Hepatitis A Infection in Food Service Employee at Sushi Shiono, Waikoloa

Hepatitis virons. Author:
Dr. Erskine Palmer, USCDCP

The Hawaiʻi State Department of Health has confirmed a new case of hepatitis A infection in a food service employee on Hawaiʻi Island. The employee has a history of exposure on Oʻahu and worked at the fast food and catering restaurant, Sushi Shiono Waikoloa, located in the Waikoloa Beach Resort, Queen’s MarketPlace at 69-201 Waikoloa Beach Drive, from July 5 through July 21, 2016 (actual dates: July 5-8, 11-15, and 18-21).

The department is advising persons who consumed any food products from this store during this period that they may have been exposed to the disease. The likelihood that patrons of this business will become infected is very low. However, as a precaution, unvaccinated individuals should contact their healthcare providers about the possibility of receiving hepatitis A vaccine or immune globulin, which may provide some protection against the disease if administered within the first two weeks after exposure.

Since the outbreak began in mid-June, there have been 93 confirmed cases of hepatitis A, 29 of which have required hospitalization. All cases have been in adults who were on Oahu during their exposure periods. DOH continues to investigate and is working to identify the source of infection for this outbreak.

“Preventing exposure from infected food handlers is difficult because patients with hepatitis A are most contagious one to two weeks before symptoms start,” said State Epidemiologist Dr. Sarah Park. “It is possible that other food service establishments will be affected with additional new cases.”

Affected food service establishments who are unable to notify their customers directly are listed on the DOH website. These businesses are not sources of this outbreak. At this time, no infections have been linked to exposure at these businesses; the list is provided to prevent possible new cases.

Hawaiʻi State law requires all unvaccinated food handlers (persons who directly prepare, serve, or handle food) who are contacts of confirmed cases be tested for infection and have a negative hepatitis A IgM test before returning to work. A “contact” with the case is defined as unvaccinated household members, unvaccinated sexual contacts, anyone sharing illicit drugs with a case, anyone sharing food or eating or drinking utensils with a case, anyone consuming ready-to-eat foods prepared by an infectious food handler with diarrhea or poor hygiene. Once an infected food handler has been identified, DOH staff coordinate directly with the owners and managers of the affected food service establishments to ensure their employees are tested before resuming their work.

Symptoms of hepatitis A infection include fever, fatigue, loss of appetite, abdominal discomfort, dark urine, diarrhea, and yellow skin and eyes. Individuals, including food service employees, exhibiting symptoms of hepatitis A should stay home and contact their healthcare provider.

While vaccination provides the best protection, frequent and thorough handwashing with soap and warm water after using the bathroom, changing a diaper, and before preparing food can help prevent the spread of hepatitis A. Appropriately cooking foods can also help prevent infection.

Additional information about hepatitis A can be found on the DOH website.

For a statewide list of vaccinating pharmacies call the Aloha United Way information and referral line at 2-1-1.