Not just strawberries: These foods are also more likely to be contaminated with hepatitis A

An ongoing outbreak of hepatitis A — a very contagious liver infection caused by the hepatitis A virus (HAV) — has now been linked to frozen strawberries and other frozen berry blends for smoothies sold at Walmart, Costco and HEB, leading to a voluntary recall, according to the Food and Drug Administration (FDA). The FDA stated that no illnesses have been reported.

It's far from the only recall of strawberries. In April, a hepatitis A outbreak triggered a recall of frozen strawberries sold at Costco, Trader Joe's and other stores in Los Angeles, Calif., as part of a multistate outbreak.

Last year, fresh organic strawberries were identified as the source of a multistate outbreak of hepatitis A. In 2016, there was another outbreak of hepatitis A with frozen strawberries.

But it’s not just strawberries. Here’s a look at which foods carry at greater risk of becoming contaminated with hepatitis A — and how best to protect yourself.

What foods are most likely to be contaminated with hepatitis A?

“In theory, any food can be contaminated with hepatitis A,” Dr. Victor Chen, assistant professor of medicine at the Johns Hopkins University School of Medicine, tells Yahoo Life. “In practice, more commonly contaminated foods include raw vegetables — including salads — and fruit, shellfish, ice and water.”

All foods are at risk of contamination with hepatitis A virus if they are handled by someone who has come into contact with the virus or rinsed food in water that is dirty and contaminated. Although it’s not too common in the U.S., since 2011, previous food-related outbreaks of hepatitis A occurred in raw scallops, frozen tuna, conventional blackberries, and pomegranate seeds.

Is organic produce more likely to be contaminated with hepatitis A?

Organic produce “certainly does not protect a consumer from getting hepatitis A,” says Chen.

According to a 2016 study, in the U.S. there have been more foodborne outbreaks associated with organic foods than conventionally grown ones. Between 1992 and 2014, 18 viral and bacterial outbreaks were caused by organic foods, with 8 of those outbreaks involving produce. However, it’s important to note that there’s been more recent outbreaks in organic food as more people are producing and consuming organic food, too.

What we do know for sure is that the risk of any produce becoming contaminated with hepatitis A increases with poor sanitation and poor hygiene, regardless of whether it was grown organically or conventionally.

How does hepatitis A virus infect people?

“Hepatitis A is transmitted through ingestion of something that contains the virus. Most frequently, that means consuming contaminated food or water,” explains Chen. This type of spreading is called the fecal-oral route, where the food or water consumed is contaminated with the stool of an infected person.

Chen says other possible ways of contracting hepatitis A include not washing your hands and then eating after contact with contaminated items, such as surfaces and diapers, and through oral-anal sex. “In both cases, the transmission is still through ingesting hepatitis A virus,” he states.

The risk of transmitting hepatitis A is also higher in areas where there are poor sanitary conditions and among those with poor personal hygiene.

How do you know if you’ve been infected?

Common symptoms of hepatitis A include nausea, diarrhea, loss of appetite, fever and feeling tired. Some people might have symptoms for longer and even more serious but rare consequences, such as liver failure or death — though this is more common in those over 50 years of age and with other chronic health conditions. It can take up to two weeks for symptoms to appear, meaning it’s possible to have no symptoms while still spreading the infection.

A blood test can determine whether you’ve been infected with hepatitis A virus. The good news is that 85% of people with hepatitis A recover within three months, and without any complications or liver damage. Having the infection also means you’ll develop antibodies, giving you lifelong immunity.

What can you do to protect yourself from hepatitis A?

“Get vaccinated against hepatitis A,” encourages Chen. The vaccine is a series of two shots that are at least six months apart, and is available to anyone over 12 months of age. “In immunocompetent individuals, hepatitis A vaccine should provide 95% protection for over 10 years, possibly even 20 to 30 years,” says Chen. If you haven’t received this vaccine, you can speak to your medical provider and see if it’s available for you.

Since hygiene is also a factor in the spread of the virus that causes hepatitis A, Chen says it's important to “wash hands thoroughly [for at least 20 seconds] with soap and warm water after handling raw foods, changing diapers, using the bathroom or before eating.” Make sure to clean and sanitize all surfaces before and after food preparation, too.

If you’re about to travel to a place with a high prevalence of hepatitis A, it’s recommended to avoid eating raw fruits and vegetables, shellfish and untreated water and ice. “Boil tap or well water before drinking or making ice, or use bottled water,” suggests Chen.

And lastly, Chen recommends following FDA announcements for food recalls to keep on top of any due to a hepatitis A outbreak. This way you can be aware of any foods that might put you at risk and know the right protocols to return or dispose of the recalled food items.

Maxine Yeung is a dietitian and board certified health and wellness coach.

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