Fall 1997 Volume 2, Number 3		Frozen strawberry-associated outbreak extended to Maine The hepatitis A outbreak attributed to frozen strawberries in March 1997, earlier thought to affect only Michigan (see HCR Spring 1997 issue), also extended to Maine. In September, Maine State Epidemiologist Kathleen F. Gensheimer reported that a group of 37 cases reported in the state during January 1 to May 15, 1997 were probably associated with the national outbreak. The state and CDC conducted a case-control study of 19 cases in Maine schools whose symptoms began during the period and who reported eating at school. Classroom contacts without disease served as controls. The study showed that illness was associated with eating lunch at school cafeterias, and that frozen strawberries was the food most associated with illness. The frozen strawberries were processed by Andrew and Williamson and distributed through the USDA school lunch program. Dr. Gensheimer said "it should be noted that the association with eating strawberries was of borderline significance and that only 68% of cases reported eating strawberries. However, no other food item was associated with illness." She also said that molecular fingerprints of HAV isolates from some of the Maine patients were the same as those from Michigan. In September, CDC announced that HAV isolates from cases in Wisconsin and Louisiana had nucleic acid sequences identical to isolates from patients in the Michigan outbreak. However, since the sequences have not been compared to isolates from throughout the U.S. or Mexico, it is too early to say whether the cases in Wisconsin and Louisiana are related to the frozen-strawberry outbreak.