Information for healthcare practitioners on Hepatitis A and frozen berry products recall

This page provides important information for healthcare practitioners.

Page last updated: 12 March 2015

Summary

  • Cases of Hepatitis A have been linked to the consumption of 1 kg packets of Nanna’s Frozen Mixed Berries across several Australian states.
  • Patients who have consumed the berries and are WELL do not require testing or vaccination.
  • Patients who have consumed frozen berries and HAVE SYMPTOMS of Hepatitis should be referred for Hepatitis A serology.
  • Suspected cases of Hepatitis A should be notified to the local public health unit so that timely prophylaxis of contacts can be provided.

What products are being recalled?

Nanna's Mixed Berries (frozen) 1kg pack, with a best before date up to and including 22/11/16 have been recalled.

The product is packed in China, containing raspberries, strawberries and blackberries grown there. The blueberries in the product were initially thought to have come from Chile, however, Health is now advised that they were sourced from Canada.

Additionally the following products have been recalled as a precaution:

  • Nanna's Raspberries (frozen) 1kg pack, with a best before date up to and including 15/09/16.
  • Creative Gourmet's Mixed Berries (frozen) 300g pack, with a best before date up to and including 10/12/17.
  • Creative Gourmet's Mixed Berries (frozen) 500g pack, with a best before date up to and including 06/10/17.

At this time, the recall only applies to the products listed above and does not apply to any other frozen berry products.

Product recall details are available at:

It is not known at this point how the berries may have been contaminated. Hepatitis A virus can be transmitted through contaminated water or soil or through contact with an infected person.

Hepatitis A

Hepatitis A is a viral disease that affects the liver. Anyone who has not been immunised either by vaccination or previous infection can be infected with the Hepatitis A virus (HAV).

The virus is spread primarily by the faecal-oral route.The disease can also be spread sexually by oral–anal contact. The virus can survive for several hours outside the body but persists on the hands and in food for even longer and is resistant to heating and freezing. Freezing food does not remove the risk of Hepatitis A infection. Food must be heated to greater than 85C for more than one minute to remove the risk of Hepatitis A infection.

The incubation period ranges between 15 and 50 days after catching the virus. The average incubation period for the virus is 28 days.

A person with Hepatitis A is infectious from two weeks before they show symptoms to one week after they develop symptoms.

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What are they symptoms of Hepatitis A?

For older children and adults, the symptoms include:

  • Fever;
  • Nausea;
  • Abdominal discomfort;
  • Dark urine; and
  • Yellow skin and eyes (jaundice).

Symptoms may last for several weeks but full recovery usually occurs. Many infected people, particularly children less than five years old, show few or no symptoms.

How should a suspected case be investigated?

In a patient who has not recently been vaccinated for Hepatitis A, diagnosis is largely established by the presence of IgM anti-HAV antibodies. IgM antibodies usually become detectable before the onset of clinical symptoms and persist for greater than 4 months in most persons (and occasionally up to 1 year).

Approximately three percent of HAV infected people will be IgM negative if blood is taken on or before the onset of jaundice. Probable cases with negative IgM results from early specimens should be retested in 4 to 7 days.

Test Sensitivity:

The anti-HAV IgM and total antibody EIAs (Enzyme Immunoassays) have sensitivities of greater than 95%, when tested on specimens from patients with typical symptoms. However, sensitivity drops off when testing specimens from asymptomatic patients.

Test Specificity:

The anti-HAV IgM and total antibody EIAs have specificities of close to 100%.

Hepatitis serology IS NOT INDICATED for asymptomatic patients unless done to confirm prior immunity (by testing for anti-HAV total antibodies) in specific circumstances, viz., persons born prior to 1950, those who spent their early childhood in an endemic area, and those with an unexplained previous episode of hepatitis or jaundice. False positive Hepatitis A IgM antibodies have been documented in some people who have undergone screening tests but have no clinical indication of hepatitis. Discussion with a specialist microbiologist may assist in the interpretation of results.

The presence of anti-HAV total antibodies in the absence of anti-HAV IgM antibodies is used to differentiate past from recent infection.

How should a confirmed case be managed?

There is no specific treatment for Hepatitis A. Supportive care aims to ease symptoms and reduce the risk of complications.

People who are immunosuppressed or have chronic liver disease may experience more severe disease and require careful clinical assessment. Complications of Hepatitis A are uncommon but include, on rare occasions, fulminant Hepatitis.

All confirmed cases should be referred to your local Public Health Unit who will be able to provide further advice on management and the management of any contacts. Infection can be prevented in contacts of confirmed cases if Hepatitis A vaccine or immunoglobulin is administered within 2 weeks of first contact.

Advise patients to not prepare food, provide personal care for others, or donate blood.

What are the indications for Hepatitis A vaccination?

Routine vaccination against Hepatitis A is recommended for the following groups:

  • Aboriginal and Torres Strait Islander children residing in the Northern Territory, Queensland, South Australia and Western Australia
  • Travellers (≥1 year of age) to Hepatitis A endemic areas
  • Persons whose occupation puts them at increased risk of acquiring Hepatitis A
  • Persons whose lifestyle puts them at increased risk of acquiring Hepatitis A including persons who engage in anal intercourse, men who have sex with men, persons who inject drugs (including inmates of correctional facilities) and sex industry workers are at increased risk of acquiring Hepatitis A
  • Persons with developmental disabilities
  • Persons with chronic liver disease, liver solid organ transplant recipients and/or those chronically infected with either Hepatitis B or Hepatitis C viruses
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This vaccine is not recommended for Australians who have consumed the affected products and have no other indication for vaccine. This is because of the low risk to an individual consumer, and because the vaccine is only effective if given soon after exposure to Hepatitis A virus. Also, a proportion of Australians (which increases with age) are already immune from previous infection, or Hepatitis A immunisation.

Further information can be found in the Australian Immunisation Handbook.

This advice is not intended to override or interfere with clinical decisions made between a patient and medical practitioner.

Further Information

Information on the public health management of cases of Hepatitis A and their contacts is available from the Department of Health website.

Reporting

Healthcare practitioners including pathologists must notify confirmed cases immediately to their state/territory communicable disease branch/centre for public health management.

Advice for contacts of cases

Contacts of cases should be directed to your state/territory communicable disease branch/centre for advice.