To all the pregnant ladies: Hepatitis E is a risk

It is of great concern that pregnant women with acute viral hepatitis (AVH) type E have serious consequences. This study aimed to estimate the case-fatality risk (CFR) and potential risk factors of pregnant women with AVH type E.

We searched the PubMed, EMBASE, and Web of Science databases for studies containing data on CFR in pregnancy with AVH type E. A pooled estimate of CFR was calculated using a random-effects model. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression. We identified 47 eligible studies with a total African and Asian population of 3968 individuals. The pooled CFRs of maternal and fetal outcomes were 20·8% [95% confidence interval (CI) 16·6–25·3] and 34·2% (95% CI 26·0–43·0), respectively. Compared with these, the pooled CFR was highest (61·2%) in women with fulminant hepatic failure (FHF). Community-based surveys had lower pooled CFR (12·2%, 95% CI 9·2–15·6) and heterogeneity (25·8%, 95% CI 20·1–32·0) than hospital-based surveys. Univariate analysis showed that hospital-based surveying (P = 0·007), and patients in the third trimester of pregnancy or with FHF (P < 0·05), were significantly associated with CFR. Intrauterine fetal mortality (27·0%) was statistically higher than neonatal mortality (3·9%).

Control measures for HEV infection would reduce feto-maternal mortality in Asia and Africa.

Case-fatality risk of pregnant women with acute viral hepatitis type E: a systematic review and meta-analysis

Epidemiology and Infection, Volume 144, Issue 10, July 2016, pp. 2098-2106, DOI: http://dx.doi.org/10.1017/S0950268816000418

Jin, Y. Zhao, X. Zhang, B. Wang, P. Liu

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10375512&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

Hepatitis A is endemic in Tunisia wastewater

Hepatitis A virus (HAV) is the main causative agent of hepatitis infection associated with waterborne outbreaks worldwide. In Tunisia, there is no specific surveillance system for HAV and current secondary wastewater treatment processes are unable to remove viral particles, which present a potential public health problem.

tunisia.wastewaterQualitative and quantitative analysis of HAV in 271 raw and treated wastewater samples from five sewage treatment plants (STPs) during 13 months was performed. Moreover, the efficiency of three secondary wastewater treatment processes (conventional activated sludge, extended aeration, and oxidation ditch activated sludge) was evaluated.

Data obtained demonstrated that HAV is endemic in Tunisia and circulates with high prevalence in both raw (66.9%) and treated (40.7%) wastewater. HAV circulates throughout the year in the coastal areas, with the highest rates found during summer and autumn, whereas in central Tunisia, high levels were shown in autumn and winter. Total virus removal was not achieved, since no difference in mean HAV loads was observed in effluents (6.0 × 103 genome copies [GC]/ml) and influents (2.7 × 103 GC/ml). The comparison of the HAV removal values of the three different wastewater treatment methods indicates that extended aeration and oxidation ditch activated sludge had better efficiency in removing viruses than conventional activated sludge did.

Molecular characterization revealed that the vast majority of HAV strains belonged to subgenotype IA, with the cocirculation of subgenotype IB in wastewater treatment plants that collect tourism wastewater.

Detection and molecular characterization of Hepatitis A virus from Tunisian wastewater treatment plants with different secondary treatments

Appl. Environ. Microbiol. July 2016 vol. 82 no. 13 3834-3845, DOI: 10.1128/AEM.00619-16

Imen Ouardani, Syrine Turki, Mahjoub Aouni, and Jesús L. Romalde

http://aem.asm.org/content/82/13/3834.abstract?etoc

 

Hepatitis A outbreak strikes in Welsh schools

Parents are being advised not to send their child to school for seven days if Hepatitis A is suspected following a number of cases in Caerphilly, South Wales

hep.aParents are being warned over an outbreak of hepatitis across schools in the UK.

Public Health Wales have confirmed that two more cases – including one at a secondary school – have been diagnosed in Caerphilly.

The total number of cases of hepatitis A in the area is now 11.

Heather Lewis, a consultant in health protection, warned there may be more cases to come, reports Wales Online.

Hepatitis A vaccination is not routinely offered on the NHS, as the infection is rare in the UK, with 13 reported cases in Wales in 2012.

It is strongly advised that anyone travelling to a country where the infection is more common should receive the vaccination.

Jimmy Page played it: Song Remains the Same in Ireland for Hep A and Norovirus in berries

I’m conflicted about food safety advice regarding frozen berries.

I love the berries.

melon.berriesBut there have been thousands stricken with Hepatitis A from frozen berries.

At my last annual blood test, I asked the physician to check if I had a titer against Hep A because I couldn’t remember if I got my second shot before coming to Australia.

I had and I have.

A while ago, a food safety type said I was silly for boiling frozen berries.

Yes, it reduces the nutritional value.

But for the thousands who have become sick with Hep A from frozen berries in Europe, as well as dozens in Australia and North America, the advice seems prudent.

And was reiterated by the Food Safety Authority of Ireland yesterday.

Why is the FSAI reiterating its advice to boil imported frozen berries for one minute?
As a result of recent outbreaks of norovirus in Sweden and hepatitis A virus in Australia, both of which have been linked to the consumption of imported frozen berries, the FSAI is reiterating its advice to continue to boil imported frozen berries for one minute before consumption. This is particularly important when serving these foods to vulnerable people such as nursing home residents.
The outbreak in Sweden occurred in a nursing home in the beginning of May, causing 70 people to become ill with norovirus.  Three deaths are reported to have been potentially linked to this outbreak.  Contrary to national food safety advice in Sweden, the frozen imported raspberries were served uncooked in a dessert. Microbiological analysis confirmed the presence of norovirus in the frozen berries.

Could contaminated imported frozen berries be on sale in Ireland?
There is no indication that batches of berries implicated in the recent Swedish and Australian outbreaks have been imported into Ireland. These outbreaks, however, demonstrate an ongoing risk in the global imported frozen berry supply chain.

How do I know if frozen berries are imported?
If the label does not state the country of origin, you should assume that the berries are imported. The shop where you purchased the berries may be able to provide this information.

Will retailers be displaying notices about the requirement to boil imported frozen berries?

frozen-berriesRetailers selling imported frozen berries need to ensure that the berries they use are sourced from reputable suppliers operating effective food safety management systems and comprehensive traceability systems. As the food chain can be quite complex, it is necessary for food businesses at each stage of the food chain to seek assurances regarding the effectiveness of the food safety management systems in place from their suppliers. If such assurances are not available, the FSAI recommends that the retailer displays a notice advising customers that the frozen berries should be boiled for one minute before consumption.

How do I know that the berries used by food businesses (e.g. smoothie bars, cake manufacturers, etc.) are safe to eat?
Food businesses using imported frozen berries need to ensure that the berries they use are sourced from reputable suppliers operating effective food safety management systems and comprehensive traceability systems. As the food chain can be quite complex, it is necessary for food businesses at each stage of the food chain to seek assurances regarding the effectiveness of the food safety management systems in place from their suppliers. If such assurances are not available, the FSAI recommends that the berries should be boiled for one minute before being used in foods.

What if I have some berries in my freezer at home – are these safe to eat?
If the berries are imported you should boil them for one minute before consumption. Boiling for one minute will destroy viruses, if present.

Are fresh berries safe/ok to eat?
There is no evidence to suggest that fresh Irish or fresh imported berries are a risk. Fresh berries should be washed before consumption which is in keeping with the advice for all fresh fruit and vegetables.

Can I eat the berries I grow in my own garden?
Yes, this issue only relates to frozen imported berries and so this advice does not apply to berries grown in your own garden and frozen after picking.

Why are imported frozen berries more of a risk than other types of berries?
Across Europe, more outbreaks have been linked to imported frozen berries than to other types of berries.  Freezing preserves viruses such as norovirus and hepatitis A.

Are all frozen berries a risk?
This safety advice refers to imported frozen berries, such as raspberries, strawberries, redcurrants, blackberries, blackcurrants and blueberries. However, as a precaution, we are advising that all imported frozen berries should be boiled for one minute before consumption.

Are tinned berries also a risk?
No, tinned or canned berries have not been identified as a risk.

What if I have eaten frozen berries recently, without boiling them?
The time from consumption of contaminated food to the onset of illness with hepatitis A, ranges from 15-50 days, with the average being 28 days. In the case of norovirus, symptoms usually appear around 12 to 48 hours after consuming contaminated food.
If you think that you have consumed frozen berries and may be ill as a result, you should seek medical advice. This applies in all cases if you believe that any food you have eaten has made you ill.

Should I stop buying frozen berries?
No, there is no need to stop buying frozen berries. Frozen imported berries should be boiled before eating until further notice.

I have given my toddler/child puree made from frozen berries, should I be worried?
If you are concerned about your toddler/child, you should seek medical advice but you should not be concerned about giving them berries that have been boiled. Boiling for one minute will destroy viruses, if present.

What is hepatitis A and what are the symptoms?
Hepatitis A infection is an acute disease of the liver caused by the hepatitis A virus. There are five main hepatitis viruses, referred to as types A, B, C, D and E.
Illness usually starts about 28 days after exposure to the virus, but it can start anytime between 15 and 50 days after infection. The most common symptoms are fever, loss of appetite, nausea, fatigue and abdominal pain, followed within a few days by jaundice. The disease often fails to show the noticeable symptoms or is mild, particularly in children below five years. Jaundice occurs in 70-80% of people aged over 14 years and less than 10% of children younger than six years. Symptoms may last from one or two weeks to a number of months. Prolonged, relapsing hepatitis for up to one year occurs in 15% of cases.

What should I do if I think I have hepatitis A?
You should seek medical advice. More information on hepatitis A can be found on the Health Protection Surveillance Centre (HPSC) website

How is hepatitis A virus spread ?
Hepatitis A is a human virus that is primarily spread from person-to-person via the faecal-oral route. The virus is shed in the faeces of infected people. It may also be spread through food that has been contaminated by infected food handlers or by contaminated water. People who have the virus are most infectious in the week or two before onset of symptoms and may be infectious up to one week after onset.

What is norovirus and what are the symptoms?
Norovirus is one of the most common causes of gastroenteritis. Symptoms include – nausea (often sudden onset), vomiting (often projectile) and watery diarrhoea. Symptoms begin around 12 to 48 hours after becoming infected. The illness is usually brief, with symptoms lasting only about 1 or 2 days. Most people make a full recovery within 1-2 days, however some people (usually the very young or elderly) may become very dehydrated and require hospital treatment.d

What should I do if I think I have norovirus?
You should seek medical advice. More information on norovirus can be found on the Health Protection Surveillance Centre (HPSC) website

How is norovirus spread?
Noroviruses are very contagious and can spread easily from person-to-person. Both the faeces and vomit of an infected person contain the virus and are infectious. People infected with norovirus are contagious from the moment they begin feeling ill to 2/3 days after recovery. Some people may be contagious for as long as 2 weeks after recovery.
It is important for people to use good handwashing and other hygienic practices after they have recently recovered from norovirus illness. In addition, noroviruses are very resilient and can survive in the environment (e.g. on surfaces) for a number of weeks.

How might berries become contaminated with norovirus and hepatitis A virus?
Contamination could occur on the farm, through use of sewage-contaminated agricultural water or through contamination by infected workers. Cross-contamination could occur post-harvest along the supply chain, through contact with contaminated surfaces of machines, equipment and facilities during freezing, mixing and packaging processes.

When did the FSAI first recommend boiling of imported frozen berries?
The FSAI first issued this advice in 2013, during the investigation of an outbreak of hepatitis A virus in Ireland which was linked to imported frozen berries.  The outbreak turned out to be part of a multi-state outbreak, with over 1,000 cases reported in 12 EU countries.

What was the source of contamination of the frozen berries in the 2013 hepatitis A virus outbreak?
The multi-state investigation did not identify the source of the contamination. The investigation concluded that contamination could have occurred at the freezing processor or at the primary production stage.  It highlighted the importance of compliance with Good Hygiene Practice (GHP) and Good Agricultural Practice (GAP) and cautioned that contaminated product related to the outbreak could still be circulating in the food chain.

What was the evidence that linked imported frozen berries with the 2013 multi-state hepatitis A virus outbreak in Europe?
Contaminated batches of mixed frozen berries/berry-containing products were identified in Italy, France and Norway and were recalled from the market. This evidence together with epidemiological and environmental investigations from the affected countries identified frozen berries as the mostly likely vehicle of infection for this outbreak and suggested that it could be a single outbreak linked to a common, continuous source of contamination.
At the request of the European Commission, the European Food Safety Authority (EFSA) coordinated the tracing activities of affected Member States. This work involved collecting data on the source of each berry delivery from retail sale back to the farmer to see if a common source or sources of contamination could be identified. Bulgarian blackberries and Polish redcurrants were identified as the most common ingredient in the food consumed by affected people. However, this might be explained by the fact that Poland is the largest producer of redcurrants in Europe, and Bulgaria is a major exporter of frozen blackberries. While no single point source of contamination was identified, twelve food operators were identified with links to cases and batches in five of the countries affected.

Going public: Hepatitis A in Houston edition

The Houston Health Department is following the mantra of share what you know, what you don’t know and be available for questions following a hepatitis A incident in Houston, TX.

According to 2 Houston, a student at Stephen F. Austin high school was diagnosed with hepatitis a and public health department officials alerted students, parents and staff that there they may have been exposed. Transmission of the virus happens when the poop of an infected person ends in someones mouth either through hands, objects, food, or drinks.stone_cold_steve_austin_01

Dates of exposure are April 20 to May 11 and Health Department officials are visiting the school to engage with the community for public information/Q&A sessions.

There are probably lots of students who work at restaurant/retail stores who also work at Stephen F. Austin.

Food Safety Talk 100: No buns in the bathroom

Food Safety Talk, a bi-weekly podcast for food safety nerds, by food safety nerds. The podcast is hosted by Ben Chapman and barfblog contributor Don Schaffner, Extension Specialist in Food Science and Professor at Rutgers University.  Every two weeks or so, Ben and Don get together virtually and talk for about an hour.1459283728049

They talk about what’s on their minds or in the news regarding food safety, and popular culture. They strive to be relevant, funny and informative — sometimes they succeed. You can download the audio recordings right from the website, or subscribe using iTunes.1461946810971

Episode 100 can be found here and on iTunes.

Here is a bulleted list of link to the topics mentioned on the show:

Consumed frozen cherry/berry mix from Costco in Canada? You might have been exposed to hep A

The often-missed Bill Keene was quoted in 2013 about using loyalty cards in an outbreak investigation ‘We rely on people’s memories, which are quite fallible, and on our interviews, which are quite fallible; Shopper club cards are a good source of finding out what people ate.’

Cards can be used to connect with members who purchased specific products if those products are part of an outbreak or recall – a tool to overcome the poor memories.

Lots of data is collected by retailers with every swipe of a loyalty or membership card: date, product, lot, location. CDC reported that the cards aided in an investigation into a 2009 outbreak of Salmonella montevideo linked to pepper (which was used as an ingredient in multiple foods).image

And this frozen cherry/berry hepatitis A outbreak at a Canadian membership retailer in 2013 (sounds familiar).

It’s not failsafe though; folks, who, according to PHAC, sampled frozen berry dishes at Canadian Costco outlets recently, may not know they might have been exposed to hepatitis A.

CBC says go ahead and get an IgG shot at Costco quickly. Because it might not work for too long (based on the window of exposure).

Eastern Health’s chief medical officer David Allison is warning people who have eaten or handled contaminated fruit to get vaccinated within 14 days.

Allison said that one person in the province has contracted hepatitis as a result, but no other cases have been found. Twelve other cases have been identified in provinces across Canada.

According to Costco, approximately 1,600 households in the province have purchased the product.

While vaccines “aren’t easy to come by,” Costco is offering post-exposure immunization to those who have come into contact with the berries.

Water suspected: 114 sick with Hepatitis A in Kenya

Mombasa residents are living in fear after the county’s health department confirmed that cases of Hepatitis A infections have risen from 21 to 114 as at Tuesday this week.

mqdefaultCounty officials on Wednesday held a crisis meeting to discuss how the menace will be tackled.

Speaking at the Coast General Hospital on Wednesday, the Mombasa County government Secretary Francis Thoya said that the outbreak has sent county health officials into panic mode.

Thoya said the rate at which the cases are increasing is disturbing, adding that the county is working round the clock to stabilise the situation.

“We have set aside eleven million shillings to tackle the problem before it gets out of hand,” said Thoya.

It’s out of control.

Collaboration two-step: 12 sick with hep A from frozen cherries grown who knows where

The Public Health Agency of Canada is collaborating with federal and provincial public health partners to investigate an outbreak of Hepatitis A infections in three provinces linked to the frozen fruit product: Nature’s Touch Organic Berry Cherry Blend.

clear.present.dangerThe Canadian Food Inspection Agency (CFIA) has issued a food recall warning advising Canadians of the recall of the frozen fruit product that has been distributed in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador.

The Public Health Agency of Canada advises Canadians not to consume the frozen fruit product Nature’s Touch Organic Berry Cherry Blend sold exclusively at Costco warehouse locations in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador.  If you suspect you have been exposed to the recalled product, or have symptoms consistent for Hepatitis A, see your health care provider immediately. Vaccination can prevent the onset of symptoms if given within two weeks of exposure.

Currently, there are 12 cases of Hepatitis A in three provinces related to this outbreak: Ontario (9), Quebec (2), and Newfoundland and Labrador (1). Individuals became sick in February and March of this year. Some of the individuals who became ill have reported eating the recalled product. The majority of cases (58%) are male, with an average age of 37 years. Three cases have been hospitalized.

Costco, where you getting those cherries from?

 

People are sick, but Canada won’t say how many: Frozen fruit strikes again

Following the outbreaks of hepatitis A throughout Europe traced to frozen fruit, I’ve taken to microwaving the product to a boil, and then cooling. Yes, my daughter is vaccinated, yes, I am getting my vaccines updated, but people shouldn’t be eating shit when they go for frozen berries.

hep.a.berryYet that is exactly what they do.

And Costco, where are you sourcing your stuff from?

The Canadian Food Inspection Agency says that Nature’s Touch brand Organic Berry Cherry Blend is being recalled due to Hepatitis A.

The following product has been sold exclusively at Costco warehouse locations in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador.

Recalled products

Brand Name             Common Name      

Nature’s Touch         Organic Berry Cherry Blend

Size     Code(s) on Product            

1.5 kg(3.3 lb) Best Before dates up to and including 2018 MR 15

UPC   

8 73668 00179 1

This recall was triggered by findings of the CFIA during the investigation into a foodborne illness outbreak. The CFIA is conducting a food safety investigation, which may lead to the recall of other products. If other high-risk products are recalled, the CFIA will notify the public through updated Food Recall Warnings.

The CFIA is verifying that industry is removing recalled product from the marketplace.

There have been reported illnesses associated with the consumption of this product.

No shit.