Te Whatu Ora Health New Zealand 27 September 2022 Warning of potential Hepatitis A risk associated with frozen berries On 14 September, following three genomically linked locally acquired hepatitis A cases, New Zealand Food Safety (NZFS) issued a statement warning of potential risk of hepatitis A associated with frozen berries. As of 27/09/2022 there have been 10 cases of locally-acquired hepatitis A in Aotearoa New Zealand reported since June 2022. Seven of these cases have occurred since 6 September. The cases are dispersed throughout the country. Results of genetic sequencing are available on eight cases and all have identical sequence profiles, indicating they are genetically linked, results on the remaining two cases are pending. All cases regularly consume large quantities of uncooked frozen berries. NZFS is conducting an investigation into the recent Hepatitis A cases focused on frozen berries as a potential source. At present no specific brands have been associated with recent cases. Background information on Hepatitis A Signs and symptoms of Hepatitis A can include fever, malaise, anorexia, nausea or abdominal discomfort, jaundice, and an enlarged tender liver. Children are often asymptomatic and occasionally present with atypical symptoms, including diarrhoea, cough, coryza or arthralgia. Jaundice is very unusual in children younger than 4 years and occurs in only 10 percent of cases in the 4-6 year age group. ‘The incubation period for Hepatitis A ranges from 15-50 days. People are most infectious during the 1-2 weeks before and the first few days after the onset of jaundice. ‘Transmission is by the faecal-oral route, usually person-to-person. Public health services investigate each case of hepatitis A and identify and manage close contacts, this can include recommending vaccination or immunoglobulin. Ifyou suspect a case of Hepatitis A please: ‘+ Notify suspected cases of hepatitis A to the local Medical Officer of Health ‘+ Request hepatitis A IgM serology and LFTs, FBC and CRP. Mark the request “Urgent” ‘© Advise the suspected case to not attend work, social events or gatherings if they are an adult. Ifa child, advise their parent/guardian their child cannot attend LN ANSGAR A TMA AUNT NNN AANA AUTAD AOA AAT AT ATschool/kindergarten/playgroup. The ill person should remain away until their illness is diagnosed ‘© Advise the ill person about the need for effective hand washing, especially after going to the toilet or before/after preparing food ‘© Advise that the ill person should have their own towel, facecloth, and toothbrush and they should not share these items; and ‘* Advise those who are ill that they should NOT prepare food for others while they are ill, especially if the food is eaten raw. ‘Ifthe person is too unwell to be managed in the community, appropriate referral to hospital may be needed on clinical discretion. Advice to pul * Elderly persons, pregnant people and those with chronic liver damage should avoid frozen berries that have not been heat treated, unless they have been immunised against hepatitis A * All people should be aware of the potential risk of hepatitis A associated with consuming frozen berries. if people wish to avoid potential risks, frozen berries should be briefly boiled before consumption, or cooked at temperatures exceeding 85 degrees Celsius for 1 minute. © Washing frozen berries will not inactivate the virus. © Those who are concerned about the safety of specific products should contact the MPI Consumer Helpline: 0800 008 333, ‘+ Those who are concerned about potential risk to their health are recommended to seek advice from a medical practitioner or to call Healthline on 0800 611 116 Details of the New Zealand Food Safety warning statement are available at: httos://www.mpi.govt.nz/dmsdocument/53131 For further information on case management and investigation please refer to the Communicable Disease Control Manual: https://www.health.govt.nz/our-work/diseases-and- conditions/communicable-disease-control-manual/hepatitis . Note that vaccination is usually only recommended for close contacts of confirmed cases General information on Hepatitis A is available at: https://www_health.govt.nz/your: health/conditions-and-treatments/diseases-and-illnesses/hepatitis For information on hepatitis A vaccine, please call the Immunisation Advisory Centre free phone ‘number 0800 IMMUNE (0800 466 863) or visit their website: www.immune.org.nz NN TT ATLA ALATA ANTI LANHAM AANA