Public health response overview and questions and answers related to hepatitis A cases linked to Costco’s Nature’s Touch Organic Berry Cherry Blend frozen berries

An ongoing multi-province hepatitis A outbreak investigation has been linked to Costco’s Nature’s Touch Organic Berry Cherry Blend frozen berries, resulting in the product being recalled from the marketplace on April 15, 2016. To date, 13 cases have been reported in Canada, 10 of which have been reported in Ontario. No cases have been reported within the Sudbury & District Health Unit (SDHU) service area. Additional details regarding the recall can be found on the Canadian Food Inspection Agency website.

The SDHU learned of the recall on Friday, April 15. It was reported that Costco is collaborating with the Public Health Agency of Canada (PHAC) and the provinces where the product was sold. PHAC advised that Costco is contacting customers who purchased Nature’s Touch Organic Berry Cherry Blend to advise them of the recall. It was also reported that Costco would be contacting customers a second time to advise them to speak with a physician. Further, Costco would be offering post-exposure immunization to eligible individuals. Health units were asked to share this information with area health care providers which the SDHU did on Saturday, April 16.

On Friday, April 15, the SDHU posted information to Twitter and Facebook using its corporate accounts to distribute information about the recalled product. Additional tweets were sent on Saturday, April 16 with information supplied by the CFIA. In addition, on Monday, April 18, the SDHU decided to proactively provide additional information to the public about this recall and to organize its own immunization clinics. This information was shared via a news release issued to all media within the SDHU service area, as well as SDHU corporate social media account (Twitter and Facebook).

The Sudbury & District Health Unit is advising members of the public who consumed Costco’s Nature’s Touch Organic Berry Cherry Blend frozen berries in the last 14 days to get a hepatitis A vaccination as soon as possible. This advisory concerns any of this product that was purchased from any Costco location in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador between December 11, 2015, and April 15, 2016. It applies only to individuals who have not been previously fully vaccinated against hepatitis A. The Health Unit is holding free hepatitis A vaccine clinics for individuals affected by this advisory.

The Health Unit is also asking anyone who ate the recalled product to monitor for signs and symptoms, practise thorough handwashing and contact their health care provider if concerned. Symptoms may include fever, stomach pain, dark urine, nausea and vomiting, loss of appetite, clay or ash-coloured bowel movements, and jaundice. They can occur from 15 to 50 days following exposure, but usually occur within 28 to 30 days.

The Health Unit is advising the public not to eat the recalled product and to dispose of it or return it to the point of purchase.

What should I do if I served the recalled product to other people?

Individuals who have served recalled product to others including patrons of food premises, family, friends and colleagues are encouraged to communicate this potential exposure to the Health Unit or with these individuals directly.

Was the recalled product served as free samples at the Costco warehouse location in Greater Sudbury?

Yes. The Health Unit has learned through its investigation that free samples of this product were served to people at the Costco warehouse location in Greater Sudbury on March 22 and 23, 2016. The product served is part of the current recall. Because the samples were served on March 22 and 23, and the 14-day  period for vaccination has now passed. However, people are advised to monitor their health for signs and symptoms of hepatitis A infection and to follow-up with their health care provider if they have any concerns.

What is hepatitis A?

Hepatitis A is a virus that causes liver infection. Symptoms can last from a few weeks to several months. The virus is not known to cause long­ term (chronic) infection and is rarely fatal. Most people develop lifetime immunity following infection.

What are the symptoms of hepatitis A infection?

Symptoms typically begin 28 to 30 days following infection but can begin as soon as 15 days or as late as 50 days following exposure. The severity of symptoms can range from mild to severe. Some infected individuals do not exhibit any symptoms.

Symptoms can include:

  • fever
  • stomach pain or discomfort
  • dark urine
  • nausea/vomiting
  • diarrhea
  • tiredness
  • loss of appetite
  • clay or ash-coloured bowel movements
  • jaundice (yellowing of the skin and whites of the eyes)

Can a person spread hepatitis A without having symptoms?

Yes. Some infected people, especially children, experience no symptoms. In addition, a person can transmit the virus to others up to 2 weeks before symptoms appear.

Can people become chronically (life-long) infected with hepatitis A virus?

No. Chronic infection is not known to occur. Hepatitis A only causes acute (recently acquired) infection. Some individuals may experience a relapse of symptoms 4 to 15 weeks after the initial symptoms have resolved; however, this is not a chronic infection.

How is hepatitis A spread?

The virus is usually found in the feces (stool) of a person infected with hepatitis A. It can be spread from person to person when hands are not properly washed following contact with infected stool (for example, after using the toilet or changing a diaper). The virus can also be spread by eating food or drinking water contaminated by an infected food handler, or by eating shellfish harvested from water contaminated with sewage.

How long does hepatitis A virus survive outside the body?

The hepatitis A virus is extremely hardy. It is able to survive the body’s highly acidic digestive tract and can live outside the body for months. High temperatures, such as boiling or cooking food or liquids for at least 1 minute at 185°F (85°C), kills the virus, although freezing temperatures do not. (Centers for Disease Control

Is testing available for hepatitis A?

When a person becomes infected, the body creates antibodies to protect itself from the virus. The common test for hepatitis A is the antibody test. There is a blood test available to measure these antibodies. Antibodies are generally detectable in serum 5 to 10 days after infection and usually decrease to undetectable levels within 6 months after onset of infection. In rare cases, they may persist for longer.

How is hepatitis A prevented?

In order to stop the virus from spreading:

  • Wash your hands often and thoroughly using soap and water. This is especially important after using the bathroom or changing a diaper, and before preparing or eating food. Handwashing is the single most important means of preventing the spread of the disease.
  • Avoid sharing common items such as cups and finger foods such as popcorn.
  • Always wash fresh fruit and vegetables such as strawberries and lettuce.
  • Get vaccinated for hepatitis A, especially if you travel to countries where the virus is known to be common (areas in Central and South America, Africa, Asia, and Eastern Europe).
  • Travellers can further minimize the risk of contracting hepatitis A by avoiding:
    • Untreated water and ice made from untreated water
    • Uncooked shellfish
    • Unwashed or uncooked fruit or vegetables

Is hepatitis A the same as hepatitis B?

No. Hepatitis B is also an infection of the liver, but it is caused by a different virus. Hepatitis B is spread differently than hepatitis A. Hepatitis B is spread by contact with the infected blood and body fluids of someone who is ill with hepatitis B. There are vaccines available that can protect you from both hepatitis A and B.

Is there a vaccine to protect me against hepatitis A?

Yes. There is a hepatitis A vaccine that helps the body make antibodies to the virus. Antibodies fight against the hepatitis A virus if a person comes in contact with the disease. There are several different vaccines that protect you from becoming ill with hepatitis A.

Hepatitis A vaccine, which protects against hepatitis A only, consists of two injections and is highly effective in preventing illness. Protection begins approximately 2 to 3 weeks after you receive the first injection. A second injection given 6 to 12 months after the first injection provides long-term immunity.

What are the possible reactions to the vaccine?

Individuals may experience soreness, redness, and swelling at the site of the injection. This may last 2days. Other side effects can include: headache, weakness, mild fever, muscle or joint ache, nausea, vomiting, and diarrhea.

Who should not be vaccinated?

  • The hepatitis A vaccine is not authorized for children less than 1 year of age.
  • Anyone allergic to any of the vaccine ingredients (for example, neomycin, aluminum, polysorbate 20, latex).
  • People with previous signs of hypersensitivity to previous hepatitis A vaccine injections.
  • Anyone who is ill with an infection or fever. Individuals should wait until they are well before getting the vaccine.
  • Women who are pregnant or breastfeeding should consult a doctor before receiving any vaccine.

Do previously vaccinated individuals require additional doses of vaccine?

Those previously vaccinated with Hepatitis A vaccine:

  • If 2 previous doses were provided, no additional doses are recommended.
  • If one dose was provided less than 6 months ago, no additional doses are recommended until at least 6 months from the last dose.
  • If one dose was provided 6 months or more in the past, one additional dose is recommended.

Who should visit their doctor and report to a public health unit?

  • Individuals who become ill or have any unusual reactions up to 4 weeks after vaccination.
  • Individuals who become  ill after returning from travel.
  • Food handlers, individuals who have direct patient care (hospital or long-term care home workers, volunteers or students) or who work in a child care setting.  Report to public health if you are ill, as well as if you are well and have been potentially exposed to hepatitis A. The Health Unit will provide you with employment specific education to help prevent spreading hepatitis A to others.

Is there a phone number where the client can contact Costco directly regarding the recalled product?

Yes. For additional information regarding the recall, please contact Costco at 705.524.8255.

This item was last modified on April 21, 2016