Another food handler has come down with hepatitis A, this time a worker at Tamashiro Market in Kalihi- Palama, which is renowned for its fresh fish.

The employee is the seventh food handler statewide to contract hepatitis A out of the 135 cases reported so far in the current outbreak, which is the worst in nearly two decades.

No cases have been linked to exposure at restaurants or businesses, but cases are being made public to spur prevention efforts, including vaccination.

“Tamashiro Market is not at fault for this, but given that much of what is sold there is typically prepared and purchased raw, it is important to inform the public of possible exposure,” said Dr. Sarah Park, state epidemiologist. “This business understands that public health is our primary concern, and they have been working with us to help prevent new cases.”

The Tamashiro worker was on duty from July 2 to 23. Individuals who worked at the Baskin-Robbins in Waikele, the Hawaii Kai Costco bakery, the Chili’s restaurant in Kapolei, the Taco Bell in Waipio and the Sushi Shiono in Waikoloa have also tested positive for hepatitis A, as has a Hawaiian Airlines flight attendant.

The department Friday encouraged members of the public to contact their health care providers about getting vaccinated against the contagious liver disease. So far, 39 people who contracted hepatitis A in this outbreak have had to be hospitalized.

The virus can spread through food or drink contaminated with traces of feces, or through close personal contact. No businesses have been identified as a source of the outbreak. Recent national hepatitis A clusters have been tied to food as disparate as fresh green onions and frozen pomegranate seeds.

The state Health Department has been trying to trace the culprit, but the job is complicated by the long incubation period — as long as 50 days — before symptoms appear after someone is exposed to the virus.

Pharmacies and clinics have been reporting brisk business in the vaccine. Many residents and some restaurant workers are signing up for hepatitis A vaccines just as a precaution, even without any known exposure to the disease.

Island Urgent Care spokesman Miguel Gonzalez said Friday that his company has vaccinated employees at California Pizza Kitchen and Roy’s in Hawaii Kai, in an abundance of caution.

“We are seeing more employers looking for the vaccine for their employees,” Gonzalez said. “More people are being proactive. We are seeing that demand increases as more news breaks of additional cases.”

Gregg Fraser, executive director of the Hawaii Restaurant Association, emphasized that food handlers who have tested positive for hepatitis A are a tiny proportion of the cases, and occur through happenstance.

“It’s not coming from the restaurants,” Fraser said. “It’s not the restaurant’s fault. A very, very, very small percentage of cases is a restaurant employee. It’s not the restaurant that’s infected.

“So don’t stop going to the restaurants,” he added. “Don’t stop going to your favorite ice cream store. Certainly, don’t stop flying your favorite airline.”

Hawaii has 100,000 food service workers, and there are 3,500 restaurants on Oahu, according to the association. Restaurants are inspected by the Department of Health. Employees must wash their hands after using the toilet and also as they enter the kitchen, he said.

“There is a requirement that there is a hand sink at the entrance to every kitchen in every restaurant,” he said. “It’s not a suggestion. It is mandatory.”

Publicity over individuals who test positive who happen to work at food establishments takes a toll on those businesses. It has prompted owners to wonder, “How do I prevent my restaurant from being the next case that’s named in the news?” Fraser said.

“The only way to truly nip it in the bud is to get everybody vaccinated,” he said.

Symptoms of hepatitis A include fever, fatigue, loss of appetite, abdominal pain, dark urine, diarrhea and yellow skin and eyes.

Vaccination provides the best protection, according to the Health Department. Frequent, thorough hand-washing with soap after using the toilet and before preparing food at home and eating also prevents the virus’ spread. Hepatitis A has been among the recommended childhood vaccines since 2006, but it isn’t required.

More information and a list of pharmacies offering vaccinations is online at health.hawaii.gov.