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A 2019 Outbreak Investigation of Hepatitis A Virus Infections in the United States Linked to Imported Fresh Blackberries |
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| Authors: | McClure Monica Nsubuga Johnson Montgomery Martha P Jenkins Erin Crosby Alvin Schoelen Daniela Basler Colin Ramachandran Sumathi Lin Yulin Xia Guo-liang Khudaykov Yury Suktankar Vilasini Wagley Angela Thomas Vincent Woods Jacquelina Hintz Leslie Oliveira Janete Sandoval Ana Lilia Frederick Justin Hendrickson Blake Gieraltowski Laura Viazis Stelios |
| Institution: | 1.Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, USA ;2.Centers for Disease Control and Prevention, Atlanta, GA, USA ;3.Office of Regulatory Affairs, Food and Drug Administration, Southeast Food and Feed Laboratory, Atlanta, GA, USA ;4.Center for Food Safety and Applied Nutrition, Food and Drug Administration, Dauphin Island, AL, USA ;5.Office of the Commissioner, Food and Drug Administration, Silver Spring, MD, USA ;6.Douglas County Health Department, Omaha, NE, 68105, USA ;7.Nebraska Department of Health and Human Services, Lincoln, NE, 68509, USA ; |
| Abstract: | Globally, hepatitis A virus (HAV) is one of the most common agents of acute viral hepatitis and causes approximately 1.4 million cases and 90,000 deaths annually despite the existence of an effective vaccine. In 2019, federal, state, and local partners investigated a multi-state outbreak of HAV infections linked to fresh blackberries sourced from multiple suppliers in Michoacán, Mexico. A total of 20 individuals with outbreak-related HAV infection were reported in seven states, including 11 hospitalizations, and no deaths. The Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and Nebraska State and Douglas County Health Departments conducted a traceback investigation for fresh blackberries reportedly purchased by 16 ill persons. These individuals reported purchasing fresh blackberries from 11 points of service from September 16 through 29, 2019 and their clinical isolates assessed through next-generation sequencing and phylogenetic analysis were genetically similar. The traceback investigation did not reveal convergence on a common grower or packing house within Mexico, but all of the blackberries were harvested from growers in Michoacán, Mexico. FDA did not detect the pathogen after analyzing fresh blackberry samples from four distributors, one consumer, and from nine importers at the port of entry as a result of increased screening. Challenges included gaps in traceability practices and the inability to recover the pathogen from sample testing, which prohibited investigators from determining the source of the implicated blackberries. This multi-state outbreak illustrated the importance of food safety practices for fresh produce that may contribute to foodborne illness outbreaks. |
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