Hepatitis A outbreak linked to frozen strawberries in the U.S. — what Canadians need to know
What other foods are most likely to cause hepatitis A?
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.
An ongoing outbreak of hepatitis A has been linked to frozen strawberries and other frozen berry blends in the U.S., prompting a voluntary recall.
The U.S. Food and Drug Administration (FDA) posted the recall of select frozen strawberries and frozen fruit blends on June 13 for a potential hepatitis A contamination.
The FDA stated that no illnesses have been reported. The recalled produce has been linked to Walmart, Costco and HEB in the United States.
In April, the Canadian Food Inspection Agency (CFIA) investigated whether frozen organic strawberries linked to a hepatitis A outbreak in the U.S. were sold in Canada, too — no Canadian incidents were reported.
The CFIA has not mentioned the most recent outbreak. In Canada, a recall was issued for two kinds of frozen fruit earlier this week due to possible norovirus contamination.
Symptoms of hepatitis A food poisoning usually occur 10 to 15 days after exposure and can include:
Fatigue
Nausea
Vomiting
Abdominal pain
Yellowing of the whites of eyes or skin (jaundice)
Dark urine
Fever
Loss of appetite
However, not everyone who gets hepatitis A will show symptoms, and young children often have no symptoms at all. Some people have symptoms for one or two weeks, while others are sick for several months.
Hepatitis A is often thought of as a traveller’s disease because it’s more common in Central and South America, Africa, Eastern Europe and Asia.
Health Canada advises to get vaccinated against the virus before travelling to high-risk countries and be cautious of food safety.
People can also prevent hepatitis A by:
Washing their hands before and after eating, and after using the bathroom or changing diapers
Following food safety guidelines
Practicing safe sex
Not sharing needles or syringes
Eating well-cooked foods and avoiding tap water in high-risk countries
Foods that can cause hepatitis A
Hepatitis A can survive for hours on people’s hands, for days on surfaces and foods, for weeks in dried feces and for up to a year in water. It easily survives freezing and is resistant to physical and chemical substances that can kill other viruses.
Because food passes through many hands before it reaches consumers, there are a lot of opportunities for contamination. Anyone who works in a farm, factory or restaurant where food is grown, packaged or prepared can spread it.
Contaminated water can also spread hepatitis A — whether it’s ingested directly or used to wash or prepare food. This is why foods that are eaten raw or undercooked are the most likely to be contaminated with the hardy virus.
The following foods have the highest risk of causing hepatitis A disease.
Berries
Berries are at a particularly high risk for contamination with hepatitis A because they can’t be peeled like many other fruits, and are often eaten raw. Berries are also usually hand-picked, providing more opportunities for people to transfer the virus from their hands to the fruit.
Since hepatitis A can survive freezing, frozen berries have been linked to several hepatitis A outbreaks in North America in past years. This includes the recent recall of frozen strawberries in the U.S.
Lettuce
Lettuce is another food that’s often associated with hepatitis A transmission. If it’s irrigated with contaminated water, the virus can survive on lettuce for weeks.
Lettuce is difficult to wash thoroughly, so it’s harder to ensure all its surfaces are cleaned well. Lettuce that’s washed in contaminated water and bagged can also contain hepatitis A.
Sprouts
Sprouts contain a lot of nooks and crannies that protect the hepatitis A virus and help it survive. The virus can survive on seeds and can be transferred via contaminated water used to sprout the seeds.
Sprouts are difficult to clean well and are usually eaten raw, which increases the risk of transmitting the disease.
Other raw fruits and vegetables
In addition to the fruits listed above, all raw fruits and vegetables carry some risk of transmitting hepatitis A because they aren’t exposed to heat that could kill the virus.
People can reduce the risk of contracting hepatitis A from raw fruits and vegetables by washing them thoroughly and peeling them before eating them. In high-risk countries, travellers should wash and peel their own fruits and vegetables.
Shellfish
Shellfish like clams, mussels, oysters and scallops absorb nutrients by filtering them through the water in which they live. If they’re grown in water contaminated by sewage, they can extract the hepatitis A virus from it.
To reduce the risk of contracting hepatitis A, Canadians are advised to buy shellfish from licensed sellers and cook it in boiling water for at least five minutes before eating.
Raw or undercooked meat and poultry
Normally, hepatitis A isn’t transmitted through meat or poultry because cooking kills the virus. However, if meat is contaminated with hepatitis A as it's being handled, packed or processed, and isn’t cooked well, the virus can survive and infect people who eat it.
Milk and dairy products
Milk that hasn’t been sufficiently pasteurized can contain the hepatitis A virus. Milk can be contaminated the same way meat and produce can, but pasteurization usually kills the hepatitis virus.
Dairy products that contain raw or incompletely pasteurized milk can also be a source of transmission.
Ice
Ice that’s made with contaminated water can transmit hepatitis A.
Travellers to high-risk countries should avoid ice unless they can be sure it’s made with safe water. Water should be bottled from a reliable source or boiled before it’s consumed or used to prepare food.
Sandwiches
Because sandwiches often contain raw vegetables and other fillings that aren't heated before consumption, they are easy candidates for spreading hepatitis A. Sandwiches have been the source of at least one outbreak of food-borne hepatitis A. such as a case where two infected cafeteria workers spread the disease to 73 people.
Smoothies and juice
Smoothies and fresh juices aren’t always pasteurized. If smoothies contain contaminated fruits, such as blueberries or strawberries, they can cause hepatitis A. For instance, an outbreak that affected over 50 people in 2016 was linked to strawberries from a smoothie restaurant.
Sun-dried tomatoes
Sun-dried tomatoes have been linked to several hepatitis A outbreaks. Sun-dried tomatoes aren’t heat-processed and retain moisture, which can help the virus survive during transport to grocery stores and restaurants.
Although hepatitis A transmission from food is fairly rare in Canada, it does occasionally happen. It's also important to take the right precautions against the virus while traveling.
Overall, the best protection from the virus is getting vaccinated and practicing good hygiene.
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