By: James Peacock

   The Hawaii State Department of Health has recently reported that it is investigating an outbreak of Hepatitis A that has hit the island of Oahu. There have been 31 people sickened in the outbreak as of July 6, 2016. These illnesses have onset dates between June 16, 2016 and June 27, 2016. Six people have been hospitalized so far because of their illnesses. The investigation began in late June, but has been unable to find the source of the outbreak. However, according to State Epidemiologist Dr. Sarah Park, “Identifying the source of infection is a challenge…[because] [a]ccurately recalling all of the foods consumed and locations visited during the period when infection could have taken place is challenging for many, especially those who are still feeling ill.”

      The outbreak was first announced on July 1, 2016, when the Hawaii State Department of Health publicized that 12 people had been sickened on the island of Oahu with similar strains of Hepatitis A. Health Department officials then worked over the July 4, 2016 holiday weekend to track down any other cases of Hepatitis A. This led to the 19 case increase that was reported in the July 6 update. Interviews, which are currently expedited by health officials, are being conducted in the hopes of pinpointing a source in the outbreak. There is speculation that the outbreak is linked to food sources, but no concrete evidence has yet to have been found. 

         Hepatitis A is a fairly rare form of foodborne illness. The CDC estimates that there are less than 5,000 cases of Hepatitis A poisoning per year in the United States. This is mostly due to the success of the Hepatitis A vaccine – a safe and effective way to prevent a Hepatitis infection. The vaccine was first introduced in 1995, and immediately led to a sharp decline in Hepatitis A cases. The number of Hepatitis A cases reached a high point of almost 40,000 cases in 1989. Many people in the general population may have already received the vaccination, as the CDC recommends that all children be vaccinated at the age of one. The vaccine should be effective for 25 years in adults and around 17 years in children. In addition to children at the age of one, the CDC also recommends the vaccination for those with certain risk factors, including those living in or traveling to areas with a high level of Hepatitis infection rates, those working in hospitals and research facilities, and those with chronic liver diseases.

         The Hawaii State Department of Health has recommended that everyone review their immunization records. If you do not have a Hepatitis A vaccination and are in Hawaii, the Department of Health also recommends that you immediately get vaccinated. They have published a full list of pharmacies offering vaccinations, which can be found here. Although vaccination is the best way to prevent a Hepatitis infection, it is also recommended that people properly wash their hands often, usually with warm water and soap.

           Most Hepatitis A infections are transmitted through the fecal-oral route. This route usually involves the ingestion of something, typically food or water, that has been contaminated by fecal matter. The easiest way to prevent contamination is to wash your hands thoroughly before preparing food. Those sickened by Hepatitis A should not prepare food, as they may contaminate it. Anyone with a case of Hepatitis A should avoid physical contact with others and practice excellent hygiene in order to prevent the spread of the infection.

          Depending on the age of the person, a person with a Hepatitis A infection may not even show symptoms. This asymptomatic Hepatitis A infection is most common in young children under the age of six. As much as 70% of infections in those under the age of six are asymptomatic. Conversely, adults and children over the age of six will usually show the symptoms of a Hepatitis A infection. About 70% of these cases also present with jaundice, or the yellowing of the skin and eyes. Hepatitis infections have a very wide range of incubation times, sometimes taking up to 50 days to produce symptoms. Even though symptoms have presented in as few as 15 days, the CDC reports that most cases of Hepatitis A show symptoms after an average of 28 days.

           Hepatitis A is an infection that mainly affects the liver. In adults, and children over the age of six, a typical infection will produce symptoms including fever, loss of appetite, vomiting, dark urine, joint pain, fatigue, nausea, abdominal pain, clay-colored bowel movements, and jaundice. These symptoms can occur abruptly at any point between 15 and 50 days after infection. The infection will generally last for around 2 months, although the CDC reports that there is a 10-15% chance of relapsing within 6 months of the Hepatitis A infection. However, there is no risk of the Hepatitis infection becoming chronic.

          Again, the best way to prevent a Hepatitis A infection is to make sure that you are vaccinated. This is even possible if you know for sure you have been exposed to the virus, as the vaccine is effective if administered within two weeks after exposure. If you or a loved one begins to show the symptoms of Hepatitis A infection, immediately contact a medical professional. A doctor can confirm a case of Hepatitis A poisoning by administering a test to look for the presence of immunoglobulin M (IgM). IgM is a natural antibody produced by the body to fight the Hepatitis A infection. Testing positive for IgM is the best way to confirm the infection. The test is important because the infection symptoms and characteristics are the same for all types of Hepatitis, A through E. However, IgM is only found in the presence of Hepatitis A. Even though the immunoglobulin tells whether or not you infected with Hepatitis A, it is actually a good thing. Antibodies are your body’s natural way of fighting infections. The purpose of the Hepatitis A vaccine is to introduce these antibodies into the body. Once someone has the IgM antibodies in their bloodstream, they are immune to being infected by the virus. Thus, like the chicken pox, it is impossible to be infected with Hepatitis A twice.

           Again, if you or a loved one begins to show the symptoms of Hepatitis A poisoning, immediately contact a medical professional. If you reside in Oahu, Hawaii, and have not been vaccinated for Hepatitis A, immediate vaccination is encouraged to help prevent the spread of this mysterious outbreak.