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A multifocal outbreak of hepatitis A traced to commercially distributed lettuce

Author

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  • Rosenblum, L.S.
  • Mirkin, I.R.
  • Allen, D.T.
  • Safford, S.
  • Hadler, S.C.

Abstract

From February 1 through March 20, 1988, 202 cases of hepatitis A were reported in and around Jefferson County, Kentucky. The epidemic curve indicated a common-source exposure. However, there was no apparent single source of exposure from a restaurant, or community gathering; nor was there a geographic clustering by residence. Cases were mainly adults 20-59 years old (89 percent); 51 percent were female. A case-control study using neighborhood controls found that factors associated with hepatitis A were: having eaten downtown (odds ratios [OR] = 4.0) and having dined at any one of three restaurants (OR = 21.0). Case-control studies of patrons of two of these restaurants found that eating green salad was strongly associated with acquiring hepatitis A: OR = 11.6 and OR = 4.4. The three implicated restaurants accounted for 71 percent of the cases. All three restaurants were supplied by the same fresh produce distributor; however, investigation suggested that contamination most likely occurred prior to local distribution. This outbreak of hepatitis A is the first in the United States apparently associated with fresh produce contaminated before distribution to restaurants, and raises important public health issues regarding the regulation of fresh produce.

Suggested Citation

  • Rosenblum, L.S. & Mirkin, I.R. & Allen, D.T. & Safford, S. & Hadler, S.C., 1990. "A multifocal outbreak of hepatitis A traced to commercially distributed lettuce," American Journal of Public Health, American Public Health Association, vol. 80(9), pages 1075-1079.
    • Handle: RePEc:aph:ajpbhl:1990:80:9:1075-1079_1
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    Cited by:

    1. Annalaura Carducci & Elisa Caponi & Adriana Ciurli & Marco Verani, 2015. "Possible Internalization of an Enterovirus in Hydroponically Grown Lettuce," IJERPH, MDPI, vol. 12(7), pages 1-14, July.

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