Brant Mauk figured he just had a miserable case of the flu.
The Pearl City resident hadn’t heard there was a hepatitis A outbreak when he fell ill, and he never thought he’d be at risk of the contagious liver disease.
The athletic 31-year-old works out, swims and hikes. As a laboratory technician, he is meticulous about hygiene.
But Mauk is among 53 adults on Oahu who have come down with hepatitis A in the worst outbreak in Hawaii in more than a decade. The viral infection, often spread through contaminated food or water, can strike anyone.
“I woke up June 30 and my whole body was aching,” he said in a phone interview from his hospital bed. “If my shirt touched my skin, it just ached all the way through. I got hot and cold flashes. I was vomiting. I had headaches.”
AT A GLANCE
Reported cases of hepatitis A in Hawaii:
YEAR NO. OF CASES
2006….. 12
2007….. 8
2008….. 20
2009….. 13
2010….. 9
2011….. 8
2012….. 5
2013….. 16
2014….. 5
2015….. 7
2016*….. 56
* Through Tuesday; includes three previous cases not part of current outbreak
Source: Hawaii Department of Health
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Things kept going downhill, and he was hospitalized on July 7, dehydrated, nauseated and in pain. He spent eight days in the hospital, receiving intravenous fluids as he fought off the infection, and was released Friday. Most of the other victims have been able to convalesce at home. Sixteen have required hospital care.
“You are most contagious before your symptoms show,” Mauk said. “I keep thinking about my wife and daughter. If I can barely survive this, I can’t imagine how it would be, especially for my daughter.”
The Health Department is trying to pinpoint the source of the outbreak, but that’s a tall order. Other foodborne illnesses, such as salmonella, hit quickly, when it’s easier to remember what you ate. Hepatitis A is more elusive because it takes 15 to 50 days to produce symptoms.
Investigators are trying to determine what people ate in the two months before falling ill, relying on patients’ sometimes fuzzy recollections and combing through records of food purchases.
“This obviously is a very notable, sizable outbreak, and that in itself does tell us that this is a widespread, commonly consumed food or drink item,” said Dr. Sarah Park, state epidemiologist, who is leading the investigation.
“We’re trying to put our heads together with our folks in the Sanitation Department and think about what is distributed mostly on Oahu and not really to the neighbor islands,” she said Wednesday. “We’d love to identify it and take it off the shelves if it’s still out there, but we don’t know and that’s the frustration.”
The date of onset of symptoms for this cluster ranges from June 12 to July 3. Symptoms include fever, nausea, vomiting, fatigue, joint and abdominal pain, dark urine and jaundice.
“It’s still possible that we are looking at a fresh food item, in which case it would definitely not be still out there,” Park said. “At the same time, as the onset date range gets longer and longer, it could argue for a frozen food item.”
The most recent notable Hawaii outbreak of hepatitis A, in 2013, was linked to frozen mixed berries. Eight Hawaii residents fell ill among 165 people sickened across the country.
Hepatitis A is usually spread through food or drinking water contaminated with the stool of an infected person. It can also be transmitted through close personal contact.
Cooking food properly and washing hands thoroughly with soap and water after using the bathroom or changing diapers can limit its spread. The Health Department is also urging Oahu residents to consult their health care providers about getting vaccinated.
This is by far the biggest outbreak in years. Hawaii had an average of 10 hepatitis A cases reported annually over the last 10 years, Health Department data show. Annual counts were much higher in the past, as high as 169 in 1992, a few years before vaccines began to be licensed.
Mauk and his wife, Ginger, agreed to discuss their personal experience publicly in hopes of raising awareness of the illness and encouraging other patients to give health investigators complete access and information to help solve the mystery.
“We just want to get public awareness on this issue,” Ginger Mauk said. “We are hoping that people that are victimized by this illness will give the state Department of Health as much information as possible. At some point there should be a common link.”
The couple has no idea what triggered his illness. Rumors flew early in this outbreak that poke, a popular raw fish dish, could be a culprit.
“Brant hates that stuff — it can’t be poke,” Ginger said, although they do sometimes eat sushi.
The victims of this outbreak are a diverse lot, Park said, so trying to find a common thread linking them together is daunting.
“They are scattered throughout Oahu, from all walks of life, a huge age range,” Park said. “We try to look for the outliers or specific commonalities, which is a real challenge.”
All are adults. Most kids in Hawaii have been vaccinated for hepatitis A, since it was added to the recommended immunization list in 2006, although it is not required for school entry in Hawaii.
“Our pediatricians are doing a great job of vaccinating our kids,” Park said.
Mauk’s wife got the vaccine shortly after he was diagnosed, as recommended by their doctor, since the disease spreads easily in households. Their 4-year-old had already been vaccinated.
There is no cure for hepatitis A; the body has to fight it off. It can take a month or two to recover. In severe cases it can lead to acute liver failure and death. Doctors were extra careful with Mauk since he had liver trouble as a teenager.
William D. Marler, a leading food safety attorney, expressed surprise at the size of the current outbreak but predicted the mystery of the source will eventually be solved.
“Hawaii has a well-respected Health Department,” said Marler, managing partner of Marler Clark in Seattle. “It’s certainly most likely that they’ll figure this out.”
He recommends that food service workers be immunized for hepatitis A. Looking ahead, he expects outbreaks to decline as vaccination becomes more common.
“Now that we have this very effective vaccine for it and kids have been getting it for a decade or more, 20 years from now it’s going to be really unlikely you’re going to be having an outbreak like this,” he said.