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. 2019 Jan:147:e74.
doi: 10.1017/S0950268818003515.

Outbreak of hepatitis A genotype IB in Australia associated with imported frozen pomegranate arils

N Franklin  1 , H Camphor  2 , R Wright  3 , R Stafford  4 , K Glasgow  1 , V Sheppeard  1
Affiliations

Outbreak of hepatitis A genotype IB in Australia associated with imported frozen pomegranate arils

N Franklin et al. Epidemiol Infect. 2019 Jan.

Abstract

Locally acquired hepatitis A infection is re-emerging in Australia owing to person-to-person outbreaks among men who have sex with men and imported frozen produce. This paper describes a multi-state foodborne outbreak in the first half of 2018. Enhanced human epidemiological investigation including a case-control study, as well as microbial surveillance and trace-back investigations concluded that the outbreak was caused by consumption of imported frozen pomegranate arils. A total of 30 cases of hepatitis A infection, genotype IB with identical sequences met the outbreak case definition, including 27 primary cases and three secondary cases. Twenty-five (83%) of the cases were hospitalised for their illness and there was one death. Imported frozen pomegranate arils from Egypt were strongly implicated as the source of infection through case interviews (19 of 26 primary cases) as well as from a case-control study (adjusted odds ratio 43.4, 95% confidence interval 4.2-448.8, P = 0.002). Hepatitis A virus (HAV) was subsequently detected by polymerase chain reaction in two food samples of the frozen pomegranate aril product. This outbreak was detected and responded to promptly owing to routine genetic characterisation of HAVs from all hepatitis A infections in Australia as part of a national hepatitis A enhanced surveillance project. This is now the third outbreak of hepatitis A in Australia from imported frozen fruits. A re-assessment of the risk of these types of imported foods is strongly recommended.

Keywords: Disease outbreaks; foodborne infections; hepatitis A.

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Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
Weekly epidemic curve of confirmed outbreak cases by onset date (n = 30).
Fig. 2.
Fig. 2.
Weekly epidemic curve of primary outbreak cases with food exposure information by onset date and pomegranate aril consumption (n = 26).
See this image and copyright information in PMC

References

    1. Heymann DL (2004) American Public Health Association. Control of Communicable Diseases Manual: An Official Report of the American Public Health Association, 18th Edn. Washington, DC: American Public Health Association.
    1. Australian Government Department of Health. National Notifiable Diseases Surveillance System. Available at http://www9.health.gov.au/cda/source/cda-index.cfm (Accessed 30 June 2018).
    1. Australian Technical Advisory Group on Immunisation (ATAGI) (2017) Hepatitis A In The Australian Immunisation Handbook 10th ed (2017 update). Canberra: Australian Government Department of Health, pp. 113–117.
    1. Conaty S et al. (2000) Hepatitis A in New South Wales, Australia from consumption of oysters: the first reported outbreak. Epidemiology and infection 124, 121–130. - PMC - PubMed
    1. Donnan EJ et al. (2012) A multistate outbreak of hepatitis A associated with semidried tomatoes in Australia, 2009. Clinical Infectious Diseases 54, 775–781. - PubMed