At least two of the 200-plus hepatitis A victims in Hawaii are so gravely ill that they are on the waiting list for a liver transplant, according to their attorney.

The two women, ages 64 and 68, appeared in normal health before eating scallop sushi and later coming down with the infectious liver disease, according to Bill Marler, managing partner at the food safety law firm Marler Clark in Seattle.

Both are Oahu residents, and they dined separately at Genki Sushi restaurants.

Last week the state Health Department shut down all Genki Sushi outlets on Oahu and Kauai after tainted raw scallops were identified as the source of the hepatitis A outbreak. The scallops, imported from the Philippines, have been recalled.

Marler, who was in Honolulu last week, has interviewed 41 hepatitis A victims or their relatives if the patients was too sick to talk.

“All of these people ate at Genki Sushi, and all of them ate the scallops and all of them have tested positive for hepatitis A,” Marler said. “I’d say the vast majority of them had been hospitalized.”

“There’s still people quite ill and still in the hospital,” he added. “This outbreak is far from over.”

To put the current hepatitis A cases in perspective, the Queen’s Transplant Center has 33 people on the waiting list for a liver transplant for chronic liver disease and acute liver failure.

As of Aug. 17 the Health Department had identified 206 hepatitis A cases in Hawaii, including 51 people who required hospitalization, in the worst outbreak in two decades. Health officials update the number of cases every Wednesday, and it is expected to rise.

On Tuesday the Health Department announced a new case of hepatitis A in a Hawaiian Airlines flight attendant. It said the risk of transmission was “extremely low” and that the airline was not the source of the outbreak, but it is publicizing the case as a precaution. Passengers can visit hawaiianairlines.com/hepatitisA for information on affected flights. If a doctor advises vaccination, the airline will cover the cost.

This was the second Hawaiian Airlines flight attendant to come down with hepatitis A. The first one was infected in July.

“This case is a reminder that hepatitis A symptoms can appear up to 50 days after exposure,” said state epidemiologist Dr. Sarah Park. “This is why we expect to continue to see cases in coming weeks and why we need to remain vigilant to prevent further transmission, even though the product has been pulled off the market.”

Marler is representing many Hawaii residents and two visitors who contracted hepatitis A on Oahu. A nurse from San Diego visited Hawaii and then was hospitalized in Pittsburgh with hepatitis A. She has since returned home. The other is a man who traveled to Hawaii and has returned to Texas.

“Given the fact that this is such a tourism destination, we may be missing ill people who have come here from around the world and have gone home, and so they’re off the radar,” Marler said.

At Genki Sushi the scallops were served raw, chopped and mixed with mayonnaise on top of a rice ball wrapped in nori, or dried seaweed. Some diners didn’t realize the scallops were raw, Marler said.

The frozen scallops were imported by Sea Port Products Corp., a California corporation, which voluntarily recalled them Thursday after Food and Drug Administration tests confirmed they were contaminated with hepatitis A.

The scallops had been distributed in California and Nevada as well as Hawaii.

“We still don’t know if there are going to be sick people from the product being sent to California and Nevada,” Marler said. “My hope is that Honolulu just got a bad batch and that the stuff that went to California and Nevada is not contaminated. But unfortunately, because of the incubation period, we are going to have to wait.”

Hepatitis A can linger from 15 to 50 days in the body before symptoms appear. The first reported patient in Hawaii fell ill on June 12, and the most recent on Aug. 9.

Symptoms include fatigue, nausea, abdominal pain, dark urine and jaundice. In rare cases, patients can develop liver failure, especially if they have pre-existing conditions.

The disease is usually spread when a person ingests even microscopic amounts of fecal matter through contaminated food, drink or objects.

Water, shellfish and salads are the most frequent sources of foodborne hepatitis A, according to the FDA. The hardy virus can survive in fresh and sea water as well as freezing temperatures for long periods of time.

Thorough cooking kills the virus. Vigorous hand-washing after using the toilet and before eating can help prevent its spread from one person to another. Vaccination provides long-lasting protection from hepatitis A.

Sea Port Products Corp. recalled three lots of frozen Bay Scallops produced Nov. 23 and 24, with lot numbers 5885, 5886 and 5887. The scallops came from De Oro Resources Inc. in Suba Basbas, Philippines, according to the Hawaii Health Department. None of the product was intended for retail sale.