Three more cases of hepatitis A in Hawaii have been linked to a recalled Townsend Farms frozen organic berry mix that caused a multistate outbreak of the illness, bringing the isle total to seven cases.

The berry mix, which had been sold at Costco stores, was recalled by its Oregon fruit distributor but has been connected to more than 120 cases of hepatitis A across the country.

Dr. Sarah Park, state Department of Health epidemiologist, said three of four cases that were being checked earlier this month were linked to the berries, two on Maui and one on Kauai. A Hawaii island case turned out to be unrelated to the outbreak strain, she said by email.

In total there were three cases on Oahu, two on Maui and two on Kauai, she said.

According to the U.S. Centers for Disease Control and Prevention, the national count is up to 122 cases in eight states. Fifty-four cases required hospitalization.

Park said it would be premature to say that there will be no more cases related to this outbreak because of the long two-week to two-month incubation period and the fact that the product is frozen and can be stored for long periods.

"We continue to monitor for additional cases and investigate any suspect ones," Park said.

Three of the seven Hawaii cases required hospitalization, but Park said all the patients have recovered or are recovering. None were children.

"It is notable that hepatitis A infection is a vaccine-preventable disease and has been part of the (national) routine childhood immunization schedule since 2006," Park said. "None of the handful of kids infected in this outbreak (all on the mainland) had been vaccinated."

Hepatitis A is usually spread through contaminated food or drinking water and can also be spread through close contact with an infected person. The hepatitis A vaccination can prevent the illness if given within two weeks of exposure.

The disease can range from a mild illness lasting a few weeks to a serious disorder lasting several months. Symptoms include fatigue, stomach pain, fever, loss of appetite, jaundice and dark urine. People with symptoms should see their doctors promptly.

After the recall, Costco offered the $80 vaccines free to customers who brought in the recalled organic berry mix.