Tainted berries cause hepatitis

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The bad news is that there was a hepatitis outbreak at all. As of the first week in April, some 170 students and school employees in Michigan had contracted the illness after eating school lunches containing strawberries contaminated with a hepatitis-causing virus. By the time the distributor of the tainted strawberries was identified, parts of the lot from which the bad fruit originated had been shipped to school cafeterias in several other states. The strawberries, grown in Mexico, never should have made it into schools in the first place; it is illegal for imported food to be used in the school lunch program because it puts U.S. farmers at a disadvantage.

The good news -- or at least the less-bad news -- is that thousands of people who could have eaten the strawberries were identified during the 30-day incubation period before symptoms of hepatitis occur. That enabled them to receive shots to prevent the onset of the illness.

Then, too, the type of hepatitis virus carried by the strawberries --hepatitis A -- generally causes the least severe form of the illness, which is a liver infection. Symptoms include jaundice, fatigue, nausea, pain in the liver area (the upper right quadrant of the abdomen), dark urine, and fever. Recovery usually takes place on its own within 3 to 6 months and results in immunity to hepatitis A in the future.

The current case notwithstanding, foodborne hepatitis A outbreaks are relatively uncommon in the U.S. But in countries such as Mexico, where sanitary conditions are more marginal, the illness can flourish. It spreads via food or water contaminated with fecal matter carrying the hepatitis A virus and also from person to person. The strawberries in question presumably were exposed to contaminated water or handled by hepatitis-infected food workers who had not washed thoroughly after going to the bathroom. The fruit was cleaned in the U.S. before it was distributed, but washing fresh produce does not guarantee removal of the virus. Only adequate cooking destroys it for certain.

More Dangerous Hepatitis Strains
While the strawberry scare is unsettling, it is more of a fluke than anything, particularly since the fruit reached as many people as it did because a law was broken. More serious than hepatitis A are hepatitis B and C, which have nothing to do with contamination of food.

Hepatitis C is particularly problematic. For 85 percent of people who contract it, it doesn't go away. Not everybody infected ends up with symptoms of hepatitis, such as fatigue, aching joints, jaundice, and abdominal swelling. But while those infected can remain symptom-free for years or even decades, the illness can end up causing cirrhosis --scarring of the liver that can ultimately result in liver failure.

Almost 4 million Americans have been infected by hepatitis C -- the number-one reason for liver transplantation. Many of them contracted the disease prior to 1990 through shared needles used for illicit drugs as well as through blood transfusions. Not until the late 80s did awareness increase about the dangers of sharing needles. And not until 1990 was there testing to detect the virus in blood.

Now that hepatitis C is much less frequently transmitted via needles and the virus is screened out of the blood supply, only 30,000 new cases are diagnosed each year. But currently there is only one intervention for people with hepatitis C -- alpha interferon -- and only a minor proportion of treated patients respond. There also is no vaccine to prevent the disease. Thus, deaths from the virus are expected to triple over the next 2 decades to more than 24,000 a year as the illness takes its toll on those already infected.

The hepatitis B strain, transmitted through bodily fluids, poses less of a threat. One reason is that there is a hepatitis B vaccine. In addition, while some people afflicted with hepatitis B can end up with life-threatening liver damage, 90 to 95 percent of adults infected make a full recovery within 6 months. About 125,000 new cases are diagnosed each year.

For more information on hepatitis, see the American Liver Foundation's website at http://www.liverfoundation.org, or call 1-800-465-4837 or 1-888-443-7222. Also helpful is the Hepatitis Foundation International, which can be reached at http://www.hepfi.org or 1-800-891-0707.

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