MEDICAL ADVISORY: Heightened Surveillance for Hepatitis A

Issued by:  Azim Kasmani, MD FRCPC, Associate Medical Officer of Health (Acting) 

The Public Health Agency of Canada has identified an outbreak of Hepatitis A associated with frozen mango products. Health care professionals should have a heightened awareness of potential Hepatitis A infections and administer post-exposure prophylaxis to exposed clients.

Background

• The Canadian Food Inspection Agency has issued a food recall warning for various frozen mangoes produced by Nature’s Touch Frozen Food Inc. These products are sold under brand names of Compliment, Irresistibles and President’s Choice
• As of July 31, 2021, the Public Health Agency of Canada has identified three laboratory-confirmed cases of Hepatitis A in Quebec (2) and Nova Scotia (1). Exposure to frozen mango products is the likely source of the outbreak.
• There have been no reported cases associated with the outbreak to date in the Niagara region or Ontario

Clinical Presentation

• Infection often manifests as an asymptomatic or mild illness, especially in childhood
• Symptoms in adults can include fever, jaundice, dark urine, malaise, anorexia, abdominal discomfort, nausea and vomiting
• Average incubation period of 28 to 30 days (range 15-50 days)

Diagnosis and Management

• Patients should be advised to return or discard the recalled products and not eat them
• One dose of Hepatitis A vaccine should be offered as post-exposure prophylaxis (PEP) to individuals 6 months and older (unless contraindicated), who have consumed the recalled product in the last 14 days
  • Hepatitis A vaccines may be requested through the High Risk Vaccine Order Form. Please indicate PEP under “Reason."
• Human immunoglobulin (Ig) may be recommended for PEP for clients from the following groups. Please contact us for more information if Ig may be needed at 1-888-505-6074 or 905-688-8248 ext. 7554/7543.
  • Infants (less than 6 months of age)
  • Individuals with contraindications towards the Hepatitis A vaccine
  • Individuals where Hepatitis A vaccine is not available
  • Ig is recommended in addition to the Hepatitis A vaccine for those who are immunocompromised or with chronic liver disease

Please report all suspect or confirmed Hepatitis A cases immediately to Niagara Region Public Health, Infectious Disease program at 1-888-505-6074 or 905-688-8248 ext. 7330 Monday to Friday 8:30 a.m. to 4:30 p.m., after hours 905-984-3690.