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UPDATED: FDA seeks Egypt’s help on outbreak linked to strawberries

UPDATED CONTENT: As of noon Friday, Sept. 2, the Virginia Department of Health reports 66 residents of the state have been confirmed with Hepatitis A infections in this outbreak. That’s an increase of seven cases in the state since the department’s report on Thursday. Overall, the nationwide total now stands at 81.

FDA officials are working with Egyptian officials on an investigation into a Hepatitis A outbreak linked to frozen strawberries from Egypt that were served in smoothies.

Egypt map on strawberry backgroundAs of today, 74 people in seven states have been confirmed through laboratory testing to be infected with the outbreak strain. Federal officials report that symptoms of at least 32 of the victims were so severe they required hospitalization. They expect additional people to be stricken because of the 15- to 50-day incubation time for Hepatitis A.

The vast majority of the victims reported having Tropical Smoothie Café smoothies containing strawberries before they became ill, according to state and federal officials.

“The FDA’s investigation into the source and distribution of the strawberries is ongoing; and the agency has been in touch with the Egyptian International Health Regulations National Focal Point to discuss the investigation,” according to a notice posted on the Food and Drug Administration’s website this afternoon.

“FDA is working to identify other parts of the relevant supply chain and will take appropriate action as necessary. However, FDA is prohibited by law in most situations from releasing publicly certain confidential commercial information about supply chains.The FDA has initiated increased surveillance of imported strawberries and will provide more information as it becomes available.”

The hardest hit state is Virginia, where 59 residents are infected, according to a noon update from the state’s health department. That’s an increase of four people in 24 hours. They range in age from 14 to 58.

People in Virginia started coming down with Hepatitis A in early May. In early August, the Virginia Department of Health recognized an abnormal spike in the number of infections. They launched an investigation and contacted the Centers for Disease Control and Prevention.

CDC leads epidemiological investigation
Today CDC posted its initial report on the outbreak — which included Virginia’s count of 55 from Wednesday — reporting 70 people from seven states are infected. The states and number of confirmed victims are: Maryland, 6; New York, 1; North Carolina, 1; Oregon, 1; Virginia, 55 (Wednesday’s count); West Virginia, 5, and Wisconsin, 1.

map Tropical Smoothie Hep A outbreakOf those 70 people, 68 reported consuming a smoothie from Tropical Smoothie Café before becoming ill. That’s 97 percent.

“Of the 54 ill people who were interviewed about the type of smoothie, all reported drinking a smoothie containing strawberries,” CDC reported.

“These ill people purchased smoothies at cafés located in a limited geographical area, including Virginia and neighboring states. The ill person in Oregon traveled to Virginia and while there, had purchased smoothies containing frozen strawberries from a Tropical Smoothie Café location.”

Although FDA did not reference any testing of the imported, frozen strawberries in its outbreak post today, CDC reported the other agency is waiting on lab results. A CDC spokeswoman said earlier this week that CDC does not test food samples. That’s the responsibility of FDA and the U.S. Department of Agriculture, depending on the food item involved.

“Investigators are working to determine which specific lots may have been contaminated with Hepatitis A virus and to find out if the frozen strawberries were distributed to other U.S. customers,” CDC reported

“Frozen strawberries used at Tropical Smoothie Café locations were collected for testing. The FDA’s analysis is ongoing.”

Both CDC and FDA reported there is no information to suggest there is an ongoing risk of Hepatitis A infection at Tropical Smoothie Cafés. Neither agency has any information suggesting any other restaurants or retailers received the implicated frozen strawberries from Egypt, according to their reports today.

Response by Tropical Smoothie Café
All U.S. and state agencies involved in the investigation have reported Tropical Smoothie Café management responded quickly upon receiving notification from Virginia officials that the strawberries used in the chain’s restaurants were a possible source of the outbreak.

To view this video, posted Sunday by Tropical Smoothie Cafe CEO Mike Rotondo, click on the image.

To view this video, posted Sunday by Tropical Smoothie Cafe CEO Mike Rotondo, click on the image.

In a video on YouTube and in statements on the corporate website, CEO Mike Rotondo said Virginia officials first notified Tropical Smoothie on Aug. 5.

“We were advised by the Virginia Department of Health that removing the strawberries was not necessary, but in abundance of caution we did it anyway,” according to a statement posted on the company’s website.

FDA and CDC report the company pulled the frozen, imported strawberries from its Virginia locations by Aug. 8 and that by Aug. 19 the restaurant chain had removed the implicated fruit from all of its locations in all states.

The restaurant chain, known for its slogan “eat better, feel better,” has drawn sharp criticism from some customers regarding the use of frozen, imported fruit in its signature menu item. Corporate officials responded by posting answers to a list of Frequently Asked Questions.

“In our 500+ locally owned cafes, we serve more than 150,000 smoothies per day. In order to meet our quality and sweetness specifications, our supplier has sourced fruit from various geographic regions to meet the volume needs of our business,” the company states on its FAQ Web page.

“Strawberries sourced from overseas were a very small part of our supply in Virginia, and an even smaller part of our overall volume. … Egyptian strawberries represent a fraction of our overall strawberries purchased, and were predominantly distributed to stores in the Virginia market. Today, our strawberries are primarily sourced from Mexico and California.”

Information for consumers
Public health officials have asked that anyone who consumed smoothies with strawberries to monitor themselves for Hepatitis A symptoms. It can take 15 to 50 days for symptoms to develop.

“Contact your doctor if you think you may have become ill from eating a smoothie containing strawberries from a Tropical Smoothie Café prior to Aug. 8 in the following states: Virginia, West Virginia, Maryland, North Carolina,” CDC advised today.

“It is important that food handlers and restaurant employees contact their doctor and stay home if they are infected with Hepatitis A. This helps prevent the virus from spreading.”

Symptoms to watch for include a yellowing of the skin and whites of the eyes known as jaundice, fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stools. The virus can be transmitted through direct contact with another person who has Hepatitis A or by consuming food or drink that has been contaminated with the virus.

For additional details on how Virginia’s health department responded to the outbreak, waiting two weeks to notify the public after it suspected the strawberries in the smoothies, please see Hepatitis A outbreak linked to smoothies spans 5 states; 51 sick

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