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Hepatitis and Strawberries

© Neal Rolfe Chamberlain

April 4th 1997, the Morbidity Mortality Weekly Report (MMWR) indicated that a total of 153 cases of hepatitis were reported in Calhoun County, Michigan. All but two of those cases have been students or staff of schools in four different school districts. Investigations by public health officials found a high association with eating frozen strawberries in school lunch and getting hepatitis. The strawberries were imported from Mexico. To get approval for distribution in USDA-sponsored lunch programs the strawberries must be from the United States. However, the distributor lied to the USDA and labeled the strawberries as being from the U.S. and NOT Mexico. Major problem.

What is hepatitis? Hepatitis simply means that a person's liver (Hepat-) is swollen and inflamed (-itis). This could be due to a microorganism or as a result of liver damage from alcohol, cancer, etc.

What caused this particular outbreak of hepatitis?
The students and staff in Michigan had a viral hepatitis. Several viruses cause hepatitis. There are Hepatitis A, B, C, D, E, and non-A non-B viruses.

This particular outbreak was due to the Hepatitis A virus. This virus grows very well in our livers and causes damage to the liver until our immune system eliminates the infection. An image of the virus is available from Dr. Baron's Medical Microbiology textbook. His textbook also contains a wealth of information on Hepatitis A virus.

How do you get this disease?

When a person gets viral hepatitis and before they start to get sick they shed the Hepatitis A virus in their feces. If this virus-containing fecal material gets into the water supply, then people drinking the water or eating food washed off with this water could get hepatitis. That is what is called a fecal-oral route of disease transmission. The fecal-oral route of transmission is the most common means of spreading this type of viral hepatitis.

People in developed nations (Western Europe, U.S., Canada) do not get Hepatitis A infections nearly as often as people in developing nations (countries in Africa, Central and South America, Asia, etc). This is because the money is available to contain and treat our raw sewage. In Mexico the treatment of raw sewage is not as available and much of their water supply is contaminated. Therefore, fruits and vegetables are more likely to cause human diseases spread by the fecal-oral route.

What are the symptoms of Hepatitis A infection?

It takes from 20 to 45 days of being infected before symptoms begin. This time period is called the incubation period. Most infections do not result in any illness. This is especially true for young children. The older a person is when they get the disease, the more likely that person will have a serious illness.

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