UPDATE: After this story posted, a spokeswoman from the Virginia Department of Health provided additional details about the outbreak. As of the afternoon of Aug. 26, there were 35 confirmed cases of Hepatitis A, with illness onset dates ranging from May 2 through Aug. 18. Because of the long incubation period of 15 to 50 days, additional people are expected to be added to the case count. The number of people sickened in a Hepatitis A outbreak linked to frozen imported strawberries served by Tropical Smoothie Cafe is increasing daily, reaching 28 as of Thursday, but state health officials are not providing any other details.

Virginia’s Department of Health issued a public warning Aug. 19, but has not posted any additional information. A department spokeswoman confirmed Thursday that there are 28 Virginia residents with the outbreak strain of Hepatitis A, which the public warning said matched a strain of the virus isolated during previous outbreaks in frozen strawberries imported from Egypt. However, Maribeth Brewster, the department’s manager of risk communication, said she could not reveal the age range of the victims or say whether any have required hospitalization. “We do not discuss details of individual cases,” Brewster said Thursday via email. She did not provide the date that the state received test results showing the victims are infected with the same strain of Hepatitis A isolated in strawberries from Egypt. In a YouTube video posted Sunday, Tropical Smoothie Cafe CEO Mike Rotondo apologized to customers and said the Virginia health department notified the chain Aug. 5 about the possible link between the Egyptian strawberries and the outbreak. He said the chain immediately removed the frozen berries from all of its stores. The company is now sourcing strawberries from California and Mexico. The lag time between Aug. 5 when the restaurant chain was notified and Aug. 19 when the public warning was issued remains unexplained by the Virginia health department. The timing is crucial because of the narrow window of opportunity for post-exposure vaccination. The post-exposure vaccine or immune globulin (IG) injections must be administered within 14 days of exposure or they are not effective, according to the Centers for Disease Control and Prevention and the Virginia department. “Individuals who consumed a smoothie from a Tropical Smoothie Cafe in Virginia that contained frozen strawberries, on August 5, 6, 7 or 8 may still benefit from vaccine or immune globulin to prevent hepatitis A. Vaccine or immune globulin administered within two weeks of exposure to Hepatitis A virus is effective at preventing the disease,” according to the state’s Aug. 19 warning. Customers file lawsuits One of the outbreak victims, Constantinos Raptis, who was hospitalized for four days because his symptoms were so severe, has filed a civil case against Tropical Smoothie Cafe. The lawsuit, filed in Loudoun County Circuit Court, seeks $100,000 in damages. Raptis, who has requested a jury trial, is represented by Seattle food safety attorney Bill Marler, founding partner of Marler Clark LLP, and Salvatore Zambri of the Washington D.C. firm Regan Zambri Long PLLC. Also represented by Marler and Zambri is Laura Pyka, a Yorktown resident who also consumed strawberry smoothies from Tropical Smoothie Cafe. Pyka has not developed a Hepatitis A infection. She received a post-exposure vaccination. Pyka’s case seeks reimbursement for the cost of the vaccination, lost wages for the time required to seek medical attention and legal fees. The case seeks class action status for others who received the post-exposure shots. “The class includes all persons who consumed adulterated food or drink, including smoothies with strawberries, during the exposure period in July and August 2016 and who, as a direct and proximate result of such consumption, were exposed to HAV (Hepatitis A virus) and, following the recommendations of public health officials or other medical personnel, obtained vaccination, and any related medical treatment, including blood tests, to prevent HAV infection. The class does not include those who developed HAV infections,” according to Pyka’s civil complaint. Both lawsuits contend that Tropical Smoothie Cafe breached the warranty of the safety of its products and is strictly liable. Hepatitis A is an inflammation of the liver caused by the Hepatitis A virus. Symptoms develop 15-50 days after exposure to the virus, which can occur through direct contact with another person who has the infection or by consuming food or drink that has been contaminated with the virus. Frequent hand-washing with soap and warm water after using the bathroom, changing a diaper, or before preparing food can help prevent the spread of Hepatitis A. For more details, please see “Egypt investigates strawberry link to Hepatitis A cases in U.S.” Editor’s note: Attorney Bill Marler is the publisher of Food Safety News. (To sign up for a free subscription to Food Safety News, click here.)