Several states, CDC, and the U.S. Food and Drug Administration (FDA) are continuing to investigate a multistate outbreak of foodborne hepatitis A. Information available at this time does not indicate an ongoing risk of acquiring hepatitis A virus infection at Tropical Smoothie Café’s, as the contaminated food product has been removed as of August 8. Symptoms of hepatitis A virus infection can take up to 50 days to appear. As a result, CDC continues to identify cases of hepatitis A related to the initial contaminated product.
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). 52 ill people have been hospitalized. No deaths have been reported.
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.
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, Tropical Smoothie Café has since switched to another supplier for all restaurants nationwide.
Contact your doctor if you think you may have become ill from eating a smoothie containing strawberries from a Tropical Smoothie Café prior to August 8, 2016 in the following states:
It is important that food handlers and restaurant employees contact their doctor and stay home if they are infected with hepatitis A. This helps prevent the virus from spreading. Not everyone will experience symptoms from a hepatitis A virus infection. Some people may experience mild flu-like symptoms. Other symptoms of hepatitis A virus infection include:
Yellow eyes or skin
The Virginia Department of Health (VDH) is investigating a cluster of hepatitis A cases and has identified a potential association with smoothies from Tropical Smoothie Cafe restaurants in Virginia. Genetic testing shows the illnesses were caused by a strain of hepatitis A that has been associated with past outbreaks due to frozen strawberries from Egypt. Upon learning of the potential link to strawberries, Tropical Smoothie Cafe immediately conducted a voluntary product withdrawal of all strawberries sourced from Egypt and found an alternate supply.
Individuals who consumed a smoothie from a Tropical Smoothie Cafe in Virginia that contained frozen strawberries, on August 5, 6, 7 or 8, 2016, may still benefit from vaccine or immune globulin to prevent hepatitis A. (Vaccine or immune globulin administered within two weeks of exposure to hepatitis A virus is effective at preventing the disease.) If you have had hepatitis A or have been vaccinated for hepatitis A, you are already immune and therefore not at risk for getting the disease. Anyone who consumed a smoothie after the frozen strawberries were removed from restaurants is not thought to be at risk for hepatitis A.
Other restaurants, and firms that supply restaurants, may also have received the frozen strawberries imported from Egypt. VDH continues to investigate cases and work with state and federal partners, including the Virginia Department of Agriculture and Consumer Services, the U.S. Food and Drug Administration, and the Centers for Disease Control and Prevention, to identify additional locations where the product may have been distributed.
Anyone who consumed a smoothie with frozen strawberries at a restaurant within the last 50 days is encouraged to watch for symptoms of hepatitis A. If illness occurs, seek medical care and take steps to protect others from the infection.
Hepatitis A is an inflammation of the liver caused by the hepatitis A virus. The classic symptom of hepatitis A is jaundice, which is a yellowing of the skin or the eyes. Other symptoms of hepatitis A include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stools. Symptoms develop 15-50 days after exposure to the virus, which can occur through direct contact with another person who has the infection or by consuming food or drink that has been contaminated with the virus.
Frequent handwashing with soap and warm water after using the bathroom, changing a diaper, or before preparing food can help prevent the spread of hepatitis A.
It is very important for people who have symptoms of hepatitis A to stay home from work, especially if they work in food service.
Routine vaccination against hepatitis A has reduced the risk of this disease in the past decade. Vaccination is available to anyone, but specifically recommended for all children, for travelers to certain countries, and for people at high risk for infection with the virus. Hepatitis A vaccine is available from health care providers (including some pharmacies and travel clinics) to protect against this disease.