Outbreak of hepatitis A infections linked to frozen mangoes.

Advisory Alert

August 5, 2021

*Cette information est seulement disponible en anglais.

Dear Colleagues:

Re: Potential for local cases of hepatitis A from certain frozen mangoes produced by Nature’s Touch Frozen Food Inc.

I am writing to advise you that on July 30, 2021, the Canadian Food Inspection Agency (CFIA) issued a Class 1 food recall warning for various frozen mangoes produced by Nature’s Touch Frozen Food Inc. These products are sold under brand names of Compliments, Irresistibles, and President’s Choice. Preliminary data from CFIA indicates that 88 134 packages of these products have been shipped within Ontario since November 2020 and have a two-year shelf life given their frozen state.

To date, there are no confirmed cases of hepatitis A linked to these products in the Public Health Sudbury & Districts service area. However, Public Health Sudbury & Districts has been advised of hepatitis A cases in Quebec and Nova Scotia. We have determined that the product was distributed to a number of stores in our service area. As a result, the public is being notified of this via local and social media. Public Health Sudbury & Districts will also offer a series of free vaccination clinics to individuals who have consumed the product within 14 days and are not already fully vaccinated. This Advisory Alert provides information on the clinical management of cases of hepatitis A infection as well as post‐exposure prophylaxis recommendations.

Post‐exposure prophylaxis (PEP)

PEP is highly recommended for individual as soon as possible and up to 14 days since their last exposure to an infectious case or affected food items.

Public Health Sudbury & Districts is advising PEP for individuals who in the last 14 days consumed the affected food items as described above. These individuals should receive hepatitis A vaccine as soon as possible. In addition, some individuals may be eligible for immune globulin as follows:

Individuals who ate affected foods more than 14 days ago are advised to monitor their health for signs and symptoms, and follow up with their health care provider if symptoms develop. People are also reminded to discard or return to point of purchase any uneaten affected food items.

Free drop-in vaccination clinics will be offered by Public Health for eligible persons. Dates, times, and locations of clinics will be announced once the vaccine supply is secured with updates posted on phsd.ca. No appointments will be required.

Additionally, Public Health staff are available to answer any inquiries regarding this advisory. They can be contacted directly at 705.522.9200 (toll-free 1.866.522.9200).

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 aged 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. Maximum communicability occurs during the latter part of the incubation period with peak levels in the 2 weeks before clinical illness. Communicability diminishes rapidly thereafter and ends shortly after the onset of jaundice. Cases are considered non-infectious 7 days after onset of jaundice although prolonged viral excretion up to 6 months has been documented in infants and children and immunocompromised individuals.

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. Individuals are generally excluded from work during their infectious period (14 days after symptom onset or 7 days after jaundice onset, which occurs earlier) if they work in high-risk settings such as food handlers, childcare staff and attendees, and health care workers.


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. 301.

Original Signed By
Dr. Marlene Spruyt Acting Medical Officer of Health

On behalf of Dr. Penny Sutcliffe Medical Officer of Health and Chief Executive Officer

NOTE: All Advisory Alerts are found on our website.

This item was last modified on August 5, 2021