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What is Hepatitis A ?

This is an update post for public safety. This article was produced for the purpose of knowledge and education, NOT to cause panic, fear, or harm. Please be responsible with the information you collect, check all sourcers, and keep up on outbreak status in your area via the link below. (* = date of reporting [7.5.23])

Hepatitis A (HAV) - what you should know

As of June 14, 2023*, 9 hepatitis A (HAV) outbreaks were reported in the following 3 states, 9/9 cases have been linked to consumption of frozen strawberries, and 3 individuals have been administered to the hospital. [1]

  • California

  • Oregon

  • Washington

The first reported case was on November 24, 2022, meanwhile the CDC has been tracking Hepatitis A outbreaks since 2017. Since then 37 states have reported a total of 44,866 cases. [2]

Hepatitis A is picornavirus (aka. an RNA virus) and is one of the most common "acute viral diseases" in the world. It is spread primarily through fecal-oral contamination via person-to-person contact. [2,5,6]

However, food exported from countries where rates of infection are higher, and where the food exported cannot be sterilized properly (i.e. heated to a temperature of viral inactivity) such as frozen strawberries, may be a main cause of outbreak for developed countries. [5]

In recent years outbreaks of hepatitis A have been increasing in both America and Europe, all of which have been linked to frozen foods. [6]

Why these foods are becoming infected with the hepatitis virus is unknown [6] through it may be related to poor irrigation and fertilization practices.

How is hepatitis A (HAV) contracted?

Person-to-Person Contact (uncommon)

Roughly 1/4 of all outbreaks can be attributed to direction personal contact. In most areas where there are high rates of infection, the majority of cases are attributed to children younger than 7 years old.[5] Although most children are asymptomatic, the virus itself - which is excreted through fecal matter - can remain on surfaces for as little as 3 months and up to 11.

Food-Borne Hepatitis A (uncommon)

In a large peer-reviewed study published in 2020 which reviewed 272 research reports regarding hepatitis A, produced the following statement:

"Spread of hepatitis A has been reported in the United States and Europe following consumption of contaminated lettuce, ice slush beverages, frozen strawberries and salad food items.

The global movement of food items that cannot be heated for viral inactivation may be a major cause of outbreaks in developed countries in the future. The recent multistate outbreak of hepatitis A following the illegal use of non-U.S. produce in school lunches illustrates the problem." (Walter, et al. 2020)

Drugs/Needles/Transfusions (uncommon)

According to CDC information for 2017, there were more than 3366 reported cases linked to a large outbreak among drug-addicted people and individuals experiencing homelessness (CDC 2017). [4] Not entirely "rare" due to outbreak size, this is still a very uncommon transmission occurrence.

Anal-To-Mouth (uncommon)

Studies which cited this as a source used the term "homosexual transmission". I decided not to use this as it doesn't really have anything to do with homosexuals. Anyone who participates in anal sex followed by oral sex is at an increased risk of transmission. [4]

Water (rare)

Albeit extremely rare, there have been reports of sewage water contaminating pools. Again, this is extremely rare and can predominantly be attributed to accidental causes. [4] Hepatitis E is much more common form of hepatitis transmitted through water.

Hospital (rare)

Another possible but extremely rare scenario, there was one reported case of a motorcyclist brought in to a hospital on traumatic injury. This patient was apparently asymptomatic with hepatitis A and was accidently transmitted to several other patients in the area. This was the only reported case where this had happened.

What do you do if you have hepatitis A?

The virus primarily affects developing countries [3] due to lack of sanitation and universal inoculation.

In these areas where infection is high, adults are largely immune to the disease, although outbreaks in America and Europe have been steadily increasing.

Still, in more developed countries such as America the rate of infection remains relatively low due to safety protocols enacted by CDC and the American Academy of Pediatrics (AAP) which requires all children aged 12-23 months old be vaccinated. [4]

One study cited by the CDC and published in 1996 states that "hepatitis A vaccine used without immune globulin halted an established epidemic of hepatitis A".

This was found to be effective for both short- and long-term inoculation. [8,9]

A note from the CDC:

If you are a state or local health department with questions about outbreak investigation, management, and/or specimens, please email DVH staff.

If you are a practicing clinician with a concern about a potential case of hepatitis A virus infection, please contact your local or state health department.

For all other inquiries, please contact CDC-INFO at 800-CDC-INFO (800-232-4636), TTY: 888-232-6348 or Email CDC-INFO


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