On August 19, 2016, we reported that government and health officials may have solved the mystery relating to the Hepatitis A outbreak in Oahu, Hawaii. For the post, please visit here. We also reported on September 1, 2016 that scallops weren’t the only food of concern related to Hepatitis A – strawberries were also to blame. Based on these, there are two active outbreaks of Hepatitis A affecting the United States. The first outbreak has been affecting the various Hawaiian Islands for over a month, while the second, more recent outbreak has sickened people in Virginia and other states in the contiguous United States. We have outlined the updates on the outbreaks below, as new information comes to light.

Hepatitis A in Hawaii

The island of Oahu has been the main center of the Hepatitis A outbreak in Hawaii. As of last week, there have been 252 people infected with Hepatitis A because of this outbreak. This was an addition of 11 cases since the previous week. Sixty-six people sickened in the outbreak required hospitalization. All but 11 cases of illness occurred in people from the island of Oahu. There have been no deaths associated with this outbreak. People sickened in the outbreak have reported onset dates between June 12 and August 30, 2016. Also since the previous update, one more employee at a restaurant has been diagnosed with Hepatitis A. This brings the total amount of restaurant employees sickened to 11. The ill employee worked at the Zippy’s Restaurant location on Oahu. Days the ill person worked include August 14, 18, 19, 21, 23, 25, and 26. This does not, however, mean that Zippy’s Restaurant is the source of the Hepatitis outbreak. Health officials have previously identified imported scallops as the source of the outbreak. Most of the contaminated scallops were embargoed in their warehouse, although some were distributed to various restaurants across the Hawaiian islands. Consumers who ate at the restaurant on these days should consider receiving a vaccination if they do not already have one.

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Hepatitis A in the Contiguous United States

The second Hepatitis A outbreak, which has affected states across the nation, has also been updated by the CDC. In this outbreak, 89 people have been diagnosed with a Hepatitis A infection. These cases of illness are spread out over 7 states, including Maryland with 10 cases, New York with 1 case, North Carolina with 1 case, Oregon with 1 case, Virginia with 70 cases, West Virginia with 5 cases, and Wisconsin with 1 case. Thirty nine people sickened in the outbreak needed to be hospitalized because of their illness. There have not been any deaths reported in association with this outbreak. Federal, state, and local health officials involved in the investigation discovered that many of the people sickened in the outbreak had reported consuming smoothies from Tropical Smoothie Cafe prior to their illness. Through the traceback investigation and genetic testing, investigators were able to pinpoint strawberries from Egypt as the source of the outbreak. Tropical Smoothie Cafe has since switched suppliers. The CDC has said that there appears to be no ongoing risk of contracting Hepatitis A from Tropical Smoothie Cafe locations. They also recommend that anyone who is sick and consumed a Tropical Smoothie Cafe strawberry smoothie prior to August 8 contact their doctors.

Hepatitis A Disease Information and Prevention

There are many ways to prevent a Hepatitis A infection from happening. Practicing good hygiene, including the thorough washing of hands, is important in halting the spread of infection. Those sickened with Hepatitis A should not prepare food for others, as the infection may spread. However, the best way to prevent a Hepatitis A infection is by getting a vaccination. The CDC recommends that anyone over the age of 1 year old receive the Hepatitis A 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, statistics reported almost 40,000 cases of Hepatitis A, but today the CDC estimates that there are less than 5,000 cases of Hepatitis A per year. Again, 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. If you have received a vaccine, even as a young child, the vaccine still protects you from infection. 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, and they work to identify a specific virus in the bloodstream, which activates the body’s immune response to destroy the virus. These antibodies also appear if Hepatitis A infects someone. Because Hepatitis A antibodies do not go away, someone who has previously been infected 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, where about 70% of infections 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. The Hepatitis A virus 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. Again, if you have already had a Hepatitis A infection, or you obtained the proper vaccination, there is no threat of infection from this outbreak. If you or a loved one begins to show the symptoms of a Hepatitis A infection, contact a medical professional.