Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study
Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study
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DOI：
10.1016/s1473-3099(14)70883-7
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发表时间：
2014-10-01
影响因子：
56.3
通讯作者：
Xu, Fujie
中科院分区：
文献类型：
--
作者：
Collier, Melissa G.;Khudyakov, Yury E.;Xu, Fujie
研究背景2013年5月，美国暴发甲型肝炎病毒感染。联邦、州和地方公共卫生官员调查了疫情爆发的原因，并采取了行动控制其传播。我们调查了甲型肝炎暴发的源头，评估了采取的公共卫生措施。方法对患者进行访谈，获取他们的购物信息，并对从患者血清和粪便样本中提取的甲型肝炎病毒进行基因分析。我们对产品进行了病毒检测，并追踪了供应链。在来自10个州的165名患者中，69人(42%)入院，两人发展为重型肝炎，一人需要肝移植；没有人死亡。发病时间为2013年3月31日至8月12日。患者的中位年龄为47岁(智商35-58岁)，91名(55%)为女性。根据零售商A的数据，153名患者(93%)报告食用了零售商A的产品B，40名患者(24%)的冰箱里有产品B，113名患者(68%)购买了产品。甲型肝炎病毒IB基因型在美洲并不常见，它是从117名甲型肝炎患者的样本中提取出来的。从土耳其进口的石榴香料在产品B中被鉴定出甲型肝炎病毒，从土耳其进口的石榴香料--那里的IB基因很常见--在产品B中没有检测到甲型肝炎病毒。通过结合流行病学和来自几个来源的数据，患者样本的基因分析和产品追踪，在调查的早期就确定了进口的冷冻石榴香料是载体。B产品被下架，公众被警告不要食用B产品，产品被召回，并提供了接触后预防甲型肝炎病毒疫苗和免疫球蛋白。我们的发现表明，现代公共卫生行动可以帮助快速检测和控制由进口食品引起的甲型肝炎病毒疾病。我们的发现表明，暴露后的预防措施可以成功地预防甲型肝炎，只要确定了特定的产品。进口食品加上一些成年人群免疫力的减弱，可能会使这种类型的干预在未来变得必要。资助美国疾病控制和预防中心、美国食品和药物管理局以及美国州和地方公共卫生部门。
Background In May, 2013, an outbreak of symptomatic hepatitis A virus infections occurred in the USA. Federal, state, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. We investigated the source of the outbreak and assessed the public health measures used.Methods We interviewed patients, obtained their shopping information, and did genetic analysis of hepatitis A virus recovered from patients' serum and stool samples. We tested products for the virus and traced supply chains.Findings Of 165 patients identified from ten states, 69 (42%) were admitted to hospital, two developed fulminant hepatitis, and one needed a liver transplant; none died. Illness onset occurred from March 31 to Aug 12, 2013. The median age of patients was 47 years (IQR 35-58) and 91 (55%) were women. 153 patients (93%) reported consuming product B from retailer A. 40 patients (24%) had product B in their freezers, and 113 (68%) bought it according to data from retailer A. Hepatitis A virus genotype IB, uncommon in the Americas, was recovered from specimens from 117 people with hepatitis A virus illness. Pomegranate arils that were imported from Turkey-where genotype IB is common-were identified in product B. No hepatitis A virus was detected in product B.Interpretation Imported frozen pomegranate arils were identified as the vehicle early in the investigation by combining epidemiology-with data from several sources-genetic analysis of patient samples, and product tracing. Product B was removed from store shelves, the public were warned not to eat product B, product recalls took place, and postexposure prophylaxis with both hepatitis A virus vaccine and immunoglobulin was provided. Our findings show that modern public health actions can help rapidly detect and control hepatitis A virus illness caused by imported food. Our findings show that postexposure prophylaxis can successfully prevent hepatitis A illness when a specific product is identified. Imported food products combined with waning immunity in some adult populations might make this type of intervention necessary in the future. Funding US Centers for Disease Control and Prevention, US Food and Drug Administration, and US state and local public health departments.