Category Archives: Hepatitis A

Food Safety Talk 166: Surprising lack of cannibalism questions

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Don and Ben traveled to SUNY Geneseo for a live version of the podcast sponsored by the Center for Integrative Learning, and hosted by the amazing Beth McCoy. The episode title comes from an unrecorded after dark which may or may not have taken place in a bar in Geneseo.

Episode 166 is available on iTunes and here.

Show notes so you can follow along at home.

Vaccines work: Beware the Hep A in Denmark from Morocco

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On 2 May 2018, Denmark reported a cluster of hepatitis A virus (HAV) infections with the subgenotype IA strain DK2018_231, through the European Centre for Disease Prevention and Control (ECDC)’s Epidemic Intelligence Information System (EPIS) for food- and waterborne diseases and zoonoses (FWD).

One of the three confirmed cases had travelled to Morocco. In response, five additional European Union (EU) countries (France, Germany, the Netherlands, Spain and the United Kingdom (UK)) reported cases (n = 20) infected with the same strain between 21 January and 10 April 2018.

Concurrently, Germany reported to EPIS that it observed more cases of hepatitis A with travel history to Morocco than expected, compared with the same period in the previous 5 years. Molecular analysis of the HAV VP1/P2A region revealed an unrelated cluster of the HAV subgenotype IB strain V18–16428. Cases infected with this unrelated strain were also reported from France, the Netherlands, Sweden and UK.

The appearance of clusters with a link to Morocco triggered further epidemiological investigations.

Two concurrent outbreaks of hepatitis A highlight the risk of infection for non-immune travelers to Morocco, January to June 2018

5.july.18

Eurosurveillance

Martyna Gassowski, Kai Michaelis, Mirko Faber, Julie Figoni…

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.27.1800329

1 dead, 24 sick check your freezers: Hepatitis A death linked to frozen pomegranate recall in Australia (grown in Egypt)

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Now for something more serious from Australia.

SA Health chief medical officer and chief public health officer Professor Paddy Phillips revealed a 64-year-old woman died last Wednesday after “some time” in hospital.

“This is a rare and tragic case and I offer my sincere condolences to the woman’s family,” Professor Phillips said.

“The majority of people infected with hepatitis A recover fully and the woman’s death is the only death linked to this recalled product nationally to date.

“The incubation period for hepatitis A is generally 15-50 days, so we don’t anticipate further cases because the product was recalled two months ago.

“While we expect most people would have disposed of the recalled product, we urge everyone to double-check freezers and remove any affected products.

“Fresh pomegranate and frozen Australian-grown pomegranate products are not affected.”

Her death had been referred to the Coroner.

The Creative Gourmet 180g frozen pomegranate arils, which are sold at Coles supermarkets, were first recalled in April after a hepatitis A outbreak in New South Wales.

Then in May, SA Health again reminded people to throw away the product, made by Entyce Food Ingredients, after 11 linked hepatitis cases.

Professor Phillips said some 2,000 packets of the fruit — grown in Egypt — were sold.

Of those, 226 packets were returned, but he said they believed many more were thrown away as instructed by health authorities.

He said it was “very rare” to die from hepatitis A.

“Most people usually recover without any consequences but occasionally this does happen,” he said.

He would not say if the woman suffered other medical conditions.

SA Health was told about the woman’s death yesterday, Professor Phillips said.

“We have come out as soon as we found out about it.”

Michigan’s hepatitis A problem is a public health cycle

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Next month I’ll be in Michigan talking food safety with Don at a live podcast recording as part of the Global Food Law Current Issues Conference.

Added to the list for our chat is a local issue, a massive hepatitis A outbreak. Tragically, according to USA Today, the outbreak has been linked to 27 deaths and hundreds of cases.

Wrapped up in this outbreak is the intersection of intravenous drug use; individuals in the homeless population; and, folks working in food service. Public health is complicated.

Most of those who have died in Michigan in this outbreak are 50 or older, Fielder said. And they died of liver failure, septic shock or other organ failure.

“Generally, it’s been people who are more sick or people who have less access to health care,” Fielder said. “You know, we’ve also seen a homeless component to this. We’re seeing this driven by a substance use disorder risk group.”

People who use illegal drugs account for about half of outbreak-related cases..

“It’s a very hard group to reach, and it’s a very hard group to get public health messaging to. There’s a lot of trust issues with government entities in general. So there’s a lot of outreach going out from local public health to … people they do trust in the community.”

As of Wednesday before Memorial Day, the hardest hit areas are Macomb County, north of Detroit, with 220 cases; Detroit itself with 170; elsewhere in Wayne County, where Detroit is located, with 144; and Oakland County, to the west of Macomb County where Pontiac is located, with 114 cases, according to the Michigan Department of Health & Human Services.

Part of the problem: As many as 35 restaurant workers in the Detroit area were found to have the virus and may have spread it unknowingly to diners. The virus is contagious weeks before a person begins to exhibit symptoms, which makes it extremely challenging for public health officials to manage.

11 now sick in Australia linked to Creative Gourmet frozen pomegranate

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Two South Australians have been hospitalised with Hepatitis A, believed to have been caused by them eating Creative Gourmet frozen pomegranate.

The product was recalled from Coles last month but SA Health is reminding South Australians to make sure they do not have the product in their freezers.

SA Health food and controlled drugs director Fay Jenkins said nationally there have been 11 cases linked to the outbreak, with two in South Australia.

“There’s a lady in her 60s and she is quite unwell and she is in hospital. There is a younger gentleman [aged 33] … and he’s actually been discharged from hospital,” Dr Jenkins said.

People are sick: Frozen strawberries grown in Egypt recalled because of hep A in Canada

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For at least the third time in the last six years, people have gotten sick with hepatitis A after consuming strawberries – fresh or frozen — grown in Egypt.

A multistate outbreak of hepatitis A virus (HAV) among European travellers returning from Egypt occurred between November 2012 and April 2013.

A total of 14 European Union (EU)-European Free Trade Association (EFTA) countries reported 107 cases. Twenty-one cases from six countries were affected by strains of sub-genotype IB harbouring identical RNA sequences, suggesting a common source outbreak.

In Sept. 2016, at least 89 were sickened in the U.S. with hepatitis A at Tropical Smoothie Cafés in Maryland, North Carolina, Virginia, and West Virginia, linked to consumption of frozen strawberries from Egypt.

Now, the Canadian Food Inspection Agency says Groupe Adonis Inc. is recalling Montana brand frozen strawberries from the marketplace due to possible Hepatitis A contamination. Consumers should not consume the recalled product described below.

The ministère de l’Agriculture, des Pêcheries et de l’Alimentation du Québec (MAPAQ) transmitted an alert to the news media concerning the affected product. Please click on the following link for details: https://www.mapaq.gouv.qc.ca/fr/Consommation/rappelsaliments/2018/04/Pages/3682.aspx (French only).

The following product has been sold exclusively from Adonis markets in Quebec and Ontario.

Recalled products

Brand Name Common Name Size Code(s) on Product UPC
Montana Strawberry
(frozen)		 1 kg All codes purchased on or before April 14, 2018 6222000401487

If you think you became sick from consuming a recalled product, call your doctor.

Check to see if you have recalled products in your home. Recalled products should be thrown out or returned to the store where they were purchased.

This recall was triggered by findings during an investigation into a foodborne illness outbreak.

CFIA won’t say how many are sick, that’s up to the Public Health Agency of Canada.

And vaccines work.

Vaccines work: Will low-cost shots for restaurant workers tame the hepatitis A outbreak in Kentucky?

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Darla Carter of Insider Louisville reports the city is taking aim at the hepatitis A outbreak by offering low-cost vaccination shots to food-service and hospitality industry workers such as restaurant employees.

The Louisville Metro Department of Public Health and Wellness and the University of Louisville Global Health Center have teamed up to provide the service at a discounted price of $25 per shot, with the restaurant or business paying the fee.

“It’s a significant discount,” said health department spokesman Dave Langdon, noting that the typical rate is more like $65 to $100 a dose.

Against the Grain, a Louisville brewery and restaurant, is among the businesses that have stepped up to get some workers vaccinated.

“We care for our employees and want them to be well and we care for our customers and want them to be well,” co-owner Adam Watson said. ” … Any place that handles food, it’s probably a wise decision to try and get this done.”

The discounted shots are part of an effort to stop an outbreak that has led to nearly 200 cases of acute hepatitis A in the Louisville area, according to the health department. At least one person has died.

Locally, the highly contagious liver infection mainly has stricken the homeless and people who use drugs. It’s usually spread when a person unknowingly ingests the virus from objects, food or drinks contaminated with small amounts of stool from an infected person, according to the U.S. Centers for Disease Control and Prevention.

The health department and its partners have given shots to thousands of people at high risk, such as the homeless, and is urging restaurants and other food handlers to practice good sanitation and hygiene as the Kentucky Derby approaches in May.

Also, by taking advantage of the discounted shots, businesses “certainly would be helping to prevent the spread of hepatitis A throughout the community,” Langdon said. “Also, they would be protecting themselves against the potential bad publicity and loss of business that might come with having one of their workers identified with being infected with hepatitis A.”

7 sick with Hepatitis A linked to frozen pomegranate in Australia

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I’m not a fan of pomegranates, and I’m really not a fan of the way the NSW Food Authority announces recalls.

Here’s what they said.

The NSW Food Authority advises:
Entyce Food Ingredients is conducting a precautionary recall of its Creative Gourmet Pomegranate Arils 180g from Coles Supermarkets nationally, due to potential Hepatitis A contamination.

Product details:

Creative Gourmet Pomegranate Arils 180g, frozen, plastic snap lock bag

All Best Before Dates up to and including 21/03/20

Consumers should not consume this product and should return it to the place of purchase for a full refund.

If you are concerned about your health you should seek medical advice.

What they didn’t mention but ABC did is seven people have been diagnosed with hepatitis A after eating frozen pomegranate purchased at Coles supermarkets, prompting NSW Health to warn anyone who bought the product to throw it out immediately.

Dr Vicky Sheppeard, director of communicable diseases at NSW Health, said it was working with the state’s Food Authority to determine whether the infection could be definitively linked to the Coles frozen pomegranates, despite the fact that each person affected had eaten the product.

I get the difference between NSW Health and the NSW Food Authority. But mention how hard is it to mention there are sick people so consumers can judge how much they should pay attention.

Vaccines still work.

Vaccines work even at fancy food places: Hepatitis A case linked to Melbourne restaurant

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Hundreds of people who dined at one of Melbourne’s best restaurants will be contacted by the health department after a food handler was diagnosed with a highly contagious liver infection.

The Age reports the staff member at Cumulus Inc., in the fine-dining hotspot of Flinders Lane, was recently found to have hepatitis A.

An alert issued by Victoria’s Department of Health on Thursday afternoon said anyone who ate at the restaurant between February 26 and March 19 should visit their GP for a free hepatitis A vaccine, and seek urgent medical attention if they feel unwell.

The department is also contacting anyone who booked at the restaurant during the same time period.

It is not yet clear how the male staff member contracted hepatitis A.

However, Victoria has been recently experiencing a local outbreak of the infectious disease, which has already claimed one life.

In response to the dozens of cases in recent months, a free vaccine has been offered to Victorian men who have sex with men and people who have injected drugs in the past year.

It follows an unusual increase in hepatitis A cases in Europe and North America that has affected hundreds of people.

The restaurant said that the hygiene systems at Cumulus Inc. were robust and safety of guests paramount.

The sick employee, who was involved in the plating up and preparation of food, is expected to make a full recovery.

Cumulus Inc. is prolific restaurateur Andrew McConnell’s stalwart all-day city restaurant, with wine bar Cumulus Up operating above.

Occupying an old clothing factory in Flinders Lane, the restaurant has consistently maintained a hat in the Good Food Guide since it opened in 2008.

Famous for its slow-cooked lamb shoulder, and still the go-to for boozy business brunches it is a kingpin of the McConnell restaurant empire, which also includes Marion, Cutler and Co. and fellow Flinders Lane occupant Supernormal.

Hepatitis A surveillance in France, 2006-2015

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(Many thanks to our correspondent in France for sending this along).
Hepatitis A surveillance has been carried out by mandatory reporting (DO) since November 2005, with the objective of detecting clustered cases in order to quickly take control measures, and estimating reporting incidence rates. The results of the analysis of cases reported during the first ten years of surveillance (2006-2015) are presented.

Methods

One case (positive anti-HAV IgM) must be notified to the Regional Health Agency using an OD card. This sheet gathers sociodemographic and clinical information as well as risky exposures (in particular cases in the entourage, stay outside the metropolis, consumption of seafood).

Results

For the period 2006-2015, 11,158 cases of hepatitis A were notified, giving an average incidence rate of 1.7 / 100,000. A downward trend in this rate has been observed since 2010. The average incidence rate of reporting in men was 1.9 / 100,000 and, in women, 1.4 / 100,000, with a downward trend for both sexes. The main exposures at risk were the presence of cases in the entourage (46%) and a stay outside metropolitan France (38%). Thirty-two percent of cases belonged to an identified episode of clustered cases. Each year, the share of grouped cases was relatively stable, ranging between 28 and 37%.

Conclusion

The annual rate of notification incidence has gradually decreased since 2010, reaching in 2015 that of a country of low endemicity for hepatitis A (1.1 / 100,000). The highest incidence of reporting was found in the under-15 age group, which is the most affected by fecal-oral transmission of the virus, favored in families and communities of children. The data collected by the OD and by the investigations of grouped episodes made it possible, in 2009, to develop vaccine recommendations in the family circle of a patient with hepatitis A and in living communities in situation precarious hygiene.

First ten years of surveillance of hepatitis A through mandatory reporting, France, 2006-2015

BEH

Elisabeth Couturier 1, Lina Mouna 2 , Marie-José Letort 1 , Dieter Van Cauteren 1 , Anne-Marie Roque-Afonso 2 , Henriette De Valk 1 

http://invs.santepubliquefrance.fr/beh/2018/5/2018_5_1.html