A possible outbreak of Hepatitis A associated with semi-dried tomatoes, England, July-November 2011

In October 2011, two primary cases of hepatitis A virus (HAV) infection with identical HAV genotype IB strains to those seen in other outbreaks associated with semi-dried tomatoes were reported in England. Both cases had consumed semi-dried tomatoes. Epidemiological investigations revealed two additional cases of genotype IB strains with different sequences who also reported having consumed semi-dried tomatoes. In November, five cases of HAV infection with closely related strains were identified in the Netherlands. A foodborne multiple-strain outbreak is suspected.

In October 2011, two cases of hepatitis A with a genotype IB strain identical to that seen in a previous outbreak associated with consumption of semi-dried tomatoes, Hu/Netherlands/RIVM-006/2010 [1] , were reported to the Health Protection Agency (HPA) in England [2].The strain was identified based on 100% sequence identity over 505 base pairs of the VP1-2PA junction.

Neither of these patients had travelled to an endemic country within 50 days before the onset of symptoms [3] and both reported substantial consumption of semi-dried tomatoes (also known as sun-dried tomatoes). In this preliminary report of the ongoing investigation we highlight the finding of this rare hepatitis strain which may be related to the possible consumption of semi-dried tomatoes in at least two European countries, the United Kingdom (UK) and the Netherlands.