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A multistate outbreak of hepatitis A associated with semidried tomatoes in Australia, 2009.
Clin Infect Dis. 2012 Mar; 54(6):775-81.CI

Abstract

BACKGROUND

A large outbreak of hepatitis A affected individuals in several Australian states in 2009, resulting in a 2-fold increase in cases reported to state health departments compared with 2008. Two peaks of infection occurred (April-May and September-November), with surveillance data suggesting locally acquired infections from a widely distributed food product.

METHODS

Two case-control studies were completed. Intensive product trace-back and food sampling was undertaken. Genotyping was conducted on virus isolates from patient serum and food samples. Control measures included prophylaxis for close contacts, public health warnings, an order by the chief health officer under the Victorian Food Act 1984, and trade-level recalls on implicated batches of semidried tomatoes.

RESULTS

A multijurisdictional case-control study in April-May found an association between illness and consumption of semidried tomatoes (odds ratio [OR], 3.0; 95% CI 1.4-6.7). A second case-control study conducted in Victoria in October-November also implicated semidried tomatoes as being associated with illness (OR, 10.3; 95% CI, 4.7-22.7). Hepatitis A RNA was detected in 22 samples of semidried tomatoes. Hepatitis A virus genotype IB was identified in 144 of 153 (94%) patients tested from 2009, and partial sequence analysis showed complete identity with an isolate found in a sample of semidried tomatoes.

CONCLUSIONS

The results of both case-control studies and food testing implicated the novel vehicle of semidried tomatoes as the cause of this hepatitis A outbreak. The outbreak was extensive and sustained despite public health interventions, the design and implementation of which were complicated by limitations in food testing capability and complex supply chains.

Authors+Show Affiliations

Victorian Government Department of Health, ational Centre for Epidemiology and Population Health, College of Medicine and Biological Sciences, The Australian National University, Melbourne, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22238166

Citation

Donnan, Ellen J., et al. "A Multistate Outbreak of Hepatitis a Associated With Semidried Tomatoes in Australia, 2009." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 54, no. 6, 2012, pp. 775-81.
Donnan EJ, Fielding JE, Gregory JE, et al. A multistate outbreak of hepatitis A associated with semidried tomatoes in Australia, 2009. Clin Infect Dis. 2012;54(6):775-81.
Donnan, E. J., Fielding, J. E., Gregory, J. E., Lalor, K., Rowe, S., Goldsmith, P., Antoniou, M., Fullerton, K. E., Knope, K., Copland, J. G., Bowden, D. S., Tracy, S. L., Hogg, G. G., Tan, A., Adamopoulos, J., Gaston, J., & Vally, H. (2012). A multistate outbreak of hepatitis A associated with semidried tomatoes in Australia, 2009. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 54(6), 775-81. https://doi.org/10.1093/cid/cir949
Donnan EJ, et al. A Multistate Outbreak of Hepatitis a Associated With Semidried Tomatoes in Australia, 2009. Clin Infect Dis. 2012;54(6):775-81. PubMed PMID: 22238166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A multistate outbreak of hepatitis A associated with semidried tomatoes in Australia, 2009. AU - Donnan,Ellen J, AU - Fielding,James E, AU - Gregory,Joy E, AU - Lalor,Karin, AU - Rowe,Stacey, AU - Goldsmith,Paul, AU - Antoniou,Mira, AU - Fullerton,Kathleen E, AU - Knope,Katrina, AU - Copland,Joy G, AU - Bowden,D Scott, AU - Tracy,Samantha L, AU - Hogg,Geoffrey G, AU - Tan,Agnes, AU - Adamopoulos,Jim, AU - Gaston,Joanna, AU - Vally,Hassan, Y1 - 2012/01/11/ PY - 2012/1/13/entrez PY - 2012/1/13/pubmed PY - 2012/6/16/medline SP - 775 EP - 81 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 54 IS - 6 N2 - BACKGROUND: A large outbreak of hepatitis A affected individuals in several Australian states in 2009, resulting in a 2-fold increase in cases reported to state health departments compared with 2008. Two peaks of infection occurred (April-May and September-November), with surveillance data suggesting locally acquired infections from a widely distributed food product. METHODS: Two case-control studies were completed. Intensive product trace-back and food sampling was undertaken. Genotyping was conducted on virus isolates from patient serum and food samples. Control measures included prophylaxis for close contacts, public health warnings, an order by the chief health officer under the Victorian Food Act 1984, and trade-level recalls on implicated batches of semidried tomatoes. RESULTS: A multijurisdictional case-control study in April-May found an association between illness and consumption of semidried tomatoes (odds ratio [OR], 3.0; 95% CI 1.4-6.7). A second case-control study conducted in Victoria in October-November also implicated semidried tomatoes as being associated with illness (OR, 10.3; 95% CI, 4.7-22.7). Hepatitis A RNA was detected in 22 samples of semidried tomatoes. Hepatitis A virus genotype IB was identified in 144 of 153 (94%) patients tested from 2009, and partial sequence analysis showed complete identity with an isolate found in a sample of semidried tomatoes. CONCLUSIONS: The results of both case-control studies and food testing implicated the novel vehicle of semidried tomatoes as the cause of this hepatitis A outbreak. The outbreak was extensive and sustained despite public health interventions, the design and implementation of which were complicated by limitations in food testing capability and complex supply chains. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/22238166/A_multistate_outbreak_of_hepatitis_A_associated_with_semidried_tomatoes_in_Australia_2009_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cir949 DB - PRIME DP - Unbound Medicine ER -