drug Administration, Silver Spring, MD, USA; Oakridge Institute for Science and Education, Oakridge, TN, USA. 12. Food and Drug Administration, Silver Spring, MD, USA. 13. Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Food and Drug Administration, Silver Spring, MD, USA. 14. Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Abstract
BACKGROUND: In May, 2013, an outbreak of symptomatic hepatitis A virus infections occurred in the USA. Federal, state, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. We investigated the source of the outbreak and assessed the public health measures used. METHODS: We interviewed patients, obtained their shopping information, and did genetic analysis of hepatitis A virus recovered from patients' serum and stool samples. We tested products for the virus and traced supply chains. FINDINGS: Of 165 patients identified from ten states, 69 (42%) were admitted to hospital, two developed fulminant hepatitis, and one needed a liver transplant; none died. Illness onset occurred from March 31 to Aug 12, 2013. The median age of patients was 47 years (IQR 35-58) and 91 (55%) were women. 153 patients (93%) reported consuming product B from retailer A. 40 patients (24%) had product B in their freezers, and 113 (68%) bought it according to data from retailer A. Hepatitis A virus genotype IB, uncommon in the Americas, was recovered from specimens from 117 people with hepatitis A virus illness. Pomegranate arils that were imported from Turkey--where genotype IB is common--were identified in product B. No hepatitis A virus was detected in product B. INTERPRETATION: Imported frozen pomegranate arils were identified as the vehicle early in the investigation by combining epidemiology--with data from several sources--genetic analysis of patient samples, and product tracing. Product B was removed from store shelves, the public were warned not to eat product B, product recalls took place, and postexposure prophylaxis with both hepatitis A virus vaccine and immunoglobulin was provided. Our findings show that modern public health actions can help rapidly detect and control hepatitis A virus illness caused by imported food. Our findings show that postexposure prophylaxis can successfully prevent hepatitis A illness when a specific product is identified. Imported food products combined with waning immunity in some adult populations might make this type of intervention necessary in the future. FUNDING: US Centers for Disease Control and Prevention, US Food and Drug Administration, and US state and local public health departments.
BACKGROUND: In May, 2013, an outbreak of symptomatic hepatitis A virus infections occurred in the USA. Federal, state, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. We investigated the source of the outbreak and assessed the public health measures used. METHODS: We interviewed patients, obtained their shopping information, and did genetic analysis of hepatitis A virus recovered from patients' serum and stool samples. We tested products for the virus and traced supply chains. FINDINGS: Of 165 patients identified from ten states, 69 (42%) were admitted to hospital, two developed fulminant hepatitis, and one needed a liver transplant; none died. Illness onset occurred from March 31 to Aug 12, 2013. The median age of patients was 47 years (IQR 35-58) and 91 (55%) were women. 153 patients (93%) reported consuming product B from retailer A. 40 patients (24%) had product B in their freezers, and 113 (68%) bought it according to data from retailer A. Hepatitis A virus genotype IB, uncommon in the Americas, was recovered from specimens from 117 people with hepatitis A virus illness. Pomegranate arils that were imported from Turkey--where genotype IB is common--were identified in product B. No hepatitis A virus was detected in product B. INTERPRETATION: Imported frozen pomegranate arils were identified as the vehicle early in the investigation by combining epidemiology--with data from several sources--genetic analysis of patient samples, and product tracing. Product B was removed from store shelves, the public were warned not to eat product B, product recalls took place, and postexposure prophylaxis with both hepatitis A virus vaccine and immunoglobulin was provided. Our findings show that modern public health actions can help rapidly detect and control hepatitis A virus illness caused by imported food. Our findings show that postexposure prophylaxis can successfully prevent hepatitis A illness when a specific product is identified. Imported food products combined with waning immunity in some adult populations might make this type of intervention necessary in the future. FUNDING: US Centers for Disease Control and Prevention, US Food and Drug Administration, and US state and local public health departments.
Authors: E E Epson; A Cronquist; K Lamba; A C Kimura; R Hassan; D Selvage; C S McNeil; A K Varan; J L Silvaggio; L Fan; X Tong; P R Spradling Journal: Public Health Date: 2016-05-04 Impact factor: 2.427
Authors: A Jablonka; P Solbach; C Happle; A Hampel; R E Schmidt; G M N Behrens Journal: Med Klin Intensivmed Notfmed Date: 2016-07-25 Impact factor: 0.840