Loading...
In 2013, 165 patients with hepatitis A were identified in 10 states; 69 of them were hospitalized, including 2 with fulminant hepatitis. Most were aged 40 to 64. Initial interviews and food histories implicated a frozen-fruit mixture. As part of the investigation, serum or stool samples from outbreak-related cases were subjected to RNA extraction and genetic sequencing; hepatitis A virus genotype IB — common in the Middle East but rare in the U.S. — was recovered from 98%. The fruit mixture, sold in 3-pound bags, was determined to include cherries from the U.S., strawberries from Argentina, and pomegranate arils from Turkey.
The epidemiologic investigation and the IB genotype implicated the pomegranate arils as the outbreak source, although …