Berry contagious: Use of post-exposure prophylaxis to respond to an outbreak of hepatitis A associated with frozen imported berries in Canada

Résumé fourni par la source

Background: In April 2016, the Public Health Agency of Canada received reports of three locally-acquired cases of hepatitis A in one province who reported consuming frozen berries sold by a common retail chain.Subsequently, cases of hepatitis A with frozen berry consumption in other provinces were reported, and all illness onsets were within an eight-week period.Objective: To conduct a national outbreak investigation with provincial and federal partners to identify the source, and determine appropriate public health measures.Methods: Epidemiological data were collected through case interviews and purchase history records were obtained from the retailer.Hepatitis A virus (HAV) genotyping and ribonucleic acid (RNA) fingerprinting identified outbreak-related cases.The food safety investigation included traceback, traceforward, and testing of the suspected product.Outcome: Of the 25 confirmed cases, 21 were genotyped, revealing a multi-strain outbreak: 16 were genotype 1B with identical RNA fingerprints; and five cases were genotype 1A with nearly identical RNA fingerprints.Epidemiologic evidence implicated a frozen berry blend (Product A).Hepatitis A virus was detected in a closed retail sample, an open sample from a case's home and a blackberry input.Product A was recalled, and post-exposure prophylaxis was offered.More than 11,000 people were vaccinated by the retailer and public health units.In September 2016, a new cluster of hepatitis A cases matching the outbreak strain was identified; the index case had consumed recalled product.Conclusion: Rapid epidemiologic investigation, purchase history records, traceback evidence, retailer cooperation and collaboration between public health partners facilitated rapid identification and product recall.

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