title: A multifocal outbreak of hepatitis A traced to commercially distributed lettuce.
abstract: From February 1 through March 20, 1988, 202 cases of hepatitis A were reported in and around Jefferson County, Kentucky. The epidemic curve indicated a common-source exposure. However, there was no apparent single source of exposure from a restaurant, or community gathering; nor was there a geographic clustering by residence. Cases were mainly adults 20-59 years old (89 percent); 51 percent were female. A case-control study using neighborhood controls found that factors associated with hepatitis A were: having eaten downtown (odds ratio [OR] = 4.0) and having dined at any one of three restaurants (OR = 21.0). Case-control studies of patrons of two of these restaurants found that eating green salad was strongly associated with acquiring hepatitis A: OR = 11.6 and OR = 4.4. The three implicated restaurants accounted for 71 percent of the cases. All three restaurants were supplied by the same fresh produce distributor; however, investigation suggested that contamination most likely occurred prior to local distribution. This outbreak of hepatitis A is the first in the United States apparently associated with fresh produce contaminated before distribution to restaurants, and raises important public health issues regarding the regulation of fresh produce.
authors.affiliation: Division of Viral Diseases, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: L S
authors.initials: LS
authors.lastname: Rosenblum
authors.forename: I R
authors.initials: IR
authors.lastname: Mirkin
authors.forename: D T
authors.initials: DT
authors.lastname: Allen
authors.forename: S
authors.initials: S
authors.lastname: Safford
authors.forename: S C
authors.initials: SC
authors.lastname: Hadler
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003132:Commerce; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination; D005511:Food Handling; D006506:Hepatitis A / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012147:Restaurants; D014675:Vegetables