As of October 26, 2016, there are now 291 confirmed cases of Hepatitis A poisoning linked to the outbreak that has been active in Hawaii for over two months. About 70 of those sickened in the outbreak needed to be hospitalized because of their infections. Most of the cases linked to this outbreak took place on Oahu, but 11 cases of illness occurred in residents of Hawaii, Kauai, and Maui. There were also 7 cases of illness in people who are not from the islands. The 291 cases of hepatitis A poisoning began on dates between June 12 and October 9, 2016. There have been 2 reports of death associated with this outbreak. One of the deaths was not attributed to Hepatitis A, as the person was in hospice care, but Hepatitis A is considered a cause of death in the other. While the outbreak has added 73 new cases, it looks like the number of new cases is beginning to slow. This is likely because it has been more than 50 days since the embargo on scallops, and Hepatitis A has a maximum incubation time of 50 days. However, health officials are still on the lookout for late onset cases as well as secondary cases.

The Hepatitis A outbreak first gained the attention of health officials in early July, when more than 30 people were diagnosed with the disease on the island of Oahu. The investigation would grow substantially over the following weeks, as more and more cases of Hepatitis were reported. On August 15, more than a month after the investigation began, state health officials with the Hawaii Department of Health reported that they had located the source of the outbreak. Raw scallops served at Genki Sushi restaurants in Oahu and Kauai were identified as the source of the outbreak after interviews and a traceback investigation. The scallops served at these restaurants were produced by Sea Port Bay Scallops, and were shipped to Hawaii from the Philippines. These scallops were then distributed by Koha Oriental Foods and True World Foods. These scallops were embargoed across the islands, whether they had been distributed to restaurants or kept in warehouses.

This Hepatitis outbreak continues to affect employees of food serving establishments. Although this does not mean that the restaurants are responsible for any illnesses caused there, people who ate at restaurants while an infected person was working should make sure that they are vaccinated. Currently, there are 4 employees who are considered to still be a risk for infecting others. An ill employee worked at the Harbor Restaurant at Pier 38 on August 26 through September 12. Another worked at Ohana Seafood at Sam’s Club on the island of Oahu between the dates of August 29 and September 11. An employee with Hepatitis worked at the Chart House Restaurant on Oahu from September 1 to September 4, and also September 8 through September 11. Lastly, an ill employee worked at an Oahu McDonald’s on a variety of dates, including September 20-21, 23-24, 27-29, and October 1, 4-5, 7, and 11. This is not the full list of employees sickened in the outbreak. Over the course of 4 months, there have been more than 10 employees of restaurants and other food service locations diagnosed with Hepatitis A. The Health Department has stated that after 50 days since the employee’s last workday, the ill employee is removed from the list.

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.

There are many ways to prevent a Hepatitis A infection from happening. Practicing good hygiene, including thorough hand washing, 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. 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.cdc.gov/hepatitis/hav/havfaq.htm#general