A total of 70 people have been reported from Maryland (6), New York (1), North Carolina (1), Oregon (1), Virginia (55), West Virginia (5), and Wisconsin (1) and 32 people have been hospitalized.
According to food history interviews, nearly all ill people drank smoothies containing strawberries at Tropical Smoothie Cafés in Maryland, North Carolina, Virginia and West Virginia.
More than 100 cases from 14 countries reported Hepatitis A in people returning from Egypt between November 2012 and April 2013, with strawberries or mangoes suspected to be the vehicle, according to a study in Eurosurveillance.
Illness onset in May, investigation in August
The investigation began in early August after The Virginia Department of Health identified an outbreak of hepatitis A cases linked to smoothies from Tropical Smoothie Café.
However onset of illness for the cases in Virginia ranges from early May to August.
Tropical Smoothie Café pulled strawberries sourced from Egypt from cafes and is now sourcing them from Mexico and California.
The café said its supplier sourced fruit from various geographies to meet volume needs of the business.
An employee at the Tropical Smoothie Café Restaurant at 8069 Stonewall Shops Square in Gainesville, Virginia, was diagnosed with hepatitis A.
VDH said people eating at the restaurant from July 28 to August 18 may have been exposed.
With an incubation period of 15 - 50 days for Hepatitis A, there is a possibility additional cases may arise from people who consumed Egyptian strawberries before August 8.
It can range in severity from a mild illness lasting a few weeks to a severe one lasting several months.
The Centers for Disease Control and Prevention (CDC) said it was not aware of other restaurants that received frozen strawberries linked to the outbreak.
Frozen strawberries used at Tropical Smoothie Café were collected for testing. The FDA’s analysis results are pending.
FDA said it had been in touch with the Egyptian International Health Regulations National Focal Point to discuss the investigation and has increased surveillance of imported strawberries.
Investigations are continuing to determine which specific lots may have been contaminated and to find out if the frozen strawberries were distributed to other US customers.