In a developed country such as the United States, outbreaks of Hepatitis A (HAV) from contaminated food are not common but are still possible and have occurred in the past. Some outbreaks have been linked to thousands of cases. It can be difficult, however, to pinpoint the source of infection because of the late onset of symptoms especially when the victims are geographically scattered. A food product can become contaminated at any step during the process of harvesting, distribution, preparation, etc… When the problem occurs at one of the early stages, say during production, this can lead to a wide-spread outbreak, such as recent outbreaks of HAV linked to imported pomegranates or HAV linked to imported strawberries.
However, most recorded HAV outbreaks in the United States have occurred at the point of sale when food is handled and served in a restaurant. While most food handlers with HAV do not transmit the virus because they practice proper personal hygiene, all an infected person has to do to spread the virus is touch food after failing to wash their hands. These “establishment” HAV outbreaks are usually in a single geographic location tied to a particular restaurant, like the relatively recent Burger King or Famous Anthony’s outbreaks.