Multistate outbreak of hepatitis A virus infections linked to pomegranate seeds from Turkey (Final Update)

Highlights

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Epidemiologic Investigation:

This outbreak investigation has been finalized.

• 165 people were confirmed to have become ill from hepatitis A linked to pomegranate arils contained in ‘Townsend Farms Organic Antioxidant Blend’ in 10 states: Arizona (23), California (79), Colorado (28), Hawaii (8), New Hampshire (1), New Jersey (1), New Mexico (11), Nevada (6), Utah (3), and Wisconsin (2). [Note: The cases reported from Wisconsin resulted from exposure to the product in California, the cases reported from New Hampshire reported fruit exposure during travel to Nevada, and the case reported in New Jersey was a household contact of a confirmed case from Colorado.] Eight of the confirmed cases were household contacts of confirmed cases (secondary cases). One person was exposed to the same pomegranate arils in a different product, ‘Woodstock Frozen Organic Pomegranate Kernels.’
  • 90 (55%) ill people were women
  • Ages ranged from 1 – 84 years;
    • 94 (58%) of those ill were between 40 – 64 years of age.
    • 11 children age 18 or under were also ill. None were previously vaccinated.
  • Illness onset dates ranged from 3/31/2013 – 7/26/2013
  • 71 (44%) ill people were hospitalized, and no deaths were reported
  • All ill people who reported eating this product purchased it from Costco markets; however, the product was also sold at Harris Teeter stores. No ill people were identified that bought the product at Harris Teeter.

Laboratory Investigation:

Regulatory Investigation:

• By combining information gained from FDA’s traceback and traceforward investigations and the CDC’s epidemiological investigation, FDA and CDC have determined that the most likely vehicle for the hepatitis A virus appears to be a common shipment of pomegranate seeds from a company in Turkey, Goknur Foodstuffs Import Export Trading.
  • FDA detained shipments of pomegranate seeds from Goknur when they are offered for import into the United States.
  • These pomegranate seeds were used by Townsend Farms to make the Townsend Farms and Harris Teeter Organic Antioxidant Blends and by Scenic Fruit Company to make the Woodstock Frozen Organic Pomegranate Kernels.
  • FDA worked with the firms that have distributed pomegranate seeds from this shipment from Turkey to help ensure that all recipients of these seeds were notified.
• On June 4, 2013, Townsend Farms, Inc. of Fairview, Oregon voluntarily recalled certain lots of its frozen Organic Antioxidant Blend because of potential hepatitis A virus contamination.
  • On June 28, 2013, Townsend Farms, Inc. of Fairview, Oregon, expanded its voluntary limited lot recall of frozen Organic Antioxidant Blend, 3 lb. because of potential hepatitis A virus contamination.
• On June 26, 2013, Scenic Fruit Company of Gresham, Oregon recalled specific lots of Woodstock Frozen Organic Pomegranate Kernels because of potential hepatitis A virus contamination.
• Additional information regarding these recalls was updated regularly at: FDA Investigates Multistate Outbreak of Hepatitis A Illnesses Associated with Pomegranate seeds from Turkish Importer.
• Consumers should not eat recalled products containing pomegranate seeds. The recalled products should be discarded.

"Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study"
Melissa G Collier, MD , et al Lancet, Online version 3 September 2014

Also available is a printable manuscript

• Cases linked to pomegranate arils in ‘Townsend Farms Organic Anti-oxidant Blend’: 162
• States: 10*
• Deaths: 0
• Hospitalizations: 71
• Recall: Yes

*The cases reported from Wisconsin resulted from exposure to the product in California, and the cases reported from New Hampshire reported fruit exposure during travel to Nevada.

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