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Communicable Disease Outbreaks

Hepatitis A Outbreak Linked to Frozen Berries and Pomegranate Seeds - 2013

The U.S. Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and state and local health departments, including the California Department of Public Health (CDPH), are investigating an outbreak of acute hepatitis A virus (HAV) infections that appears to be associated with the consumption of Townsend Farms brand Organic Antioxidant BlendNew Window sold by Costco stores and Organic Antioxidant Berry BlendNew Window sold by Harris Teeter.

Additionally, a recall of Woodstock Frozen Organic Pomegranate KernelsNew Window distributed by Scenic Fruit Company was announced on June 26 due to potential risk of HAV contamination.  At this time, no illnesses have been linked to the Woodstock product. This product was distributed throughout the U.S., including California. An investigation into the distribution of the additional recalled products is still ongoing by FDA and CDC.

People who purchased any of the recalled products should discard the product or return to the point of sale. The risk of illness due to these product is considered to be low, however, anyone who has consumed these specific products in the last 14 days should contact their healthcare provider to discuss possible hepatitis A infection prevention options.

More information about this outbreak is available on the CDC Webpage: http://www.cdc.gov/hepatitis/Outbreaks/2013/A1b-03-31/.

New California Updates 

As of August 14, 2013, there are 77 California residents from 21 local health jurisdictions who reported consuming Townsend Farms Organic Antioxidant Blend purchased from Costco before becoming ill with HAV infection. The majority of patients (96%) have been adults. Thirty-three (43%) patients have been hospitalized, there have been no deaths.  There have been no cases who reported consuming the Woodstock Frozen Organic Pomegranate Kernels.

Outbreak Associated Recalled Products - follow links to see recall notice and implicated lot numbers

  • Woodstock Frozen Organic Pomegranate Kernels
  • Organic Antioxidant Berry Blend sold by Harris Teeter stores
  • Townsend Farms brand Organic Antioxidant Blend sold by Costco Stores
  • Information for the Public

  • Health Alert to Costco Customers from the CDCNew Window
  • Hepatitis A outbreak – FAQ for the publicNew Window
  • Hepatitis A outbreak – FAQ for the public (en Español)New Window
  • What do I do if I have purchased this product?
  • What do I do if I ate any of the recalled products?
  • What if I don’t have a healthcare provider or health insurance?
  • Information for Health Professionals

  • Hepatitis A outbreak – FAQ for medical providersNew Window
  • What is the background and current status of this outbreak?
  • What is the recommendation for patients who consumed any of the affected product?
  • What do I do about patients who don’t know if they’ve received hepatitis A vaccine and have no records?
  • What is the recommendation for patients who think they may have consumed a recalled product, but aren’t sure (product is consumed and no bag left)?
  • What is the recommendation for patients who ate other frozen berry or pomegranate products, but did not eat the recalled product?
  • What if un- or under-insured adult patients request hepatitis A vaccine?
  • Should my asymptomatic patient be tested for HAV infection?
  • What should I tell my patients?
  • What if my patient has been exposed and has only received one dose of HAV vaccine?
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    Information for the Public

    What do I do if I have purchased this product?

    Do not eat any of the recalled products.  Discard any remaining product from your freezers, even if some of the product has been eaten without anyone in your home becoming ill.

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    What do I do if I ate any of the recalled products?

    Talk to your healthcare provider about getting the hepatitis A vaccine. Hepatitis A vaccine may prevent disease, but only if given within two weeks after eating the contaminated food. If you have already been vaccinated against hepatitis A or have had hepatitis A disease in the past, you are protected and unlikely to become ill. Most children are vaccinated against hepatitis A.  If so, they’re already protected. Hepatitis A vaccine was introduced in 1995 and has been recommended for California children since 1999.

    If you’ve eaten any of the recalled products, but haven’t eaten it in the last two weeks, look for symptoms of hepatitis.  Contact your healthcare provider right away if you develop any of these symptoms:

    • Yellow eyes or skin
    • Abdominal pain
    • Pale stools (feces)
    • Dark urine

    Hepatitis A can develop from 2 to 6 weeks after consuming contaminated food or drink. If you ate this product more than six weeks ago and currently feel well, your risk of infection is very low. If you ate this product between 2 and 6 weeks ago and now have symptoms of hepatitis, see your health care provider.

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    What if I don’t have a healthcare provider or health insurance?

    If you need to find free or low-cost health care, search for a list of community health centers here: http://findahealthcenter.hrsa.gov/Search_HCC.aspx.

    To search for a list of providers, including pharmacies, that may carry hepatitis A vaccine (persons should call first to ensure that hepatitis A vaccine is in stock), access the "Adult Vaccine Finder" at: http://vaccine.healthmap.org.

    For additional questions, please contact your local health department: http://www.cdph.ca.gov/programs/immunize/pages/californialocalhealthdepartments.aspx.

    For additional information about hepatitis A, see: http://www.cdc.gov/hepatitis/A/aFAQ.htm.

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    Information for Health Professionals

    What is the background and current status of this outbreak?

    National updates are posted regularly on the CDC website at: http://www.cdc.gov/hepatitis/Outbreaks/2013/A1b-03-31/index.html.

    What is the recommendation for patients who consumed any of the affected products?

    Those who have consumed any of the recalled products in the last two weeks are recommended to receive hepatitis A vaccine or immune globulin (IG), as appropriate (most people are recommended to receive hepatitis A vaccine).  Please see the  CDPH guidance on hepatitis A post-exposure prophylaxis at: http://www.cdph.ca.gov/programs/immunize/Documents/CDPH_HAV%20PEP%20Clinical%20Guidance.pdfNew Window.

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    What do I do about patients who don’t know if they’ve received hepatitis A vaccine and have no records?

    Single-antigen hepatitis A vaccine, administered in a two-dose series, was introduced in 1995 and has been recommended for all children in California since 1999. Most children in California have been vaccinated, however many adults have not unless they have received vaccine prior to international travel.

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    What is the recommendation for patients who think they may have consumed a recalled product, but aren’t sure (product is consumed and no bag left)?

    The recommendations are the same for these people as for those who are sure they consumed the product.  However, IG is in limited supply so attempt to verify exposure prior to administration if IG is warranted.

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    What is the recommendation for patients who ate other frozen berry or pomegranate products, but did not eat the recalled products?

    Any susceptible patient who would like to reduce their risk of hepatitis A infection may receive hepatitis A vaccine.  We would not recommend IG for persons who did not consume the affected product.  However, the investigation is ongoing and it is likely that additional products may be implicated in this outbreak.  If this happens, the information will be made public and patients who consumed such products in the prior two weeks would be recommended to receive postexposure prophylaxis.

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    What if un- or under-insured adult patients request hepatitis A vaccine?

    If you are unable to provide vaccine for such patients, they may be advised to contact their local health department.  For a list of California local health department phone numbers, see: http://www.cdph.ca.gov/programs/immunize/pages/californialocalhealthdepartments.aspx.

    Adults who wish to receive hepatitis A vaccine can also access free or low cost health care, including vaccines, at federally qualified health centers.  A list of these health centers is available at: http://findahealthcenter.hrsa.gov/Search_HCC.aspx.

    In addition, adults may find providers of adult vaccines, including pharmacies, by accessing the "Adult Vaccine Finder" at: http://www.vaccines.gov/more_info/features/healthmapvaccinefinder.html.

    Persons wishing hepatitis A vaccine should call facilities they find on this website before they go in to make sure hepatitis A vaccine is  available.

    All un- and under-insured children <18 years of age in California are eligible for free vaccines under the federal Vaccines for Children (VFC) Program.

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    Should my asymptomatic patient be tested for HAV infection?

    Patients who recall consuming any of the recalled products should NOT be tested for HAV infection unless they have symptoms of acute hepatitis. False positive HAV IgM test results are common when asymptomatic people are tested. Therefore, asymptomatic persons should not be tested.  Notify your local health department if any highly suspicious cases are identified.

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    What should I tell my patients?

    The risk of HAV infection is very small and not everyone who ate these products will get sick.  However, anyone who ate a recalled product should monitor for symptoms of acute hepatitis, including: yellow eyes or skin (jaundice), abdominal pain, vomiting, pale stools, or dark urine.  People infected with hepatitis A can spread it to others. It is very important that people who have symptoms do not go to work, especially if they work in food service, health care or child care.

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    What if my patient has been exposed and has only received one dose of HAV vaccine?

    One dose of hepatitis A vaccine is highly effective against hepatitis A infection, however exposed persons should complete the series if it has been >6 months since their first dose.

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    Last modified on: 8/19/2013 11:40 AM