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

Questions and Answers about hepatitis A virus and hepatitis A vaccination in regards to the multi-state outbreak investigation of hepatitis A

1. What is Hepatitis A?
   Hepatitis A is a liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces or stool of an infected person.
2. Can Hepatitis A virus infection be prevented if a person has been exposed to the Hepatitis A virus from contaminated food or water?
   It depends. If the exposure occurred within the last 14 days, a dose of Hepatitis A vaccine or immune globulin (IG) can prevent illness. Vaccination after 14 days is not believed to help prevent a person from getting hepatitis A.
3. What vaccine is needed to prevent Hepatitis A virus infection from contaminated food or water?
   The vaccine or shot that is used depends upon a person’s their age and health status. Two different shots may be used: the hepatitis A vaccine and a different type of shot called immune globulin (IG). IG is a substance that helps boost a person’s immune system. Healthy persons between the ages of 12 months – 40 years should receive Hepatitis A vaccine. Persons older than 40 years of age should preferably receive immune globulin, although Hepatitis A vaccine can be used if immune globulin cannot be obtained. Children less than 12 months of age, immunocompromised persons, persons with chronic liver disease, and persons for whom Hepatitis A vaccine is contraindicated should receive immune globulin..
4. What is CDC’s recommendation regarding vaccination for people who have eaten the recalled products?
   As epidemiologic investigations have not linked Woodstock Organic Pomegranate Kernels to any cases of hepatitis A, evidence is lacking for wide-spread post-exposure prophylaxis. These additional products have not been linked to anyone known to be ill with hepatitis A. This additional product was recalled as a precaution.
   
   An epidemiologic investigation has linked Townsend Farms Organic Antioxidant Blend frozen berry and pomegranate mix to cases of hepatitis A. The Harris Teeter Organic Antioxidant Blend is the same product sold under a different brand. If you have eaten either the Townsend Farms Organic Antioxidant Blend frozen berry and pomegranate mix or the Harris Teeter Organic Antioxidant Blend within the last 14 days, you need to get the hepatitis A vaccination.
5. If I am getting the Hepatitis A vaccine to prevent infection, do I need another dose in the future?
   If your healthcare provider determines that you should receive Hepatitis A vaccination, you should receive a second dose of vaccine 6 months after the first dose.
6. Do I need blood tests after getting Hepatitis A vaccine or immune globulin (IG)?
   Blood tests are not routinely recommended for persons after receiving Hepatitis A vaccine or immune globulin (IG).
7. I am pregnant. Is it safe for me and my unborn baby to receive vaccination for protection against Hepatitis A? Is it safe for me and my unborn baby to receive immune globulin (IG) for protection against Hepatitis A?
   The safety of Hepatitis A vaccination during pregnancy has not been determined. Since the vaccine contains inactive Hepatitis A virus, the risk to the developing fetus is expected to be low. The benefits and risks of vaccination should be discussed with your health care provider. Pregnancy and breast feeding are not contraindications to vaccination or receiving immune globulin (IG).
8. If I ate Townsend Farms Organic Antioxidant Blend frozen berry and pomegranate mix or Harris Teeter Organic Antioxidant Berry Blend and am breastfeeding my infant, can I continue to breastfeed?
   Breastfeeding women who ate the food product that might have been contaminated with Hepatitis A virus should usually receive Hepatitis A vaccine, if the product was eaten within the last 14 days. If a woman develops Hepatitis A, the Hepatitis A virus can be found in breast milk but is not known to infect the infant. Mothers may continue to breastfeed. Infants who are less than 1 year of age and exposed to someone with Hepatitis A in their household should receive immune globulin (IG).
9. I still have some of the recalled food product in my refrigerator/freezer. What should I do with it?
   The food product should be thrown away. Even if some of the product has been eaten without anyone in your home becoming ill, the rest of the food product should be thrown away.
10. My child who is less than 1 year old ate some of the Townsend Farms Organic Antioxidant Blend frozen berry and pomegranate mix? Can he/she receive Hepatitis A vaccination?
    Most infants are not sick with Hepatitis A infection, but can transmit the infection to other members of the household. CDC does not recommend Hepatitis A vaccination for infants less than 12 months of age. However, immune globulin (IG) is effective for preventing Hepatitis A in children younger than 12 months of age. Giving Hepatitis A vaccine to children younger than 12 months of age is safe, but might not be as effective as when the vaccine is given at the recommended age (12-23 months). All children should start to receive the Hepatitis A vaccine series when they reach 12 months of age.
11. I am older than 40 years of age. Should I receive Hepatitis A vaccine or immune globulin (IG) or both?
    For healthy persons over 40 years of age who ate Townsend Farms Organic Antioxidant Blend frozen berry and pomegranate mix or the Harris Teeter Organic Antioxidant Berry Blend in the last 14 days, immune globulin (IG) is preferred for preventing Hepatitis A infection. However, Hepatitis A vaccine can be used if immune globulin cannot be obtained.
12. I received one dose of Hepatitis A vaccine several years ago. Should I receive another dose now to complete the series?
    Hepatitis A vaccines are generally administered in a series of two or three vaccine doses. Persons who received one dose of Hepatitis A vaccine in the past should complete the vaccine series.
13. I received Hepatitis A vaccine series (2 or 3 doses) in the past. Do I need a booster dose?
    Hepatitis A vaccines are generally administered in a series of two or three vaccine doses, depending on the particular type of vaccine. Persons who have completed a Hepatitis A vaccine series in the past do not need to receive a booster dose. Persons who do not have a normal immune system and ate the food product that might be contaminated with Hepatitis A should consult their provider to determine if they require immune globulin (IG).
14. I received one dose of Hepatitis A vaccine in the past. My provider wants to give me a different kind of Hepatitis A vaccine to complete the series. Is that OK?
    Yes, finishing the vaccine series with a different kind of Hepatitis A vaccine is acceptable.
15. I was planning to get the Hepatitis B vaccine. Can I get the combination Hepatitis A-Hepatitis B vaccine (3 shots) now for protection against Hepatitis A?
    The combination Hepatitis A-Hepatitis B vaccine is NOT recommended for preventing Hepatitis A infection in someone who recently ate food that was possibly contaminated with Hepatitis A virus.
16. How long do I have to wait to get the second dose of Hepatitis A vaccine?
    The answer depends on the type of Hepatitis A vaccine. For Hepatitis A vaccines that are not part of the combination Hepatitis A-Hepatitis B vaccine, the second dose is generally administered 6 months after the first dose.
17. If I ate a food product that was similar to the contaminated product what should I do?
    If you are sure that you ate a different product than the one possibly contaminated with Hepatitis A virus, you do not need to do anything. If you are concerned, discard the product. You may check the FDA or CDC websites for more information about the recalled products that might be contaminated.
18. What are the symptoms of Hepatitis A?
    • Yellow eyes or skin
    • Abdominal pain
    • Pale stools
    • Dark urine
    • Fever
    • Tiredness
    • Loss of appetite
    • Nausea/vomiting
    • Joint pain
19. How is Hepatitis A spread?
    Hepatitis A can be spread by eating or drinking food or water contaminated with the virus, including frozen or undercooked food. It may also be spread person-to-person, such as when an infected person does not wash his or her hands properly after going to the bathroom and touches other objects or food, or when a parent or caregiver does not properly wash his or her hands after changing diapers or cleaning up the stool of an infected person. It may also be spread from certain sexual activities.
20. Where can I find additional information?
    Additional information can be found from the CDC website at http://www.cdc.gov/Hepatitis/HAV/HAVfaq.htm#protection
    You may also contact your local or state health department for additional information.

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