State health officials are investigating cases of hepatitis A infections in three Hawaii residents who consumed a frozen berry product purchased at Costco.
The three – two on Oahu and one on Kauai – all ingested the product identified as Townsend Farms Organic Antioxidant Blend.
A spokeswoman for the state Department of Health said they became ill in early to late May and all are recovering or have recovered.
Hawaii is among six states in which the product was implicated. The others were Colorado, New Mexico, Nevada, Arizona and California.
In Hawaii, Costco pulled the product from its shelves last week.
The chain said it was contacting all customers who purchased the product and the public is advised to discard or return any remaining product.
Officials said hepatitis A is a virus that can cause fever, fatigue, loss of appetite, abdominal discomfort, dark urine, diarrhea and yellow skin and eyes.
Illness usually occurs from two weeks to as long as 50 days after consumption of contaminated food or water, which officials described as that prepared by an infected food handler who did not properly wash their hands, or from produce contaminated in the field.
“Hepatitis A infection is a vaccine preventable disease, and fortunately, most children and adolescents have been vaccinated as part of routine childhood vaccination recommendations,” said state epidemiologist Dr. Sarah Park. “However, many adults have not been vaccinated and will be susceptible.”
Officials said anyone who consumed the implicated product during the past month is encouraged to consult their medical provider regarding vaccination.
Most persons with hepatitis A infection will recover without complications but may require supportive therapy and close monitoring by their physician, Park said.
State officials said all cases of suspected hepatitis A infection should be reported to the Department of Health by calling (808) 586-4586.
According to the Centers for Disease Control and Prevention, a hepatitis A vaccination can prevent illness if given within two weeks of exposure to the contaminated product.
The CDC said the product’s label said it contains pomegranate seeds and other produce from the US, Argentina, Chile and Turkey.
It said laboratory analysis of two of the 34 cases suggests this strain of hepatitis A is rarely seen in the Americas but has origins in North Africa and the Middle East. It was previously identified to an outbreak earlier this year in Europe linked to frozen berries and a 2012 outbreak related to a frozen berry blend with pomegranate seeds from Egypt.
Fairview, Ore.-based Townsend Farms has not yet issued a recall, the CDC said.
***Updated on Tuesday, June 4, to correct number of states where the cases have occurred.***
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