A hepatitis A outbreak linked to Egyptian berries used in smoothies has expanded to six states and 69 victims, with Virginia tallying the most reported cases. Officials have traced the outbreak to Tropical Smoothie Café, which appeared in all 55 of Virginia’s cases.

The Virginia Department of Health said in a press release that about 55 percent of the infected residents had been hospitalized as of Monday. There are more than 500 smoothie franchises across the country, and all 96 locations in Virginia pulled potentially contaminated Egyptian-sourced berries no later than Aug. 8 or Aug. 9.

On Sunday, Tropical Smoothie Café CEO Mike Rotondo said in a posted video that all of the implicated strawberries had been pulled from locations in Virginia after health officials contacted the company on Aug. 5.

More on this...

West Virginia health officials did not name a specific smoothie retailer in their public posting, but they identified frozen strawberries from Egypt “used by restaurants in a variety of smoothies,” as the culprit, Food Safety News reported. The state has seven reported cases of hepatitis A.

“While there is no information to suggest there is an ongoing risk of hepatitis A virus from the strawberries used in the smoothies, there can be transmission from person to person with contacts of the reported cases,” the West Virginia Department of Health said, according to the report.

The Centers for Disease Control and Prevention (CDC) is leading the epidemiological investigation of the outbreak, an agency spokesman told Food Safety News. Officials in Maryland, North Carolina, Oregon and Wisconsin have confirmed other cases.

Symptoms of hepatitis A typically take between 15 and 50 days to present, and can include fever, fatigue, loss of appetite nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain and jaundice. Symptoms typically last for up to two months.