Multi-province hepatitis A outbreak linked to frozen berries (April 16, 2016)

Advisory Alert

April 16, 2016

*Cette information est seulement disponible en anglais.

I am writing to inform you that the Public Health Agency of Canada (PHAC), in collaboration with affected provinces, including Ontario, are investigating a hepatitis A outbreak linked to Nature’s Touch Organic Berry Cherry Blend frozen berries. To date, 12 cases have been reported in Canada, 9 of which have been reported in Ontario.

Nature’s Touch Organic Berry Cherry Blend brand frozen berries was recalled from the marketplace on April 15, 2016, and was sold exclusively at Costco warehouse locations in Ontario, Quebec, New Brunswick, Nova Scotia, Newfoundland and Labrador. Additional details regarding the recall can be found on the Canadian Food Inspection Agency website at:

PHAC has posted a Public Health Notice on their website at: PHAC will provide updates to this Public Health Notice as additional information becomes available.

PHAC has reported that Costco is contacting customers who purchased Nature’s Touch Organic Berry Cherry Blend to advise them not to eat the product and will be advising customers to speak with a physician, Costco pharmacist or local public health unit if they have any questions or concerns. PHAC has also reported that Costco will be offering post-exposure immunization, at Costco locations, to customers who consumed the recalled product within the last 14 days.

Clinical presentation

Hepatitis A usually results in an acute self‐limiting illness which only rarely leads to fulminant hepatitis. Those with underlying liver disease especially from chronic hepatitis C are at greatest risk of poor outcomes. Hospitalization may occur in up to 20% of those who are symptomatic. Children are usually asymptomatic with jaundice developing in less than 10% of children age 6 years and under. Adults typically present with more severe disease, characterized by 1 to 7 days of prodrome then abrupt onset of fever, malaise, anorexia, nausea and abdominal pain, often followed by jaundice. Infants and the elderly are at greatest risk of mortality.

Transmission and communicability

Hepatitis A virus (HAV) infection is transmitted primarily by the fecal‐oral route, through direct contact with infected people or indirectly through ingestion of contaminated water or foods. Transmission may also occur through sexual activities that include direct or indirect oral‐anal contact, but not through exposure to saliva, semen or urine.

The incubation period ranges from 15 to 50 days with an average of 30 days. Individuals are infectious throughout the incubation period and for about 7 days after jaundice appears.

Testing, Treatment and Exclusion

Laboratory detection of anti‐HAV IgM, in the absence of recent hepatitis A vaccination, confirms a case of hepatitis A. Serum should be collected in a red top tube and submitted for anti‐HAV IgM (antibody) and anti‐HAV Total (IgG and IgM combined antibody) testing. Treatment is supportive only.

Exclude individuals such as food handlers, childcare staff and attendees, and healthcare workers from high‐risk settings for 14 days after onset of symptoms, or 7 days after onset of jaundice, whichever comes earlier.


Under the Health Protection and Promotion Act, both suspected and confirmed cases of hepatitis A must be reported to the Medical Officer of Health. Laboratory‐confirmed cases should be reported immediately to Public Health by phone as soon as identified. Please report to 1.866.522.9200, ext. 464 or after-hours to 705.688.4366.

For more detailed information on hepatitis A refer to the MOHLTC Infectious Disease Protocol, Appendix A: Disease‐Specific Chapters, 2015. A full copy can be accessed at:


P. Sutcliffe, MD, MHSc, FRCPC

Medical Officer of Health

This item was last modified on September 9, 2016