Published Online: April 16, 1997

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Hepatitis Outbreak Spurs Inoculations in 5 States

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Education and health officials in five states inoculated thousands of students and school staff members last week after investigations revealed that frozen strawberries served in school lunches came from the same lot that spurred an outbreak of hepatitis A in Michigan schools.

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U.S. Department of Agriculture officials announced earlier this month that a batch of tainted strawberries responsible for more than 150 cases of hepatitis A among students and school workers in Michigan had been dispatched to schools in Arizona, California, Georgia, Iowa, and Tennessee as part of the agency's school lunch program.

So far, only Michigan residents are known to have been exposed to the highly contagious liver disease. ("Hepatitis Scare Spurs Administrators Into Action," April 9, 1997.)

To offset a situation that could have led to widespread panic among parents and students, state health departments and school districts quickly set up emergency hepatitis A hot lines and spread the word through local newspapers and fliers about where and when to get children inoculated.

Officials in Georgia mounted a mass inoculation campaign last week, administering more than 5,000 gamma-globulin injections to students and school personnel who may have consumed the tainted strawberries.

In an elementary school in Camden County, Ga., 250 students--three-fourths of the student body--who ate strawberry fruit cups at the end of March lined up for their injections last week.

Camden school officials had to act quickly because gamma globulin is only effective for 14 days after exposure and the entire district was on spring break the previous week.

"It was difficult because people were spread hither and yon because of the holiday," said Ann Proctor, the associate superintendent of the 9,000-student district. "Fortunately, it worked out time-wise."

Officials in the Los Angeles school district also promptly responded to the potential health crisis and issued shots to 8,400 students and staff members in 17 schools who may have been exposed to the virus after eating the fruit cups in their midday meals.

"Its been running amazingly smoothly," said Pat Spencer, a spokesman for California's largest, and only, district to receive the questionable fruit.

California health department officials estimate the total cost of the 9,000 shots at about $30,000.

Andrew & Williamson, the San Diego packing company that supplied the berries, said last week that it would pick up the tab for all inoculations related to the outbreak. So far, the federal Centers for Disease Control and Prevention has delivered 30,000 doses of gamma globulin to schools across the country.

Knock on Wood

While states like California and Georgia rushed to immunize their school populations, other states decided against a widespread vaccination campaign. Iowa health officials determined that the risk of infection was too low and the potential risks serious enough to avoid a massive public health response.

"Anytime you do an inoculation, there's a very slight risk from complications, so we didn't want to do it here," Kevin Teale, the spokesman for the Iowa health department, said. About 100 schools in Iowa served the suspect berries to students in January. No one has become sick yet. The CDC says that individuals with hepatitis A often begin to show symptoms of nausea, fatigue, and loss of appetite within three to six weeks. "Right now, it's fingers crossed, knock on wood," Mr. Teale said.

Many school officials are still waiting for government assurances on the integrity of the school meals program. "We'll be interested in hearing what kinds of guarantees we can expect on [the USDA's] other products," said Mr. Spencer. USDA and CDC officials are trying to pinpoint where the virus might have entered the school food supply. The infection is spread orally or through human waste, often by people with poor hygiene who handle food.

Contamination could have occurred in the growing, storing, or packing of the product that was shipped from Mexico to the California producer, CDC officials said. They have ruled out school-based food handlers as the contamination source.

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