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. 1990 Sep;80(9):1075–1079. doi: 10.2105/ajph.80.9.1075

A multifocal outbreak of hepatitis A traced to commercially distributed lettuce.

L S Rosenblum 1, I R Mirkin 1, D T Allen 1, S Safford 1, S C Hadler 1
PMCID: PMC1404849  PMID: 2382744

Abstract

From February 1 through March 20, 1988, 202 cases of hepatitis A were reported in and around Jefferson County, Kentucky. The epidemic curve indicated a common-source exposure. However, there was no apparent single source of exposure from a restaurant, or community gathering; nor was there a geographic clustering by residence. Cases were mainly adults 20-59 years old (89 percent); 51 percent were female. A case-control study using neighborhood controls found that factors associated with hepatitis A were: having eaten downtown (odds ratio [OR] = 4.0) and having dined at any one of three restaurants (OR = 21.0). Case-control studies of patrons of two of these restaurants found that eating green salad was strongly associated with acquiring hepatitis A: OR = 11.6 and OR = 4.4. The three implicated restaurants accounted for 71 percent of the cases. All three restaurants were supplied by the same fresh produce distributor; however, investigation suggested that contamination most likely occurred prior to local distribution. This outbreak of hepatitis A is the first in the United States apparently associated with fresh produce contaminated before distribution to restaurants, and raises important public health issues regarding the regulation of fresh produce.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Davis H., Taylor J. P., Perdue J. N., Stelma G. N., Jr, Humphreys J. M., Jr, Rowntree R., 3rd, Greene K. D. A shigellosis outbreak traced to commercially distributed shredded lettuce. Am J Epidemiol. 1988 Dec;128(6):1312–1321. doi: 10.1093/oxfordjournals.aje.a115084. [DOI] [PubMed] [Google Scholar]
  2. Jones A. E., Smith J. L., Hindman S. H., Fleissner M. L., Judelsohn R., Englender S. J., Tilson H., Maynard J. E. Foodborne hepatitis A infection: a report of two urban restaurant-associated outbreaks. Am J Epidemiol. 1977 Feb;105(2):156–162. doi: 10.1093/oxfordjournals.aje.a112368. [DOI] [PubMed] [Google Scholar]
  3. Kosatsky T., Middaugh J. P. Linked outbreaks of hepatitis A in homosexual men and in food service patrons and employees. West J Med. 1986 Mar;144(3):307–310. [PMC free article] [PubMed] [Google Scholar]
  4. Lednar W. M., Lemon S. M., Kirkpatrick J. W., Redfield R. R., Fields M. L., Kelley P. W. Frequency of illness associated with epidemic hepatitis A virus infections in adults. Am J Epidemiol. 1985 Aug;122(2):226–233. doi: 10.1093/oxfordjournals.aje.a114093. [DOI] [PubMed] [Google Scholar]
  5. Leger R. T., Boyer K. M., Pattison C. P., Maynard J. E. Hepatitis A: report of a common-source outbreak with recovery of a possible etiologic agent. I. Epidemiologic studies. J Infect Dis. 1975 Feb;131(2):163–166. doi: 10.1093/infdis/131.2.163. [DOI] [PubMed] [Google Scholar]
  6. Mackowiak P. A., Caraway C. T., Portnoy B. L. Oyster-associated hepatitis: lessons from the Louisiana experience. Am J Epidemiol. 1976 Feb;103(2):181–191. doi: 10.1093/oxfordjournals.aje.a112216. [DOI] [PubMed] [Google Scholar]
  7. Martin D. L., Gustafson T. L., Pelosi J. W., Suarez L., Pierce G. V. Contaminated produce--a common source for two outbreaks of Shigella gastroenteritis. Am J Epidemiol. 1986 Aug;124(2):299–305. doi: 10.1093/oxfordjournals.aje.a114388. [DOI] [PubMed] [Google Scholar]
  8. McCaustland K. A., Bond W. W., Bradley D. W., Ebert J. W., Maynard J. E. Survival of hepatitis A virus in feces after drying and storage for 1 month. J Clin Microbiol. 1982 Nov;16(5):957–958. doi: 10.1128/jcm.16.5.957-958.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Portnoy B. L., Mackowiak P. A., Caraway C. T., Walker J. A., McKinley T. W., Klein C. A., Jr Oyster-associated hepatitis. Failure of shellfish certification programs to prevent outbreaks. JAMA. 1975 Sep 8;233(10):1065–1068. doi: 10.1001/jama.233.10.1065. [DOI] [PubMed] [Google Scholar]
  10. Reid T. M., Robinson H. G. Frozen raspberries and hepatitis A. Epidemiol Infect. 1987 Feb;98(1):109–112. doi: 10.1017/s095026880006177x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Schoenbaum S. C., Baker O., Jezek Z. Common-source epidemic of hepatitis due to glazed and iced pastries. Am J Epidemiol. 1976 Jul;104(1):74–80. doi: 10.1093/oxfordjournals.aje.a112275. [DOI] [PubMed] [Google Scholar]

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