If a tree falls in the woods, does it make a sound? If a food worker in Egypt fails to properly wash his hands, does it cause an epidemic in another nation? More than 80 people in seven US states have been infected with food-born Hepatitis A, and at least 32 people have been hospitalized. The outbreak is linked to frozen strawberries from Egypt that were served up in smoothies in a Virginia restaurant chain. Well, hello there, global food network.

Hepatitis A is a highly contagious liver infection and a “self-limited disease that does not result in chronic infection” according to the US Centers for Disease Control (CDC). Symptoms include jaundice, fever, fatigue, nausea, vomiting, and abdominal pain, and they can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months, as per the CDC.

The virus is transmitted through direct contact with someone who has Hepatitis A or by consuming food or drink that has been contaminated with the virus. This commonly occurs when contaminated fecal matter finds its way to food items via improper handling, according to the Mayo Clinic.

Most of those infected are Virginia residents, according to that state’s Department of Health and the federal Centers for Disease Control and Prevention (CDC). Confirmed victims also hail from New York, Maryland, North Carolina, West Virginia, Oregon and Wisconsin, a CDC spokeswoman said Tuesday. All had consumed strawberry smoothies from the Tropical Smoothie Cafe chain.

Tropical Smoothie Cafe immediately removed the fruit from all of its locations, according to CEO Mike Rotondo in a YouTube video posted Sunday by the chain. They are now sourcing strawberries from suppliers in California and Mexico, but health officials are braced for more illnesses to arise due to the disease’s long, asymptomatic incubation period. That incubation period can last for 50 days, making outbreaks are difficult to identify and investigate.

Virginia health officials became aware of the current cases between May and the end of August, but did not identify them as a cohesive outbreak until early August, at which time they notified the restaurant. The state did not alert the public for another two weeks.

That two week delay is now central to looming victim litigation because of the narrow window for administering post-exposure Hepatitis A vaccinations, which are only effective if given within 14 days of exposure, according to Virginia health officials and CDC.

“I think it’s important for the Virginia Department of Health and Tropical Smoothie Café to say why they didn’t alert the public sooner,” said Bill Marler, a Seattle food safety attorney who is representing outbreak victims. “By not coming forward they kept people who had been exposed from having the opportunity to protect themselves and their families from Hepatitis A.”

The state health department said officials waited because they wanted to gather as much information as possible “to determine with enough scientific certainty what the risk to the public was so we could understand the risk and communicate it accurately.”

But even with confirmation from CDC on August 12, Virginia officials waited before warning the public. A September 2 editorial in the Charlottesville Daily Progress asserts that there are more reasons to question the health department than the delay in issuing a public alert.

A lawyer (among a group of attorneys who have been in contact with victims and potential victims who might eventually file lawsuits) is complaining that Tropical Smoothie franchises took up to four days to remove all of the suspect strawberries.

Attorney William D. Marler says that two-week gap was critical, as – if warned – people can stave off infection by getting vaccinated. Some victims contracted the disease who, if forewarned, might have protected themselves.

Virginia officials continue to urge anyone who had a smoothie at any restaurant “within the last 50 days” to monitor themselves for symptoms of Hepatitis A.

Stave off spread of Hepatitis A with frequent hand-washing before preparing food and after using the bathroom or changing a diaper. Eat food that is grown local, by people you know, using processes that are clean and safe. Hydroponically-grown food is a great way to better “know” the source as its highly monitored.

Routine vaccination which involves two injections given six months apart has reduced cases of Hepatitis A in the past ten years.  Injections are specifically recommended for children, travellers to certain countries, and for people at high risk for infection.