Journal of Food Protection (May 2025)
Investigation of Two Outbreaks of Hepatitis A Virus Infections Linked to Fresh and Frozen Strawberries Imported from Mexico – 2022–2023
- Monica McClure,
- Margaret Kirchner,
- Tiffany Greenlee,
- Sharon Seelman,
- Asma Madad,
- Johnson Nsubuga,
- Ana Lilia Sandoval,
- Timothy Jackson,
- Mary Tijerina,
- Grace Tung,
- Kurt Nolte,
- Alexandre J. da Silva,
- Jeffrey Read,
- Vanessa Noelte,
- Jacquelina Woods,
- Angela Swinford,
- Jessica L. Jones,
- Melanie LaGrossa,
- Crystal McKenna,
- Efstathia Papafragkou,
- Christine Yu,
- Oliver Ou,
- Megan G. Hofmeister,
- Christina R. Samuel,
- Robin Atkinson,
- Monica To,
- Alison Orr,
- Joyce Cheng,
- Jamie Borlang,
- Katherine Lamba,
- Brandon Adcock,
- Christian Bond,
- Michael Needham,
- Summer Adams,
- Genny Grilli,
- Laurie K. Stewart,
- Tasha Martin,
- Julie Wagendorf,
- Danni Pinnick,
- Erin Smilanich,
- Alida Sorenson,
- Augustina Manuzak,
- Monique Salter,
- Alvin Crosby,
- Stelios Viazis
Affiliations
- Monica McClure
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States; Corresponding author.
- Margaret Kirchner
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Tiffany Greenlee
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Sharon Seelman
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Asma Madad
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Johnson Nsubuga
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Ana Lilia Sandoval
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Timothy Jackson
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Mary Tijerina
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Grace Tung
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Kurt Nolte
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Alexandre J. da Silva
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Jeffrey Read
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Vanessa Noelte
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Jacquelina Woods
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Angela Swinford
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Jessica L. Jones
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Melanie LaGrossa
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Crystal McKenna
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Efstathia Papafragkou
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Christine Yu
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Oliver Ou
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Megan G. Hofmeister
- Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
- Christina R. Samuel
- Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
- Robin Atkinson
- Canadian Food Inspection Agency, Ottawa, Ontario, Canada
- Monica To
- Canadian Food Inspection Agency, Ottawa, Ontario, Canada
- Alison Orr
- Canadian Food Inspection Agency, Ottawa, Ontario, Canada
- Joyce Cheng
- Public Health Agency of Canada, Guelph, Ontario, Canada
- Jamie Borlang
- Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Katherine Lamba
- California Department of Public Health, Sacramento, CA 95899, United States
- Brandon Adcock
- California Department of Public Health, Sacramento, CA 95899, United States
- Christian Bond
- California Department of Public Health, Sacramento, CA 95899, United States
- Michael Needham
- California Department of Public Health, Sacramento, CA 95899, United States
- Summer Adams
- California Department of Public Health, Sacramento, CA 95899, United States
- Genny Grilli
- Minnesota Department of Health, St. Paul, MN 55164, United States
- Laurie K. Stewart
- Washington State Department of Health, Shoreline, WA 98155, United States
- Tasha Martin
- Oregon Health Authority Public Health Division, Portland, OR 97232, United States
- Julie Wagendorf
- North Dakota Department of Health and Human Services, Bismarck, ND 58505, United States
- Danni Pinnick
- North Dakota Department of Health and Human Services, Bismarck, ND 58505, United States
- Erin Smilanich
- Minnesota Department of Agriculture, St. Paul, MN 55155, United States
- Alida Sorenson
- Minnesota Department of Agriculture, St. Paul, MN 55155, United States
- Augustina Manuzak
- Hawaii Department of Health, Honolulu, HI 96813, United States
- Monique Salter
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Alvin Crosby
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- Stelios Viazis
- Food and Drug Administration, Human Foods Program, College Park, MD 20740, United States
- DOI
- https://doi.org/10.1016/j.jfp.2025.100505
- Journal volume & issue
-
Vol. 88,
no. 6
p. 100505
Abstract
Foodborne hepatitis A illnesses and outbreaks have been associated with the consumption of ready-to-eat foods contaminated with the feces of person(s) shedding hepatitis A virus (HAV). Outbreaks have been linked to fresh and frozen produce imported from countries where HAV is endemic, hygiene and sanitation are inadequate, or food safety standards are lacking or unenforced. In 2022 and 2023, federal, state, and international partners investigated two multijurisdictional outbreaks of infections involving the same HAV genotype IA strain linked to fresh and frozen organic strawberries sourced from a single grower in Baja California, Mexico. These resulted in 39 reported cases in the U.S. and Canada, 21 hospitalizations, and no reported deaths. The United States Food and Drug Administration (FDA), Canadian Food Inspection Agency, and U.S. state partners conducted traceback investigations for fresh strawberries in 2022, while FDA and U.S. state partners traced back frozen strawberries in 2023. Based on the traceback investigations, implicated strawberries were harvested during the 2022 growing season and sold to fresh and frozen berry markets. During a farm inspection in Mexico in 2023, gaps were observed in agricultural practices that could have contributed to the contamination of strawberries with HAV. FDA did not detect HAV in the two frozen strawberry samples linked to the recalled lots or environmental water samples collected at the implicated grower in 2023; no samples were collected during the 2022 investigation. Indicator organisms associated with human fecal contamination (male-specific coliphage and crAssphge) were detected in environmental water. Challenges in these investigations included limited recall of food exposures, exposures associated with multiple purchase dates, commingling of strawberries within the frozen market supply chains, and complexities with communicating these outbreak investigations to the public.
Keywords
