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Multistate outbreak of hepatitis A virus infections linked to pomegranate seeds from Turkey (Final Update)

Posted October 28, 2013 4:30 PM ET

This particular outbreak appears to be over. However, Viral Hepatitis is still an important cause of human illness in the United States. More information about Viral Hepatitis, and steps people can take to reduce their risk of infection, can be found on the CDC Viral Hepatitis website.

Highlights

Read the Advice to Consumers »

Epidemiologic Investigation:

This outbreak investigation has been finalized.

  • 165 people were confirmed to have become ill from hepatitis A linked to pomegranate arils contained in ‘Townsend Farms Organic Antioxidant Blend’ in 10 states: Arizona (23), California (79), Colorado (28), Hawaii (8), New Hampshire (1), New Jersey (1), New Mexico (11), Nevada (6), Utah (3), and Wisconsin (2). [Note: The cases reported from Wisconsin resulted from exposure to the product in California, the cases reported from New Hampshire reported fruit exposure during travel to Nevada, and the case reported in New Jersey was a household contact of a confirmed case from Colorado.] Eight of the confirmed cases were household contacts of confirmed cases (secondary cases). One person was exposed to the same pomegranate arils in a different product, ‘Woodstock Frozen Organic Pomegranate Kernels.’
    • 90 (55%) ill people were women
    • Ages ranged from 1 – 84 years;
      • 94 (58%) of those ill were between 40 – 64 years of age.
      • 11 children age 18 or under were also ill. None were previously vaccinated.
    • Illness onset dates ranged from 3/31/2013 – 7/26/2013
    • 71 (44%) ill people were hospitalized, and no deaths were reported
    • All ill people who reported eating this product purchased it from Costco markets; however, the product was also sold at Harris Teeter stores. No ill people were identified that bought the product at Harris Teeter.

Laboratory Investigation:

  • The major outbreak strain of hepatitis A virus, belonging to genotype 1B, was found in clinical specimens of 117 people in nine states: AZ, CA, CO, HI, NH, NJ, NM, NV, and WI. This genotype is rarely seen in the Americas but circulates in North Africa and the Middle East.
  • This genotype was identified in a 2013 outbreak of hepatitis A virus infections in Europe linked to frozen berries and a 2012 outbreak in British Columbia related to a frozen berry blend with pomegranate seeds from Egypt. However, there is no evidence at this time that these outbreaks are related to the ongoing U. S. outbreak.

Regulatory Investigation:

Peer Reviewed Publication

"Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study"
Melissa G Collier, MD , et al Lancet, Online version 3 September 2014

Also available is a printable manuscript

At a Glance:

  • Cases linked to pomegranate arils in ‘Townsend Farms Organic Anti-oxidant Blend’: 162
  • States: 10*
  • Deaths: 0
  • Hospitalizations: 71
  • Recall: Yes

*The cases reported from Wisconsin resulted from exposure to the product in California, and the cases reported from New Hampshire reported fruit exposure during travel to Nevada.

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