Multi-province hepatitis A outbreak linked to frozen berries (April 18, 2016)

Advisory Alert

April 18, 2016

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Further to the Advisory Alert issued to the Emergency Departments by the Sudbury & District Health Unit on April 16, 2016, the following Advisory Alert provides an update and important information.

To date, 13 cases have been reported in Canada, 10 of which have been reported in Ontario. No cases have been reported within the Health Unit’s service area. Persons who have never had a Hepatitis A infection, or have not been vaccinated with Hepatitis A vaccine may be at risk of developing infection.

Nature’s Touch Organic Berry Cherry Blend brand frozen berries was recalled from the marketplace on April 15, 2016, and was sold exclusively at Costco warehouse locations in Ontario, Quebec, New Brunswick, Nova Scotia, Newfoundland and Labrador.

The Health Unit will be hosting free hepatitis A vaccine clinics for eligible individuals within its service area who, within the last 14 days, consumed Nature’s Touch Organic Berry Cherry Blend brand frozen berries purchased from any Costco warehouse location between December 11, 2015, and April 15, 2016. For a list of clinic times and locations, please visit the Health Unit’s website at: www.sdhu.com.

Members of the public are being encouraged to contact their local public health unit or speak with their primary care provider should they have any questions or concerns related to potential hepatitis A exposure.

The SDHU will share updates via the Advisory Alert as additional information becomes available.

Additional details regarding the recall can be found on the Canadian Food Inspection Agency website at: http://www.inspection.gc.ca/about-the-cfia/newsroom/food-recall-warnings/complete-listing/2016- 04-15/eng/1460746426915/1460746429622.

PHAC has posted a Public Health Notice on their website at:

http://www.phac-aspc.gc.ca/phn-asp/2016/hepatitisa-eng.php. PHAC will provide updates to this Public Health Notice as additional information becomes available.

Clinical presentation

Hepatitis A usually results in an acute self‐limiting illness which only rarely leads to fulminant hepatitis. Those with underlying liver disease especially from chronic hepatitis C are at greatest risk of poor outcomes. Hospitalization may occur in up to 20% of those who are symptomatic. Children are usually asymptomatic with jaundice developing in less than 10% of children age 6 years and under. Adults typically present with more severe disease, characterized by 1 to 7 days of prodrome then abrupt onset of fever, malaise, anorexia, nausea and abdominal pain, often followed by jaundice. Infants and the elderly are at greatest risk of mortality.

Prevention, transmission and communicability

Individuals over the age of 12 months, without contraindications, who have consumed the affected product within the last fourteen days are eligible for HA vaccine. Select individuals may also benefit from immune globulin (Ig). The Health Unit can be contacted for further information.

For those previously vaccinated with hepatitis A vaccine:

• If two previous doses were provided, no additional doses are recommended.
• If one dose was provided less than 6 months ago, no additional doses are recommended until at least 6 months from the last dose.
• If one dose was provided 6 months or more in the past, one additional dose is recommended.

Hepatitis A virus (HAV) infection is transmitted primarily by the fecal‐oral route, through direct contact with infected people or indirectly through ingestion of contaminated water or foods. Transmission may also occur through sexual activities that include direct or indirect oral‐anal contact, but not through exposure to saliva, semen or urine.

The incubation period ranges from 15 to 50 days with an average of 30 days. Individuals are infectious throughout the incubation period and for about 7 days after jaundice appears.

Testing, Treatment and Exclusion

Laboratory detection of anti‐HAV IgM, in the absence of recent hepatitis A vaccination, confirms a case of hepatitis A. Serum should be collected in a red top tube and submitted for anti‐HAV IgM (antibody) and anti‐HAV Total (IgG and IgM combined antibody) testing. Treatment is supportive only.

Exclude individuals such as food handlers, childcare staff and attendees, and healthcare workers from high‐risk settings for 14 days after onset of symptoms, or 7 days after onset of jaundice, whichever comes earlier.

Reporting Under the Health Protection and Promotion Act, both suspected and confirmed cases of hepatitis A must be reported to the Medical Officer of Health. Laboratory‐confirmed cases should be reported immediately to the Health Unit by phone as soon as identified. Please report to 705.522.9200, ext. 464 (toll-free:1.866.522.9200) or after-hours to 705.688.4366.

For more detailed information on hepatitis A refer to the MOHLTC Infectious Disease Protocol, Appendix A: Disease‐Specific Chapters, 2015. A full copy can be accessed at: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/infdispro.aspx.

Sincerely,

P. Sutcliffe, MD, MHSc, FRCPC

Medical Officer of Health

This item was last modified on September 9, 2016