Health officials are urging foodservice operators — including schools and restaurants across the country — to check their freezers for recalled strawberries from Egypt that may be contaminated with Hepatitis A.

The strawberries, produced and exported from Egypt by the International Company for Agricultural Production and Processing (ICAPP), are implicated in a nine-state Hepatitis A outbreak that has already sickened at least 134 people.

Egypt map on strawberry backgroundAlthough the frozen, imported strawberries were identified as the source of the outbreak in early August, 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.

That all changed Wednesday when the Food and Drug Administration reported the strawberries were distributed to other foodservice operations across the country and may have been served as recently as Oct. 27.

California officials confirmed the potentially infectious strawberries have been distributed and served recently in their state. Almost 3,000 retailers, schools, restaurants and other entities received the strawberries, according to the California Department of Public Health (CDPH).

Now the scramble is on to notify people who could still benefit from a post-exposure shot to protect them from the infection, which attacks the liver and in some cases results in death.

“… 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,” according to an update posted Wednesday by FDA officials.

“The FDA and CDC are not currently aware of any illnesses related to any recalled products other than whole frozen strawberries. However, because Hepatitis A can have serious health consequences, 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 two weeks ago.”

Shasta County, CA, public health officials are sure the implicated berries were served at at least one elementary school and a restaurant in their jurisdiction. Kern County officials aren’t sure if the berries were served, but they know foodservice operations received them.

“Bella Vista Elementary officials said the used the strawberries in smoothies they served on Oct. 25,” according to a public health alert from Shasta County. “Vittles restaurant said the strawberry syrup and toppings may contain strawberry parts, from the same vendor, that was on tables and available from Oct. 20-25.” if not all of the elementary school students should not be in danger because the Hepatitis A vaccination has been recommended for California children since 1999 and is routinely administered with other childhood immunizations.

However, unvaccinated children and older people who have not been vaccinated could benefit from post-exposure treatment, but only if they act quickly. Consequently, Shasta County’s public health clinic will offer free vaccinations for those who were potentially exposed during two special clinics on Friday from 1 p.m. to 4:30 p.m. and on Saturday from 10 a.m. to 2 p.m. at 2650 Breslauer Way in Redding.

People who have already been vaccinated or who have had Hepatitis A do not need the vaccine.

“We want to give those school students and restaurant employees every opportunity to get this very effective Hepatitis A vaccine, if they have not already received it,” Supervising Public Health Nurse Venessa Vidovich, Supervising Public Health Nurse said in the public notice.

For more information on the special clinic, call 530-225-5591. Free Hepatitis A vaccines will also be given to those potentially exposed through November 10, during normal clinic hours.

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:

  • C.H. Belt of Lake Forest, CA, which sold the strawberries under the CH World brand;
  • Jetro/Restaurant Depot of College Point, NY, which sold them under James Farm brand and unbranded as “Bits & Pieces;”
  • Sysco Corp. of Houston, TX, which sold them under the Sysco brand;
  • Patagonia Foods of San Luis Obispo, CA, which sold them under the Patagonia brand; and
  • Reddy Raw of Woodridge, NJ, which sold them under the Regal brand.

Earlier this week a spokesman for Sysco, which is the largest breadline foodservice supplier in the country, told Food Safety News that shipments of the implicated strawberries were halted Aug. 19.

“On Oct. 27 ICAPP issued a recall of this product. We subsequently communicated this action to our facilities and customers, in an abundance of caution and despite the fact that we have not been distributing the product involved in the recall since August, so that our customers could ensure that they did not have any affected product in their inventories,” the Sysco spokesman said via email.

Officials with Patagonia Foods did not respond Wednesday to requests for comment on the situation.

CDC investigating non-smoothie cases
While 129 of the 134 confirmed outbreak victims reported drinking strawberry smoothies from Tropical Smoothie Café restaurants before becoming sick, five of the victims did not have smoothies, according to the Centers for Disease Control and Prevention’s update posted Wednesday.

“There are five sick people who did not have Tropical Smoothie Café exposure. The latest illness onset date among these cases was October 1, 2016. The investigation into these cases is ongoing,” the CDC reported.

CDC reported no new illnesses among Tropical Smoothie customers have been reported since Sept. 23. That’s in line with the incubation time for Hepatitis A. Symptoms usually develop within 14 to 50 days after exposure.

The 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.

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