There is still mystery on the island of Oahu concerning the Hepatitis A outbreak. The local, state, and national health agencies are still scrambling to find evidence to pinpoint the exact source of the outbreak and a means to link the known illnesses to the source.

Since its initial announcement, the Hepatitis A outbreak on the Hawaiian island of Oahu has worsened significantly. As of July 26, 2016, there have been 93 confirmed cases of Hepatitis A. The number of cases has increased by a total of 62 over the last 20 days. Those sickened in the outbreak reported that their illnesses began between the dates of June 12, 2016 and July 19, 2016. Although all people sickened in the outbreak were on Oahu at the time of infection, four of those people are no longer on the island. These four now live on the islands of Hawaii, Kauai, and Maui. All cases of Hepatitis A infection have occurred in adults. A total of 29 cases have required hospitalization. No deaths have been reported.

            Investigators have struggled to pinpoint the source of the outbreak, as mentioned in our most recent post on this topic. There have been multiple restaurant employees diagnosed with Hepatitis A over the course of the outbreak, although none of these businesses have been declared the source of the outbreak, and no cases of illness have been directly tied to the outbreak. However, health officials have recommended that consumers that ate at the restaurants staffed by these employees contact their personal doctor and look into preventative treatment. Although there is little risk to consumers who ate at these restaurants, Hepatitis A prevention, via a vaccine, is a very effective way to prevent infection not only in the current outbreak, but also in the future. A full list of pharmacies on Oahu that are distributing Hepatitis A vaccines can be found here.

            The first restaurant with an employee who tested positive for Hepatitis A was a Baskin-Robbins on Oahu. This restaurant is located in the Waikele Center. The employee who was diagnosed with Hepatitis A worked on dates including June 17, 18, 19, 21, 22, 25, 27, 30, and July 1 and 3. Consumers who ate at this restaurant on these dates should consider visiting a doctor or getting a vaccination.

            The second restaurant with a sick employee is a Taco Bell, also on the island of Oahu. The restaurant is located in the city of Waipio. The ill employee worked on days including June 16, 17, 20, 21, 24, 25, 28, 29, 30, and July 1, 3, 4, 6, 7, and 11. Even still, health officials recommend that anyone who consumed food or drink from that Taco Bell location between the dates of June 16 and July 11 consider receiving a vaccination.

            Lastly, an employee of Sushi Shiono also tested positive for Hepatitis A. This restaurant, though, is located on the main island of Hawaii, not Oahu. The Sushi Shiono location can be found at the Waikoloa Beach Resort, Queen’s Marketplace. The employee with Hepatitis A worked on the dates July 5-8 and 11-15.

            There are many ways to avoid and prevent infection from the Hepatitis A virus. Practicing good hygiene, including the thorough washing of hands, is paramount in halting the spread of infection. Those infected with Hepatitis A should be especially careful, as the virus is contagious. Hepatitis A is spread through the fecal-oral route, meaning that in order for an infection to take place, a person must come into contact with contaminated fecal matter. Those sickened with Hepatitis A should not prepare food for others, as the infection may spread.

            The best way to prevent a Hepatitis A infection, though, is by getting a vaccination. The CDC recommends that anyone over the age of 1 year old receive this vaccination. The vaccine is safe for all people to receive, and is administered through two shots given over a period of six months. The vaccine was first introduced in 1995, and had a tremendous effect on the incidence rates of Hepatitis A. In 1989, almost 40,000 cases of Hepatitis A were reported. Now the CDC estimates that there are less than 5,000 cases of Hepatitis A per year. The Hepatitis A vaccine is effective for at least 17 years in children and at least 25 years in adults, although it may last for the rest of the person’s life. The CDC recommends that all children over the age of 1 receive the vaccination, as well as those traveling to areas with high incidence rates of Hepatitis A, those working in hospital and research facilities, and those with chronic liver diseases.

            The vaccine works by introducing inactivated Hepatitis A virus to a person’s body in order to spur the creation of antibodies. These antibodies represent the body’s natural immune response to the presence of the virus. Antibodies work by identifying a specific virus in the bloodstream, which activates the body’s immune response to destroy the virus. These antibodies also appear if someone is infected with Hepatitis A. Because these antibodies do not go away, someone who has previously been infected with Hepatitis A cannot be infected a second time, much like the chicken pox.

            Hepatitis A infections may not produce symptoms in those it infects, depending on their age. Asymptomatic cases of Hepatitis A are most common in children under the age of 6. About 70% of infections in children are asymptomatic. Adults and children over the age of 6 will present the typical symptoms of a Hepatitis A infection, but 70% of these cases also present with jaundice, or yellowing of the skin and eyes. A case of Hepatitis A poisoning will abruptly produce symptoms in as soon as 15 days after infection, although it may take up to 50 days. The CDC reports that a Hepatitis A infection will produce symptoms after 28 days, on average.

            Hepatitis A is a virus that targets the liver, and can cause symptoms including fever, vomiting, joint pain, nausea, clay-colored bowel movements, loss of appetite, dark urine, fatigue, abdominal pain, and jaundice. Although the symptoms will usually last for about 2 months, the CDC has said that there is between a 10 to 15% chance of relapsing within 6 months. There is no risk of the infection becoming chronic. If you or a loved one begins to show the symptoms of a Hepatitis A infection, contact a medical professional.

Sources:

http://health.hawaii.gov/docd/hepatitis-a-outbreak-2016/

http://www.staradvertiser.com/breaking-news/waikele-ice-cream-store-worker-confirmed-to-have-hepatitis-a/

http://khon2.com/2016/07/01/state-investigating-hepatitis-virus-outbreak-on-oahu/

https://health.hawaii.gov/news/files/2013/05/16-045-Hep-A-in-Food-Service-Employee.pdf

http://health.hawaii.gov/docd/files/2013/07/IMM_Adult_Resource_List.pdf

http://www.cdc.gov/hepatitis/HAV/HAVfaq.htm#general