Health Advisory
HEPATITIS A HEALTH ALERT

The Delaware Division of Public Health (DPH) is forwarding this health advisory from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) to the Delaware health care community.

Although no known source of contaminated green onions is known in Delaware, the regional extent of this outbreak has not yet been determined. DPH advises health care providers to consider Hepatitis A as the cause of illness in patients presenting with compatible symptoms. Such patients should be questioned about consumption of green onions, food from restaurants in known affected states, and specifically food from Mexican style restaurants in the Pittsburgh area.

DPH regulations require health care providers to report suspect or confirmed Hepatitis A. Timely reports are especially encouraged now to assist in the determination of the extent and source of this outbreak. DPH will monitor reports of Hepatitis A in order to identify and investigate unusual increases that may suggest a source of contaminated green onions within Delaware.

For further information about this advisory or to report suspect or confirmed cases of Hepatitis A, call DPH at 1-888-295-5156. This number is available during normal business hours, and for emergencies during non-business hours.

CDC Health Advisory
From FDA: CONSUMERS ADVISED THAT
RECENT HEPATITIS A OUTBREAKS
HAVE BEEN ASSOCIATED WITH GREEN ONIONS

Distributed via Health Alert Network
November 15, 2003, 19:28 EST (7:28 PM EST)
CDCHAN-00164-03-11-15-ADV-N

The Food and Drug Administration is advising the public that several recent Hepatitis A outbreaks have been associated with eating raw or undercooked green onions (scallions). Hepatitis A is a liver disease that develops within 6 weeks of an exposure. Hepatitis A is usually mild and characterized by jaundice (yellow discoloration of the skin), fatigue, abdominal pain, loss of appetite, nausea, diarrhea and fever. It can occasionally be severe, especially in people with liver disease.

Hepatitis A outbreaks associated with raw or undercooked green onions served in restaurants occurred in Tennessee, North Carolina and Georgia in September. Another outbreak of Hepatitis A among patrons of a single restaurant occurred in Pennsylvania during late October and early November, although the source of the outbreak has not yet been determined. CDC and the State of Pennsylvania have an investigation underway to determine if a specific food is associated with the Pennsylvania outbreak, and if so, the exact source. The source of the green onions in the Tennessee outbreak is Mexico. FDA is continuing to investigate and is working with Mexican authorities to assess appropriate measures. FDA offers the following advice to consumers concerned about the possibility of getting Hepatitis A from green onions:

• Cook green onions thoroughly. This minimizes the risk of illness by reducing or eliminating the virus. Cook in a casserole or sauté in a skillet.
• Check food purchased at restaurants and delicatessens and ask whether menu items contain raw or lightly cooked green onions. Consumers who wish to reduce the risk of contracting hepatitis should avoid food that contains raw green onions and specifically request that raw or lightly cooked green onions not be added to their food. Foods such as freshly prepared salsa and green salads often contain raw green onions.

FDA, CDC and the States are actively investigating the outbreaks in an attempt to determine the exact source of the green onions associated with the outbreaks and how they became contaminated, so that corrective action can be taken.

While the investigations are ongoing, FDA will closely monitor the safety of green onions and will take further actions as necessary to protect consumers. Consumers who have recently eaten raw or lightly cooked green onions do not need to take any specific measures, but should monitor their health. Consumers who are experiencing symptoms that could be Hepatitis A should consult their health care providers or the local health department.

For More Information

• About FDA on the Internet: www.fda.gov
• About Hepatitis A: http://www.cdc.gov/ncidod/diseases/hepatitis/a/faqa.htm