Hepatitis A outbreak in British Columbia, Canada: the roles of established surveillance, consumer loyalty cards and collaboration, February to May 2012

Abstract

Non-travel-related hepatitis A is rare in Canada. We describe a hepatitis A outbreak investigation in British Columbia in February to May 2012 in which exposure history was collected from nine confirmed non-travel-related cases. Suspected foods were tested for hepatitis A virus (HAV): a frozen fruit blend was identified as a common exposure for six of the nine cases using supermarket loyalty cards. Consumption of the product was confirmed in each case. Genetic analysis confirmed HAV genotype 1B in the six exposed cases. Of the three non-exposed cases, the virus could not be genotyped for two of them; the virus from the other case was found to be genotype 1A and this case was therefore not considered part of the outbreak. HAV was detected by PCR from pomegranate seeds, a component of the identified frozen fruit blend. Historically low levels of HAV infection in British Columbia triggered early recognition of the outbreak. Loyalty card histories facilitated product identification and a trace-back investigation implicated imported pomegranate seeds.

Globalization and the Changing Epidemiology of Hepatitis A Virus

“…A multistate outbreak in the United States in 2013 was attributed to imported frozen pomegranate arils from Turkey, which is classified as an upper middle-income country (Collier et al 2014). Pomegranate seeds from Egypt were implicated in an HAV outbreak in Canada in 2012 (Swinkels et al 2014). Hundreds of Australians contracted HAV from imported sundried and semidried tomatoes in 2009, and the same strain also caused a tomato-borne outbreak in the Netherlands in 2009-2010 (Donnan et al 2012).…”

Hepatitis A Outbreaks in Developed Countries: Detection, Control, and Prevention

“…The affected population size and time course varied greatly between the nine outbreaks: the most important outbreak associated with frozen berries involved 1589 cases across 13 EEA countries (Severi et al, 2015), with the most cases occurring in Italy (1438 cases). The duration of this EEA outbreak was comparatively longer than those in the United States (Collier et al, 2014) and Canada (Swinkels et al, 2014) (Table 1).…”

“…The HAV sequencing protocols in European countries were not harmonized before 2015; hence, HAV genomic fragments of different lengths were characterized (Severi et al, 2015). During the Canada outbreak, 373 nucleotides in the VP1-2A region were analyzed (Swinkels et al, 2014). For the United States, comparison of the sequencing results was generally based on 315 nucleotide segments of the VP1-2B junction (Collier et al, 2014;Viray et al, 2018).…”

“…CDC, 2016;Viray et al, 2018). With the industrialization of food production and globalization, many high-risk products (shellfish, fresh or frozen fruits, and vegetables) are produced in HAVendemic countries and consumed in developed countries (Berger et al, 2010;Strawn et al, 2011), contributing to the HAV outbreaks in food-importing countries (Nordic Outbreak Investigation Team, 2013;Collier et al, 2014;Swinkels et al, 2014;Severi et al, 2015;U.S. CDC, 2016;Viray et al, 2018;Franklin et al, 2019).…”

Infection par le virus de l’hépatite A associée à l’utilisation du cannabis

“…Médecin hygiéniste, organisme de santé publique Alberta Health Services, Edmonton, AB2 Université de l'Alberta, Edmonton, AB3 Laboratoire provincial de santé publique, organisme de santé publique Alberta Health Services, Edmonton, AB4 Laboratoire national de microbiologie, Agence de la santé publique du Canada, Winnipeg, MB5 Université du Manitoba, Winnipeg, MB *Correspondance: christopher. sikora@ahs.ca…”