State and local health departments across the country are apparently being left to their own devices to alert the public to potential Hepatitis A exposure from strawberries from Egypt as the window of opportunity for post-exposure vaccination slips closed.
Field workers harvest strawberries in Egypt. Strawberry exports are heavily promoted on the Egyptian government’s website.
The recalled frozen strawberries were served as recently as Oct. 27, according to the Food and Drug Administration, which means people who ate them on that date in restaurants, school cafeterias, hotels, hospitals and other foodservice settings one have until Nov. 10 to secure the vaccination. The post-exposure shots are not effective at preventing infection unless given within two weeks of exposure to the virus, according to the Centers for Disease Control and Prevention.
Although the FDA published the list of five distributors who handled the frozen strawberries from Egypt, neither the federal agency nor those distributors have made public the list of customers that received the recalled fruit.
Michigan and California state departments of health have posted lists of entities that received the strawberries and are updating them as new information is available. As of Friday night California had about 3,000 on its list and Michigan had about 100.
Spot checks Friday of several other states’ websites showed no mention of the recall or the related nine-state Hepatitis A outbreak that has already sickened at least 134 people.
The receiving entities in both states include public schools, hotels including Holiday Inn, service clubs including the American Legion and a variety of venues and event organizers.
“It shouldn’t be left up to responsible states like California and Michigan to compile and release this information to consumers,” said food safety attorney Bill Marler who is representing some of the outbreak victims.
“The FDA and the companies that received the product from ICAPP (the Egyptian producer/exporter International Company for Agricultural Production and Processing) should be responsible for releasing the names of retailers and others who got the strawberries.”
Federal officials urged restaurants and other food service operations to check for the recalled strawberries in its outbreak update Thursday.
“The FDA recommends that institutions and food service operations supplied by any of the five companies identified below immediately reach out to their suppliers and determine if they received frozen strawberry product recalled by ICAPP,” the FDA update states.
“Then, if needed, institutions and food service operations that find they served any recalled product within the last two weeks should contact their local health department and communicate to their customers regarding possible exposure to hepatitis A virus and the potential benefit of post exposure prophylaxis. … CDC advises post exposure prophylaxis (PEP) for unvaccinated persons who have consumed any of the recalled frozen strawberry products in the last two weeks. PEP offers no preventive benefit to persons whose exposure occurred more than 2 weeks ago.”
The ongoing outbreak
The frozen, imported strawberries were identified as the source of the outbreak in early August, but the Egyptian company did not issue a recall until this past week, several days after the Food and Drug Administration imposed an Import Alert on the company’s strawberries citing Hepatitis A contamination. The recall includes all frozen strawberries ICAPP has sent to the U.S. since Jan. 1.
Initially state and federal officials investigating the outbreak thought only Tropical Smoothie Café locations, mostly in Virginia, received the frozen strawberries. The CDC reported Thursday that 129 of the 134 confirmed outbreak victims reported drinking strawberry smoothies from Tropical Smoothie Café restaurants before becoming sick.
However, five of the victims did not have smoothies from that restaurant chain. The latest illness onset date among those cases was Oct. 1. No new illnesses among Tropical Smoothie customers have been reported since Sept. 23.
Hepatitis A infection can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Some people do not develop symptoms, but they are contagious. Symptoms can include yellow eyes or skin, abdominal pain, fever, fatigue, loss of appetite, nausea, dark urine or pale stools.
As of Oct. 17, nine states had reported outbreak victims so far, with 52 people having such severe symptoms that they required hospitalization, the CDC reported Wednesday. The states and number of confirmed cases in each are: Arkansas 1, California 1, Maryland 12, New York 3, North Carolina 1, Oregon 1, Virginia 107, West Virginia 7, and Wisconsin 1.
Five companies distributed the strawberries across the U.S., according to the FDA. None of the recalled berries were packaged for retail sale to consumers. However, they may have been repackaged or used in other products.
The five consignees who received recalled frozen strawberry products from ICAPP are:
(To sign up for a free subscription to Food Safety News, click here.)