A fruit distributor in Oregon is voluntarily recalling a frozen blend of organic berries after the Centers for Disease Control linked it to a multistate outbreak of hepatitis A, a virus that affects the liver.

Hawaii health officials said Monday three of the hepatitis A cases were in Hawaii, striking three adults, including one person who was hospitalized. All three consumed the frozen berry product from Costco and became ill in May. Two of the three are on Oahu, and one is on Kauai.

Townsend Farms of Fairview, Ore., said it was recalling its Organic Antioxidant Blend, a mix that includes pomegranate seeds imported from Turkey, which the company said might be the source of the virus that has affected 49 people in seven states: Arizona, California, Colo­rado, Hawaii, Nevada, New Mexico and Utah.

Townsend said the seeds might be linked to an outbreak of the illness "outside the United States."

The berries were sold in Costco stores in Hawaii and on the West Coast and in Harris Teeter stores, primarily in the Southeast.

The Food and Drug Administration and the CDC issued a warning about the berries May 29, a day after a major Chinese meat processing company announced plans to buy Smithfield Farms, one of the largest U.S. pork producers, increasing awareness of how much food the U.S. imports and raising questions about its safety.

The FDA has been working to gain approval from the Obama administration for proposed regulations aimed at enhancing the safety of food produced and processed internationally for export to the United States.

"The timing of this recall is interesting because everyone is waiting for the FDA to come out with the import rules, and now there will be more heat on them to finalize them," said Gwendolyn Wyard, regulatory director for organic standards and food safety at the Organic Trade Association.

The CDC said workers handling ingredients in the Townsend frozen berries may not have washed their hands properly, a factor that the pending regulations address.

Because the berries and pomegranate seeds involved were certified as organic by the Agriculture Department, it should make the recall easier, Wyard said.

"The requirements for record-keeping and traceability in organics are in place and apply to certified organic operations in Turkey and other places even without the food safety rules," she said, "making it a relatively easy process for auditors to go in and trace ingredients."

Preliminary lab studies of two specimens suggest that the strain of the hepatitis virus involved in the outbreak is one found in the Middle East and North Africa but rarely in North or South America, according to the CDC. It has a genotype that was associated with an outbreak of hepatitis A in Europe this year, which also involved frozen berries, and to an outbreak in British Columbia last year involving pomegranate seeds from Egypt, the agency said.

The CDC said the Townsend product contained ingredients from the United States, Argentina and Chile in addition to Turkey.

The agency interviewed 25 people who had the virus, 19 of whom said they had bought the Townsend frozen berry mix from Costco, which has retail stores across the country. At Costco the berries have been sold since February in 3-pound bags labeled Townsend Farms Organic Antioxidant Blend.

Craig Wilson, vice president for quality assurance and food safety at Costco, said the retailer Thursday contacted 240,000 of its members who had bought the contaminated berries to let them know about the problem.

"Although it wasn’t a recall at that point, we treated it as a recall," Wilson said.

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Stephanie Strom, New York Times