Government and health officials may have solved the mystery relating to the Hepatitis A outbreak in Oahu, Hawaii.

Since our last update, the Hepatitis A outbreak on the Hawaiian island of Oahu has more than doubled in size. As of August 17, 2016, there have been 206 people sickened in the outbreak. The outbreak has increased in size by 113 cases since late July. Those sickened in the outbreak have reported illness onset dates between June 12 and August 9, 2016. All of the people sickened with Hepatitis A have been adults. Fifty one people have required hospitalization because of their illness. Although the outbreak is mostly centered on Oahu, 9 people from the islands of Hawaii, Kauai, or Maui have reported a case of Hepatitis A. One person sickened in the outbreak has returned to the mainland United States.

Until recently, health officials have been unable to pinpoint a source for the outbreak. On August 15, 2016 though, the Hawaii Department of Health ordered all 11 Genki Sushi restaurant locations on the islands of Oahu and Kauai to close. The investigation had discovered that the likely source of the Hepatitis outbreak is imported frozen scallops. Various Genki Sushi locations served these frozen scallops raw. In addition to closing Genki Sushi restaurants, the Hawaii Department of Health also issued an embargo on scallops distributed by Koha Foods. The Honolulu based distributor got the scallops from Sea Port Products Corp, who imported the products from the Philippines. An embargo on the product means that the government forbids the sale, purchase, or consumption of frozen scallops throughout the state. Around 70% of people sickened in the outbreak reported eating at a Genki Sushi restaurant prior to being sick.

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Dr. Virginia Pressler, the Health Director, recently commented that “The business has complied with all orders, contacted all of their Hawaii restaurants, and is working with the department to ensure the safety of its customers. Our staff is in the field today working with distributors to embargo the product.” Genki Sushi has also released a statement, saying “We will continue to work with the Department of Health to ensure we are in compliance so we can open our restaurants as soon as possible.” There have been no reports of illness from any employees of Genki Sushi.

Hawaii state health officials continue to be open-minded about confirmation of the link to scallops. Epidemiologist Dr. Sarah Park said in a statement Thursday, August 19, 2016 “This laboratory confirmation is important validation of our investigation findings … We are continuing efforts to end this outbreak by working to assure no other product is left in the state and to monitor for those who unfortunately may have been infected and do not yet have symptoms.”

In July, Dr. Park was open to the public about the challenges of confirming the source of the outbreak. She stated “We have to sit down with each person and say look at the calendar, go back almost two months and list every single thing that passed through your mouth — food or drink or what-not — in the past 52 days.”

However, studies found a series of employees from other companies with Hepatitis A diagnoses. At least one employee from businesses including Baskin-Robbins, Chili’s, Costco Bakery, Hawaiian Airlines, Hokkaido Ramen Santouka, Sushi Shiono, Taco Bell, Tamashiro Market, Papa John’s Waipahu, and New Lin Fong Bakery. Consumers who ate at restaurants staffed by ill employees may be at risk of contracting a Hepatitis A infection. Health officials have recommended that anyone with potential exposure to Hepatitis A seek vaccine as soon as possible.

At the Baskin-Robbins location at Waikele Center, an ill employee was working on June 17, 18, 19, 21, 22, 25, 27, 30, and July 1 and 3, 2016. Ill employees worked at the Farrington Highway Chili’s location on July 10, 12, 14, 15, 17, 18, 20, 21, 22, 23, 25, 26, and 27, 2016. At the Costco Bakery at Hawaii Kai, ill employees worked on June 16-20, 2016. Between July 1 and July 26, ill employees worked at Hawaiian Airlines. At the Honolulu location of Hokkaido Ramen Santouka, ill employees worked on days including July 21, 22, 23, 26, 27, 28, 29, 30, and August 2, 3, 4, 5, 6, 9, 10, and 11. Ill employees worked at the Waikoloa Beach Resort location of Sushi Shiono on July 5, 6, 7, 8, 11, 12, 13,14,15, 18, 19, 20, and 21. The Taco Bell located in Waipio had ill employees working on June 16, 17, 20, 21, 24, 25, 28, 29, 30, and July 1, 3, 4, 6, 7, and 11. At Tamashiro Market, located in Kalihi, had ill employees working on July 2, 4, 6, 7, 8, 11, 12, 13, 15, 16, 17, 18, 19, and 23. At the Papa John’s location in Waipahu, ill employees worked on July 23, 24, and August 2. Lastly, on July 20, 22, 23, 25, 27, 29, 30, and August 5-6, ill employees worked at New Lin Fong Bakery on the island of Oahu. More information about companies with ill employees can be found here.

Again, health officials have recommended that anyone who has eaten at restaurants associated with the outbreak get a vaccination. This vaccination is the best way to prevent infection. The vaccine is safe to receive for anyone over the age of 1. Since its introduction in 1995, the Hepatitis A vaccine has led to a sharp decline in annual Hepatitis A infections. Medical providers administer the Hepatitis A vaccine over the course of 2 injections, which build up antibodies in the bloodstream. These antibodies help the body destroy any Hepatitis A virus. A full list of pharmacies on Oahu that are distributing Hepatitis A vaccines can be found here.

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. 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. Around 70% of infections in children are asymptomatic. Adults and children over the age of 6, though, will present the typical symptoms of a Hepatitis A infection. Hepatitis A infections in adults and children over the age of 6 presents with jaundice, or yellowing of the skin and eyes in 70% of cases. 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. If you or a loved one begins to show the symptoms of Hepatitis A poisoning, contact a medical professional.