What You Must Know About Hepatitis A and Where to Get Vaccinated Right Now

Now that the primary source of Hawai‘i’s recent outbreak of infectious hepatitis has been identified, does it still make sense to get a shot? Yes. Here’s why.

By Don Wallace

Photo: Hawai‘i State Department of Health

If you aren’t worried about hepatitis A by now, maybe you should be—because the viral liver disease that first surfaced in Hawai‘i on June 12 keeps coming back to haunt us. The revelation that two of the 228 (and counting) victims have suffered liver failure and will require organ transplants underscores our level of urgency.

From the very first, the state Department of Health’s Disease Outbreak Control Division has recommended vaccinations. And some people have gotten them. But the number of the infected has continued to grow.

“We strongly encourage people to get vaccinated,” says Melissa Viray, deputy state epidemiologist. “This is a sizable outbreak.”

Caused by contaminated food, able to be transmitted by eating or human contact, tricky to diagnose due to a 15-to-50-day incubation period, this particular strain of hep A was finally tracked to its source—frozen scallops from the Philippines served raw at Genki Sushi bars on O‘ahu and Kaua‘i—Aug. 16. But just because the restaurants have been closed for cleaning and the Sea Port Bay Scallops have been removed from the shelves doesn’t mean the threat is over.

“With a 50-day window of infection,” says Viray, “we will continue to see cases.”

Liver failure is at the extreme end of the spectrum for hepatitis A, but those with the disease may experience fatigue, nausea, vomiting, abdominal and joint pain, fever, dark urine and yellow eyes and skin. The symptoms can range from mild to severe and last from weeks to months; a number of the current outbreak have been hospitalized.

The sooner people are vaccinated, the sooner the outbreak can be curtailed. Food handlers such as flight attendants and restaurant and school cafeteria workers have come down with the disease, raising the odds that pools of secondary infection will prolong the crisis.

Getting vaccinated now is particularly important because the vaccine doesn’t take effect immediately. “At two weeks after taking the vaccine, 54 to 62 percent of people will have evidence of the protective antibodies,” says Viray. But it takes about four weeks before “nearly 94 to a 100 percent” of the vaccinated will have the protective antibodies.

Genki Sushi has been cleaning the restaurants from floor to ceiling since they were closed Aug. 15. The company sent out a statement on Aug. 24 saying officials continue to work with the health department to comply with all standards so they can reopen.

‘‘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,” said Mary Hansen, chief administrative officer, Genki Sushi USA. “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.”

The company said it has been discarding produce, open packages of food, and single-serve equipment and utensils, as well as thoroughly cleaning and sanitizing the restaurants according to state standards and making sure that all employees in the impacted restaurants are being screened and vaccinated. Test results of the 358 employees will be compiled and provided to the state for review and certification.

“We appreciate our customers’ understanding and support as we continue to focus on preparing our restaurants to reopen so that customers can have confidence in the safety and quality of the food we serve,” said Hansen.

Where to get your shot

The bottom line: You can be exposed to and develop hepatitis A after being vaccinated. So putting it off isn’t doing you, your family, or the rest of us, any good.

But has the message sunk in with the public? Paying a visit to the Fort Street Mall on Wednesday, we put two questions to members on a takeout lunch line. “Are you concerned about hepatitis A?” And: “Have you been vaccinated?”

The results weren’t encouraging: out of seven asked, five younger respondents hadn’t heard anything about the outbreak, or else shrugged.

But not Melissa Nakamura. “The vaccine? I already got it last month,” she said. “I’m one of those people who keeps up to date on medical stuff. I go with what my doctor recommends.”

Janice Heidt hadn’t gotten her shot yet, which she found a little ironic. “I was just thinking about that because I got sick off some food earlier this week,” she said, smiling. “Plus I’m a plaintiff’s attorney and we were just talking about hepatitis A lawsuits.” The mother of young children is a partner at Turbin Chu Heidt. “There are several hepatitis lawsuits that have been filed this week; a Seattle law firm is doing a few and I’m sure there are going to be more.”

Her husband did get his shot. “He eats sushi a lot,” she noted. And her children, she discovered, had already received the vaccine as part of their routinely scheduled vaccinations.

This is par for the course, says Viray. Due to hepatitis A vaccines being added to the standard array of shots required for school attendance, “We haven’t had a single case of hepatitis A in a child.”

There is no shortage of vaccine in the Islands. Depending on your insurer’s policy, you may not even need a prescription for the shot; just walk into a pharmacy and ask them to check if your insurance will cover it. The Department of Health has released a list of providers (see below) or you can call the Aloha United Way’s referral line (at 211).

Viray has another point to make. “Wash your hands. Soap and water.” Hand sanitizer? There are no data to support the effectiveness of the many formulations on the market, so the health department can’t take a position on it. “But hand-washing is absolutely critical. If you look at the highest risk factor in transmission, it’s the household contact with people who share a bathroom, share food—the people you live with. So wash your hands with soap and water. Often.”