Egyptian strawberries may not be source of US hepatitis A outbreak

While media reports have surfaced in the past few days tracing an outbreak of hepatitis A that left 10 people infected in the United States state of Virginia to strawberries imported from Egypt, several medical experts have questioned the validity of this explanation.

The Tropical Smoothie Cafe chain issued a statement last Friday reporting that it had been notified by the Virginia Health Department that the contamination was linked to frozen strawberries imported from Egypt.

The fruit drink company stated that Egyptian strawberries only represent a fraction of their supply and were primarily used in the Virginia market. However, Tropical Smoothie Cafe decided to withdraw Egyptian strawberries at all of its locations as a precautionary measrue.

NBC News reported that officials at the Virginia Health Department urged anyone who had consumed a drink containing frozen strawberries in the last 50 days to monitor themselves for symptoms of hepatitis A, which include jaundice, fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stool.

On Sunday, Egyptian Agriculture Minister Essam Fayed announced the formation of a committee of experts on liver disease, agricultural quarantine and plant diseases to investigate the Virginia Health Department’s claims, the privately owned Al-Masry Al-Youm newspaper reports.

Al-Azhar Medical School gastroenterology and liver disease professor Amer Afify has already questioned the validity of the health department claim. Afify tells Mada Masr that hepatitis A is likely to be caused by contamination on the exterior surface of food rather than to be carried inside of food. Thus, the source of the fruit is irrelevant in determining the cause of the outbreak, Afify asserts, adding that an examination of the hygiene of the transportation chain would yield more answers.

Alaa Awad, a professor of liver disease at the Theodor Belharz Research Institute, also impugns the health department’s account of the outbreak, telling Mada Masr that it is unlikely that the virus could survive the various preservation mechanisms, which include freezing and boiling. According to Awad, the hepatitis A virus is usually weak and cannot survive outside of its incubatory environment for long.

Aim Shams Medical School Professor of Liver Surgery Alaa Ismail agrees that the virus would not have survived being frozen and also contended that is more likely that the juice makers are responsible for the contagion. However, the only way to identify the source of the outbreak, according to Ismail, would be to test the fruit.

Unlike other liver viruses, hepatitis A’s onset is immediate, but it is easily curable, and, once a patient has been infected, they are generally immune to future contractions.

Awad explains that the virus’s behavior has changed in the last decade, moving away from being a silent virus without clear symptoms that predominantly affects children to having more violent symptoms and affecting an older demographic. The Theodor Belharz Research Institute professor credits this decreased number of infections among children to increased awareness among middle class families and greater attention paid to hygiene.

While hepatitis A is prevalent in Egypt, Awad says that there are no precise statistics. The infectious disease is known to be prevalent in areas suffering from a lack of clean water and proper sewage systems, amid more a general lack of hygiene.

Egyptian strawberries were previously linked to two outbreaks of the disease in the European Union in 2013. The first incident occurred in several northern European countries. A European Center for Disease Prevention and Control study attributed the outbreak to frozen strawberries from Egypt and Morocco. The second incident was reported to have begun when a number of tourists consumed fresh strawberries during a visit to Egypt.

According to information provided by the Egyptian Agriculture Export Council, Egypt exported 28,000 tons of strawberries between September 2015 and May 2016, generating US$66 million.


Translated by Heba Afify

Mohamed Hamama 

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