A map showing the affected states. (Courtesy of Centers for Disease Control and Prevention)

As of early Friday morning, 70 cases of hepatitis A in seven states have been linked to tainted frozen strawberries shipped to the United States from Egypt and served by a popular smoothie restaurant chain.

Most of the cases of the liver infection caused by the hepatitis A virus are in the Mid-Atlantic area.

With 55 confirmed cases, Virginia contains the bulk of the outbreak. Six more cases were confirmed in Maryland, five in West Virginia, and one in North Carolina, Wisconsin, New York and Oregon, the Centers for Disease Control and Prevention reported Thursday.

As of now, 32 people have been hospitalized, but no deaths have been reported.

The number of confirmed cases — which The Washington Post reported to be 35 last Friday, after the Virginia Health Department announced that a Northern Virginia restaurant worker had been diagnosed with the disease — has been steadily growing throughout the week.

The strawberries appear to have been served in Tropical Smoothie Cafe, a company that began in Tallahassee in 1997. It now boasts more than 500 locations across the United States, including a cluster in Northern Virginia.


(iStock photo)

These particular strawberries appear to have been consumed at locations in Maryland, North Carolina, Virginia and West Virginia, the CDC reported Thursday.

The cases in other states also appear to be linked to these locations. The person in Oregon, for example, had traveled to Virginia and consumed a smoothie containing strawberries there.

Mike Rotondo, the chief executive of Tropical Smoothie Cafe, addressed the outbreak in a video posted to the company’s Facebook page.

In it, Rotondo apologized to those who had fallen ill and said, ” ‘Eat better, feel better’ is not just a marketing slogan. It’s a promise.”

He said the Virginia Department of Health contacted the company on Aug. 5 to inform it of a potential link between the hepatitis A cases and strawberries the cafe was using in its smoothies.

“We voluntarily and immediately removed all of those strawberries from all of our cafes,” he said. “And we have sourced new strawberries for every location.”

Rotondo concluded the statement by saying, “We take this issue very seriously. Your health and your safety is our top priority. We want you to have confidence that we source high-quality products so that you’ll come back again and visit us very soon.”

See it, below.

Strawberries served at Tropical Smoothie Cafe have been linked to 70 cases of hepatitis A in seven states. CEO Mike Rotondo apologized in a video posted Aug. 21, 2016. (Tropical Smoothie Café)

A later statement released on the company’s website on Thursday stated that the company would no longer source strawberries from overseas.

“We are now sourcing strawberries only from the Americas,” it read.

It also stated that health officials “praised” the company for “cooperation and swift action.”

The number of cases may be higher than reported, though, as symptoms don’t generally appear until a few weeks after one contracts the virus.

Some don’t develop any symptoms.

The symptoms include a wide-range of ailments: fatigue, nausea/vomiting, abdominal pain (particular on one’s right side, under the lower ribs, where the liver resides), clay-colored stool, appetite loss, low-grade fever, dark urine, joint pain and jaundice (yellowing of the eyes and/or skin).

The severity of the disease varies, and it can last from several weeks to several months. It can be fatal, but rarely is in the United States.

It is generally contracted when a person ingests contaminated fecal matter, which can find its way to food items via improper handling.

The Mayo Clinic states that it is “usually is spread when a person ingests even tiny amounts of contaminated fecal matter.”

But it also states the disease is “highly contagious” and can be spread by “being in close contact with a person who’s infected — even if that person has no signs or symptoms” or via sexual contact.

Though Tropical Smoothie Cafe was alerted of the potential outbreak on Aug. 5, the Virginia Department of Health did not publicly announce its investigation until Aug. 19.

“I think it’s important for the Virginia Department of Health and Tropical Smoothie Cafe to say why they didn’t alert the public sooner,” Bill Marler, a Seattle food safety attorney who is representing outbreak victims, told Food Safety News. “By not coming forward they kept people who had been exposed from having the opportunity to protect themselves and their families from hepatitis A.”

Diane Woolard, director of the health department’s division of surveillance and investigation, said the department needed to gather more information before publicly announcing the potential outbreak.

“We did not know for sure where the frozen strawberries were distributed, if the risk was associated with one restaurant chain or more general to other potential sources, if it was limited to Virginia or it extended further. We wanted more information to feel confident that the source was strawberries and not other fruits, especially since smoothies contain so many ingredients,” Woolard told Food Safety News.

This is the latest in a series of food borne illness outbreaks.

An outbreak of E. coli traced to the Chipotle restaurant chain sickened at least 50 people last year. Following a recall of Blue Bell ice cream (which led to a temporary shutdown of the company’s manufacturing plants and a $850,000 fine) due to a listeria outbreak linked to the ice cream, CRF Frozen Foods of Pasco, Wash., announced a recall of 360 different organic and nonorganic frozen fruits and vegetables that may be contaminated with listeria.

Unlike the affected people in those cases, though, consumers infected with hepatitis A can pass it on to others, even after their symptoms subside.

“If you’re harboring hepatitis A, it has an incubation period from two to four weeks and you can pass it along to others,” David Bernstein, chief of the hepatology division at Northwell Health in Manhasset, N.Y., told CBS. “After you’ve been exposed you are shedding virus for two to four weeks. At that point, you may not even be ill, but you can pass it on at work, at school and to the people you live with.”