By Joe Whitworth  https://www.foodsafetynews.com/author/jwhitworth/ on May 1, 2019

Officials are investigating an outbreak of Hepatitis A https://www.fda.gov/food/foodborne-pathogens/bad-bug-book-second-edition

 in Sweden related to dates from Iran that are suspected to be the source of the infections.

The Public Health Agency (Folkhälsomyndigheten), https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/

and National Food Agency (Livsmedelsverket), https://www.livsmedelsverket.se/en

the relevant infectious disease units and municipalities are investigating to identify the source of infections.

Officials from Folkhälsomyndigheten and Livsmedelsverket told Food Safety News https://www.foodsafetynews.com

that hepatitis A cases are reported to the national database. At that point the suspected source of infection is often unknown.

“We observed an increase of domestically acquired hepatitis A virus infections with genotype IIIA strains, a genotype which we usually associate with travel-related cases in Sweden,” they said.

Since the end of February, nine cases of the viral infection have been linked to the outbreak, with the last one reported on April 16. Eight of the patients are confirmed and have the same type of hepatitis A infections from the genotype IIIA, which is also known as 3A. The ninth patient’s infection is suspected to be the same.

Patients are between the ages of 28 and 73. Five are men and four are women. They are from seven counties: Örebro, Stockholm, Uppsala, Skåne, Södermanland, Kalmar, and Halland.

The investigation has not yet identified one brand of dates or a joint producer.

“The cases (patients) reported consumption of dates https://www.foodsafetynews.com/tag/hepatitis-a-outbreak/

of different brands from different suppliers on the Swedish market but all dates are from Iran. Cases have bought dates from different supermarkets. The regional departments of communicable disease control are interviewing the cases. The dates have a long shelf life so it´s still too early to say that the outbreak is over.”

Outbreak in Denmark last year
In eight confirmed outbreak patients in 2018, four different strains from genotype IIIA were detected. Two of the Swedish patients have similar virus strains to those found in an outbreak in Denmark in 2018 linked to dates from Iran.

In the Danish outbreak, 27 people fell ill from December 2017 to February 2018, with 22 admitted to hospitals. Dates from Iran were imported by RM Import A/S and sold in Rema1000. Norway also reported one case as part of the outbreak.

In the 2018 outbreak, several variants of genotype IIIA strains were detected in patients. One of the outbreak strains was also detected in dates.

 

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Folkhälsomyndigheten and Livsmedelsverket reported there are no ISO methods for detection of Hepatitis A on dates.

“The National Food Agency has used a similar method as Denmark used last year when they were able to detect hepatitis A virus in dates. After steps of elution with wash buffer and concentration of the virus, molecular analyses with PCR (polymerase chain reaction) is used to detect the virus. So far no viruses have been found in the different samples of dates but further analyses are ongoing,” according to agency officials.

Representatives from the agencies confirmed they had shared information on the outbreak strains with the European Centre for Disease Prevention and Control, but no other countries had seen them so far this year.

Additional consumer information on hepatitis A https://www.cdc.gov/hepatitis/outbreaks/hepatitisaoutbreaks.htm

Hepatitis A is a viral liver disease that can cause mild to severe illness, including liver failure. It can take up to 50 days for symptoms to appear. Some infected people don’t develop symptoms at all, but they are contagious and can easily contaminate foods and beverages they prepare or otherwise handle.

The hepatitis A virus (HAV) can also be transmitted through direct contact with an infectious person.

The incubation period is usually 14 to 28 days. Symptoms include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine, and jaundice, which is a yellowing of the skin and whites of the eyes. Recovery following infection may be slow and take several weeks or months. For more contact food handlers permit process.

The outbreak of Salmonella Infections Linked to Pre-Cut Melons

ttps://www.cdc.gov/salmonella/carrau-04-19/index.htmlCDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella Carrau infections linked to pre-cut melons supplied by Caito Foods LLC.

At A Glance:

• Reported Cases: 117
• States: 10             
• Hospitalizations: 32
• Deaths: 0
• Recall: Yes

Do not eat, serve, or sell recalled pre-cut melon and fruit medley products produced by Caito Foods LLC and sold under several brands and labels.

On April 12, 2019, Caito Foods LLC 

Recalled pre-cut watermelon, honeydew melon, cantaloupe, and pre-cut fruit medley products containing one of these melons supplied at the Caito Foods LLC facility in Indianapolis, Ind.

Recalled pre-cut melons were packaged in clear, plastic clamshell containers. The products were distributed in Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, New York, North Carolina, Ohio, Pennsylvania, Tennessee, West Virginia, and Wisconsin.

These products were sold at Kroger under the Renaissance Food Group label and the Boar’s Head private label; at Target under the Garden Highway Label; at Trader Joe’s under the Trader Joe’s label; at Walmart under a Freshness Guaranteed label; and at Amazon/Whole Foods under the Whole Foods Market label.

Check FDA’s website for a full list of where recalled products were sold. If you cannot determine if any pre-cut melon you purchased was produced by Caito Foods LLC, don’t eat it and throw it away.

Check your fridge and freezer for recalled products and throw them away or return them to the place of purchase for a refund. Follow these steps to clean your fridge lif you had any recalled product.

Contact a healthcare provider if you think you got sick from consuming pre-cut melon.

• Most people infected with Salmonella develop the following signs and symptoms 12 to 72 hours after eating a contaminated product:
  • Diarrhea
  • Fever
  • Abdominal cramps

 

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Latest Outbreak Information

• A total of 117 people infected with the outbreak strain of Salmonella Carrau have been reported from 10 states.
  • Illnesses started on dates ranging from March 4, 2019 to April 8, 2019.
  • 32 people have been hospitalized. No deaths have been reported.
  • Most of the ill people are adults over the age of 50 years.
• Epidemiologic and traceback evidence https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/index.html indicates that pre-cut melons supplied by Caito Foods LLC is the likely source of this outbreak.
• On April 12, 2019, Caito Foods LLC recalled pre-cut watermelon, honeydew melon, cantaloupe, and pre-cut fruit medley products containing one of these melons produced at the Caito Foods LLC facility in Indianapolis, Ind.
• This investigation is ongoing, and CDC will provide updates when more information is available.

Investigation of the Outbreak

Epidemiologic and traceback evidence https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/index.html indicate that pre-cut melon supplied by Caito Foods LLC of Indianapolis, Ind. is the likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other Exposures  https://www.cdc.gov/features/solvingoutbreaks/index.htmlin the week before they became ill. Forty-six (73%) of 63 people interviewed reported eating pre-cut melons purchased at grocery stores, including pre-cut cantaloupe, watermelon, honeydew, or a fruit salad mix or fruit tray with melon. Five additional people reported eating pre-cut melon outside the home.

Information collected from stores where ill people shopped indicates that Caito Foods LLC supplied pre-cut melon to these stores. On April 12, 2019, Caito Foods, Inc. recalled pre-cut watermelon, honeydew melon, cantaloupe, and pre-cut fruit medley products containing one of these melons produced at the Caito Foods LLC facility in Indianapolis, Ind.

This investigation is ongoing, and CDC will provide updates when more information is available.