The outbreak was first identified on Aug. 12 when officials from the U.S. Centers of Disease Control and Prevention noticed multiple people sickened by the same strain of hepatitis A. The outbreak has now been linked to frozen strawberries from Egypt that were used in smoothies at Tropical Smoothie Cafe locations in Virginia, according to the state health department.
The 40 people reported sickened are ages 15 to 68, and all said they consumed a smoothie before exhibiting symptoms.
At least 55 percent of those who tested positive for the virus and had their information available to health authorities had to be hospitalized, the department said on Monday.
The strawberries have been voluntarily removed from all restaurants, according to company officials.
Tropical Smoothie Cafe CEO Mike Rotondo addressed customers in a statement.
"'Eat better, feel better' is not just a marketing slogan — it's a promise, and it's something I believe in very dearly. Recently some strawberries may have made their way into the supply chain that could challenge that concept. I sincerely apologize for any issues this may have caused for any of our customers," he said in a statement on video on the company's Facebook page on Aug. 21. "We voluntarily and immediately removed all of those strawberries from all of our cafes, and we have sourced new strawberries for every location. We take this issue very seriously. Your health and your safety is our top priority."
In a statement earlier this month, company officials said the Egyptian strawberries accounted for a small portion of the company's overall supply.
"Egyptian strawberries represent a fraction of our overall strawberries purchased and were predominantly distributed to stores in the Virginia market. Today, our strawberries are primarily sourced from Mexico and California," company officials said in an Aug. 19 statement. "However, in an abundance of caution, we voluntarily pulled all strawberries sourced from Egypt from every cafe in our system, not only the Virginia cafes. Our primary concern is for the safety and well-being of our guests and crew members, and we will continue to cooperate with the health authorities."
The hepatitis A virus can cause inflammation of the liver. Symptoms can develop within 15 to 50 days of exposure and can include fever, fatigue, loss of appetite, vomiting and abdominal pain. A vaccine and immunoglobulin treatment are available for hepatitis A, and both can help protect against the virus if they are taken soon after exposure to the virus.