The number of hepatitis A victims in Hawaii continues to climb, reaching 228 on Wednesday, but the outbreak appears to be slowing now that the scallops that triggered it have been taken off the market.
The Health Department releases the case total every Wednesday. Over the past week, 22 new cases were identified, nearly an 11 percent increase. That was a slower rise than the Aug. 17 tally of 206, which was almost a 23 percent jump from the previous week.
Cases of the infectious liver disease will continue to crop up because the virus can linger for weeks in the body before causing symptoms, officials warn.
“We know our work is not done,” state epidemiologist Dr. Sarah Park said Wednesday. “Fortunately we pulled the scallops before we even knew for certain, and it was great to have corroboration from the lab. But unfortunately, the scallops have been out there and we have to continue to monitor for potential new cases and control for potential secondary cases.”
Only a few cases in this outbreak are secondary cases, transmitted from one person to another, she said. “They usually are the same household, same family kind of situations, where people are in really close contact,” Park said.
Among the 22 new cases reported this week is a cafeteria worker at Kipapa Elementary School, who informed her principal Monday that she had tested positive. The school cafeteria was quickly closed and a commercial company was hired to clean it.
School meals are being prepared elsewhere and cafeteria workers are being tested for hepatitis A, Education Department spokeswoman Donalyn Dela Cruz said Wednesday. So far all tests have come in negative, she said.
All the victims identified in this outbreak are adults, including three visitors who have since returned to the mainland. Most children in the state are protected from the disease through vaccination, which is recommended but not required for school entry.
According to 2014 data from the Centers for Disease Control and Prevention,
87 percent of children aged 18 months to 35 months in Hawaii have had the first dose of the hepatitis A vaccine, while 55 percent had both doses. The vaccine provides 20 years or more of protection.
Last week, the state Health Department traced the outbreak to contaminated scallops that were imported frozen from the Philippines and served raw at Genki Sushi restaurants on Oahu and Kauai. It shut down all Genki Sushi outlets on the two islands on Aug. 15 and the scallops have been recalled by their importer, Sea Port Products Corp., headquartered in Kirkland, Wash.
Genki Sushi has been thoroughly sanitizing the restaurants and ensuring that every employee is screened and vaccinated, according to Mary Hansen, chief administrative officer for Genki Sushi USA. The company has 358 employees at its 10 restaurants on Oahu and one outlet on Kauai, which remain closed.
“While our goal is to reopen our restaurants as soon as possible, Genki Sushi’s top priority is the health and safety of our customers, employees and the community,” Hansen said.
“Since the Department of Health announced the source of the illness was a food product that was received from a distributor, we have been working closely with state health officials to take the necessary actions to ensure all of our restaurants meet or exceed DOH guidelines and requirements,” she said.
Symptoms of hepatitis A include fatigue, nausea, abdominal pain, fever, dark urine, pale stool and jaundice. In rare cases, patients can develop liver failure, especially those with pre-existing conditions. So far, 58 victims have required hospitalization.
Hepatitis A can survive in fresh or salt water and freezing temperatures. Thoroughly cooking food kills the virus. Vigorous hand-washing after using the toilet and before eating can stem the disease, which spreads through fecal-oral contact.
“Foodborne hepatitis A outbreaks can occur with raw shellfish because they are filter feeders and if the water is contaminated with fecal material, sewage discharge, then the uncooked shellfish can pass any viruses along to the consumer,” said associate professor Amy Brown of the University of Hawaii medical school. “Another hepatitis A source is raw produce, fresh or frozen, that was exposed to sewage-contaminated water.”
Brown cautioned anyone with hepatitis A to avoid any alcohol, recreational drugs or acetaminophen, the ingredient in Tylenol.
“The inflamed liver is already stressed and these products are metabolized by the liver,” said Brown, who is in the UH Department of Complementary and Alternative Medicine.
Patients should also avoid dietary supplements or herbs without a doctor’s approval, and guard against dehydration by drinking fluids, she said.
Local residents have been flocking to pharmacies and clinics to get vaccinated in hopes of warding off the disease.
“We continue to see a lot of people requesting the vaccine,” said Dr. Robert Ruggieri, founder and medical director of Island Urgent Care. “Some of them have had some exposure and some not.”
He added: “There are many people who don’t know if they’ve been exposed, people who might be spreading it unknowingly. Anyone who has symptoms, it’s important that they consider getting tested because we don’t want it to keep spreading.”