An Outbreak of Hepatitis A Associated with Green Onions

• Published in: The Journal of infectious diseases Vol. 183; no. 8; pp. 1273 - 1276
• Main Authors: Dentinger, Catherine M., Bower, William A., Nainan, Omana V., Cotter, Suzanne M., Myers, Gert, Dubusky, Letitia M., Fowler, Suzanne, Salehi, Ellen D. P., Bell, Beth P.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.04.2001; University of Chicago Press; Oxford University Press
• Subjects: Allium; Biological and medical sciences; California; Case-Control Studies; Concise Communications; Disease Outbreaks; Diseases; Epidemiology; Food Microbiology; Foodborne illnesses; Fundamental and applied biological sciences. Psychology; Hepatitis A; Hepatitis A - epidemiology; Hepatitis A - transmission; Hepatitis A Antibodies; Hepatitis A virus; Hepatitis Antibodies - blood; Hepatovirus - classification; Hepatovirus - genetics; Hepatovirus - isolation & purification; Human viral diseases; Humans; Infections; Infectious diseases; Medical sciences; Mexico; Microbiology; Odds Ratio; Ohio - epidemiology; Onions; Onions - microbiology; Phylogeny; Preventive medicine; Restaurants; Sustainable food systems; Viral diseases; Viral hepatitis; Virology; Central America; Mexico; Ohio; United States; North America; America; California; Monocotyledones; Hepatitis A virus; Picornaviridae; Hepatic disease; Case control study; IgM; Prevention; Viral hepatitis A; Angiospermae; Serum; Food; Human; Immunopathology; Allium cepa; Antibody; AIDS; Immune deficiency; Contamination; Hepatovirus; Infection; Virus; Case study; Liliaceae; Sensitivity; Viral disease; Digestive diseases; Isolate; Spermatophyta
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/319688

Forty-three cases of serologically confirmed hepatitis A occurred among individuals who ate at restaurant A in Ohio in 1998. Serum samples from all restaurant A employees who worked during the exposure period were negative for IgM antibodies to hepatitis A virus (HAV). A matched case-control study determined that foods containing green onions, which were eaten by 38 (95%) of 40 case patients compared with 30 (50%) of 60 control subjects, were associated with illness (matched odds ratio, 12.7; 95% confidence interval, 2.6–60.8). Genetic sequences of viral isolates from 14 case patients were identical to each other and to those of viral isolates from 3 patients with cases of hepatitis A acquired in Mexico. Although the implicated green onions, which could have come from one of 2 Mexican farms or from a Californian farm, were widely distributed, no additional green onion–associated cases were detected. More sensitive methods are needed to detect foodborne hepatitis A. A better understanding of how HAV might contaminate raw produce would aid in developing prevention strategies