What You Need to Know About Hepatitis A in Hawaii

This preventable disease has been a problem in Hawaii.

Medically reviewed in December 2021

Mention a certain popular sushi chain today, and even years later, you may be met by groans and bad memories. The 2016 hepatitis A virus (HAV) outbreak linked to raw scallops served at the popular chain still looms large in many locals' memories. That outbreak sickened nearly 300 individuals in a state that rarely sees more than a handful of HAV cases annually.

What is hepatitis A?
HAV is a contagious, acute viral infection that causes inflammation of the liver. The severity of the infection can vary person-to-person and can range from a mild discomfort that lasts one to two weeks to a severe illness that lasts months and may require hospitalization. Rarely, HAV causes liver damage that requires a transplant, or even death.

As Sarah Park, MD, head of the Disease Outbreak Control Division for the State of Hawaii in Honolulu explains, “those conditions [death or transplants] are pretty rare for Hep A, but it just underscores that this is not a mild disease.” She also notes that people with underlying liver conditions and the elderly are more susceptible to a severe infection.

HAV is spread via fecal-oral transmission, usually when someone unintentionally eats food tainted with small amounts of feces that contain the virus. It can also spread by living in close contact with an infected person, drinking contaminated water, or sexual contact with someone who has HAV.

People at particular risk of infection include:

  • Travelers visiting countries where HAV is common
  • Those who have come in direct contact with someone with an active HAV infection, including caretakers of individuals with HAV
  • Drug users (injection and non-injection)
  • Men who have sex with other men
  • Recently incarcerated individuals
  • Those experiencing housing instability or homelessness

Signs and symptoms
Like many infections that inflame the liver, HAV can be very unpleasant. “When your liver is inflamed, it's not happy,” says Dr. Park.

Some of the common symptoms include:

  • Fever
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Jaundice
  • Dark urine
  • Clay-colored stool
  • Loss of appetite
  • Fatigue
  • Joint pain

HAV has a fairly long incubation period, or the time between exposure and developing symptoms. It can take as long as 50 days and as short as two weeks for symptoms to appear, but usually it takes around four weeks after exposure. That can make it difficult for epidemiologists to pinpoint the source of an outbreak. People who have HAV become infectious one to two weeks before the onset of symptoms and may remain contagious up to three weeks after symptoms arise.

How outbreaks happen
HAV is fairly uncommon in the U.S. In 2016, there were around 4,000 total cases reported. According to Park, new cases of HAV in Hawaii usually occur in people who recently traveled off island, particularly internationally. There have been domestic outbreaks though both in Hawaii and across the Mainland. Often, these outbreaks are associated with imported foods; the scallops that caused the Hawaii outbreak were imported from The Philippines.

“What we're seeing more and more is, countries like the U.S., first world nations, are relying on food production from third world nations or developing nations where standards of hygiene in food production may not be up to our standards,” says Park.

The CDC is still collecting information for the number of cases of HAV in the U.S. in 2017 and 2018, but it is likely there will be an increase from previous years. This is likely due to increased cases among drug users, those experiencing homelessness, and men who have sex with other men.

Prevention is key
There is no specific treatment for HAV. Supportive care for the disease includes rest, drinking fluids, and eating well. Thankfully, there is a vaccine available. The vaccine requires two shots, administered six months apart. “It's a highly effective vaccine,” says Park. “It's reported to be 99, almost 100 percent effective.”

Despite the availability of a vaccine, HAV outbreaks persist. That’s partially due to the fact that many adults in the U.S. have never received the vaccination. Adults typically get the HAV vaccine if they have been identified as at higher risk for infection or if the plan to travel outside of the U.S.

While many adults have never received the vaccine, it has been part of standard childhood immunizations since 2006. This will hopefully result in fewer and fewer cases of HAV over time.

If you would like to receive the HAV vaccine, particularly if you are in an at-risk population, talk to your healthcare provider and be sure to follow up with the second dose six months after the original.

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