The state Health Department now says three Hawaii residents — two on Oahu and one on Kauai — have been diagnosed with hepatitis A that may be linked to a frozen organic berry mix that was pulled from Costco shelves on Wednesday.

All are adults, Health Department officials said Monday. The residents, who became ill in early to late May, are recovering or have recovered, the state said. One required brief hospitalization.

The state earlier said it was aware of two cases.

The Food and Drug Administration and the Centers for Disease Control and Prevention had previously linked 30 hepatitis A illnesses in five western states to Townsend Farms Organic Anti-Oxidant Blend, which is believed to contain a tainted pomegranate seed mix. Nine of the reported cases resulted in hospitalization, according to the CDC. The earliest illness report dates back to April 29.

Costco is contacting customers who bought the product since late February.

A Costco representative told the Hawaii Health Department that the company voluntarily pulled the product from its shelves in all Hawaii stores on May 29 and 30, the department said. The public is advised to discard or return any remaining product.

“Hepatitis A infection is a vaccine preventable disease, and fortunately, most children and adolescents have been vaccinated as part of routine childhood vaccination recommendations,” said Dr. Sarah Park, Hawaii epidemiologist. “However, many adults have not been vaccinated and will be susceptible.”

A Townsend Farms representative told the Associated Press that the company is checking to see if any other retailer besides Costco may have distributed the product.

According to the CDC, preliminary laboratory studies of specimens from two cases suggest the outbreak strain of hepatitis A virus is genotype 1B, a strain is rarely seen in the Americas but known to circulate in the North Africa and Middle East regions.

This genotype was identified in a 2013 outbreak in Europe linked to frozen berries and another 2012 outbreak in British Columbia related to a frozen berry blend with pomegranate seeds from Egypt, the CDC said.

According to the label, the Townsend Farms Organic Anti-oxidant Blend frozen berry mix associated with illness contained pomegranate seeds and other produce from the U.S., Argentina, Chile and Turkey.

Illness from hepatitis A infection occurs within 15 to 50 days of exposure and symptoms can include fatigue, abdominal pain, jaundice, abnormal liver tests, dark urine and a pale stool.

The CDC is advising the public not to eat Townsend Farms Organic Anti-Oxidant Blend and to discard any remaining product.

The Hawaii Department of Health asks people to report suspected cases of hepatitis A infection to the department at 586-4586.

———

For more information regarding the multistate outbreak, go to www.cdc.gov/hepatitis/Outbreaks/2013/A1b-03-31/index.html.  

For more information regarding hepatitis A, go to http://hawaii.gov/health/DOCD/DIB/HepatitisA.html.  

For a list of pharmacies that provide hepatitis A vaccine, go to http://hawaii.gov/health/Immunization/Documents/AdultVaxResourceList.pdf.