Fresh organic strawberries have recently been identified as the source of a multi-state outbreak of hepatitis A - a highly contagious liver infection caused by the hepatitis A virus (HAV). 2016 saw another outbreak of hepatitis A in frozen strawberries.
But it's not just strawberries. Here's which foods are more likely to be contaminated with hepatitis A and how to best protect yourself.
Which foods are most likely to be contaminated with hepatitis A?
"Theoretically, any food can be contaminated with hepatitis A," Dr. Victor Chen, assistant professor of medicine at Johns Hopkins University School of Medicine, told Yahoo Lifestyle. "In practice, the more common contaminated foods include raw vegetables - including salads - as well as fruit, shellfish, ice and water."
All foods are at risk for contamination with the hepatitis A virus if they are handled by someone who has been exposed to the virus or if they have been rinsed with dirty and contaminated water. Although it is uncommon in the United States, previous food-related hepatitis A outbreaks have occurred since 2011 in raw scallops, frozen tuna, conventional blackberries and pomegranate seeds.
Are organic products more likely to be contaminated with hepatitis A?
Organic products "certainly do not protect consumers from hepatitis A," Chen said.
According to a 2016 study, there have been more foodborne illness outbreaks associated with organic foods than conventionally grown ones in the U.S. Between 1992 and 2014, 18 viral and bacterial outbreaks were caused by organic foods, eight of which involved produce. However, it is important to note that organic food outbreaks are increasing as more and more people are also producing and consuming organic foods.
What we do know is that the risk of contamination of any produce with hepatitis A increases with poor sanitation and hygiene, whether it is organically grown or conventionally grown.
How does the hepatitis A virus infect people?
"Hepatitis A is transmitted by ingesting something that contains the virus. Most commonly, this means consuming contaminated food or water," Chen explains. This type of transmission is known as the fecal-oral route, in which food or water consumed is contaminated with the feces of an infected person.
Other possible ways to contract hepatitis A include not washing hands and then eating after touching contaminated items, such as surfaces and diapers, and through oral sex, Chen said. "In both cases, transmission is still through ingestion of the hepatitis A virus," he said.
The risk of transmitting hepatitis A is also higher in areas with poor sanitation and poor personal hygiene.
How do you know if you're infected?
Common symptoms of hepatitis A include nausea, diarrhea, loss of appetite, fever and feeling tired. In some people, symptoms may last longer and even have more serious but rare consequences, such as liver failure or death - although this is more common in people over age 50 and in people with other chronic health conditions. It may take up to two weeks for symptoms to appear, which means there may be no symptoms while the infection is being spread.
A blood test can determine if you have the hepatitis A virus. The good news is that 85 percent of people with hepatitis A recover within three months without any complications or liver damage. Infection also means that you will develop antibodies that will give you lifelong immunity.
What can you do to protect yourself from hepatitis A?
"Get the hepatitis A vaccine," encourages Chan. The vaccine is a series of two injections given at least six months apart and can be given to anyone over the age of 12 months. "In immunocompetent individuals, the hepatitis A vaccine should provide 95 percent protection for more than 10 years, and possibly even 20 to 30 years," Chen says. If you haven't had this vaccine, you can check with your health care provider to see if it's available.
Since hygiene is also a factor in the spread of hepatitis A virus, Chen says it's important to "clean up after handling raw food, changing diapers, using the bathroom or before eating." Make sure you clean and sanitize all surfaces before and after preparing food.
If you are traveling to an area with a high prevalence of hepatitis A, avoiding raw fruits and vegetables, shellfish and untreated water and ice is recommended. "Boil tap or well water before drinking or making ice, or use bottled water," Chen advises.
Finally, Chen recommends following the FDA's food recall notices to stay informed about hepatitis A outbreaks. In this way, you can learn about any food that may put you at risk and understand the proper protocol for returning or disposing of recalled foods.