The department on Tuesday warned the public they may have been exposed to the disease if they ate any food from Sushi Shiono in the Waikoloa Beach Resort during certain dates between July 5 and 21.
Health officials say there’s a very low likelihood restaurant patrons will become infected. But as a precaution, they recommend unvaccinated people talk to health-care providers about options, including the hepatitis A vaccine.
The department says all of the 93 patients are adults who were exposed on Oahu.
Health officials have yet to identify the source of the outbreak.
Some food service employers have been offering the vaccine to workers.
“That’s why we only have one person working now, because it’s really that slow,” Baskin-Robbins employee Erika Espiritu said.
On July 12, the Hawaii State Department of Health (DOH) announced that anyone who ate at Baskin-Robbins at Waikele Center between June 17 and July 3, 2016 (actual dates: June 17, 18, 19, 21, 22, 25, 27, 30, and July 1 and 3), may have been exposed to hepatitis A.
That’s because one of the workers there caught the virus.
Since then, business has dropped 75 percent.
“The toughest part is having to take in all the harassment because I worked the — I might tear up — I worked the next morning and people would call and say mean stuff, and you just have to take it in, because you can’t control what people think,” Espiritu said.
She said people have told them they want to sue the store, or that they want the store to pay for their family to get vaccinated.
In fact, state epidemiologist Dr. Sarah Park said the store is “not at fault. They should not be looked down upon. This could happen to any food establishment out there.”
“We don’t deserve to be harassed or slandered because it’s not fair. We didn’t ask for our employee to have the infection, you know,” Espiritu said.
KHON 2 reports that according to the state Department of Health, there are 74 confirmed cases of hepatitis A in the current outbreak.
Since the last update on July 12, 2016, HDOH has identified 22 new cases of hepatitis A, 26 have required hospitalization.
All of the cases are residents of Oahu with the exception of two individuals who now live on the islands of Hawaii and Maui, but were on Oahu during their exposure period.
The onset of illness for the cases have ranged between 6/12/2016 and 7/14/2016.
The source of the outbreak remains under investigation. Identifying the source of infection is a challenge due to the long incubation period of the disease. This makes it difficult for patients to accurately recall the foods consumed and locations visited during the period when infection could have taken place.
The site also identifies two restaurants where employees tested positive for the virus: Baskin-Robbins in Waikele and Taco Bell in Waipio.
AHS said it confirmed a case of the infection in a food handler who works at two Edo restaurants in the Capital Region – the Manning Town Centre location in Edmonton and the Tudor Glen Market location in St. Albert.
People who consumed food from the above locations between June 13 and 18, 2016 and June 21 and 28, 2016 may have been exposed to hepatitis A, AHS said Tuesday afternoon.
“While we believe the risk to the public is low, hepatitis A is a serious infection,” Dr. Joanna Oda, medical officer of health with the AHS Edmonton Zone, said.
Hepatitis A can be spread through the fecal-oral route, direct contact with an infected person or by ingesting contaminated food or water. If an infected person does not property wash his or her hands after using the washroom, the virus can be transmitted through food and beverages prepared by the infected individual.
Anyone who ate food from either Edo location is urged to monitor themselves and their family members for symptoms of hepatitis A until Aug. 17.
Gregg K. Kakesako of the Star Advertiser writes that patrons of a Baskin-Robbins ice cream store in Waikele Center during the last two months may have been exposed to the hepatitis A virus after one of the store’s employees was confirmed to have the disease, the state Health Department said today.
People who haven’t had the hepaptitis A vaccine or immune globulin and who consumed any food or drinks from the Waikele store on June 17, 18, 19, 21, 22, 25, 27, 30, and July 1 and 3 should contact their healthcare providers about getting vaccinated, which may provide some protection against the disease if administered within the first two weeks after exposure, the Health Department said in a news release.
All cases have been in adults on Oahu, 16 have required hospitalization.
“The source of this outbreak has still not been determined. In the meantime, we encourage all persons consider and talk to their healthcare provider about getting vaccinated,” said State Epidemiologist Dr. Sarah Park. “This case demonstrates the potential to spread hepatitis A virus to many others who remain susceptible. In an effort to stem the spread of disease, individuals, including food service employees, exhibiting symptoms of hepatitis A infection should stay home and contact their healthcare provider.”
“If I was a restaurant manager right now, I’d make sure that all of my employees had the vaccine. I’d even pay for it,” he said.
The vaccine part makes sense. The handwashing advice with warm water is wrong.
And how happy are restaurant owners going to be if their employees actually followed all government sanctioned advice, and didn’t work when they were sick, washed their hands everytime they were supposed to, like after scratching their nose, or wore cloves and then scratched their ass.
Six have required hospitalization. Their onsets of illness have ranged from June 16 through June 27, 2016.
Health officials aren’t sure where this outbreak is coming from.
The department says this is just the beginning of the outbreak, so more cases are likely to be reported. There’s been no direct link to any of the infected patients so far.
“So we’re asking where have you been? What kind of potlucks have you been to? What celebrations? Where do you go shopping? What foods do you commonly like to eat? So it’s a lot to go over with people,” said state epidemiologist Dr. Sarah Park.
It is of great concern that pregnant women with acute viral hepatitis (AVH) type E have serious consequences. This study aimed to estimate the case-fatality risk (CFR) and potential risk factors of pregnant women with AVH type E.
We searched the PubMed, EMBASE, and Web of Science databases for studies containing data on CFR in pregnancy with AVH type E. A pooled estimate of CFR was calculated using a random-effects model. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression. We identified 47 eligible studies with a total African and Asian population of 3968 individuals. The pooled CFRs of maternal and fetal outcomes were 20·8% [95% confidence interval (CI) 16·6–25·3] and 34·2% (95% CI 26·0–43·0), respectively. Compared with these, the pooled CFR was highest (61·2%) in women with fulminant hepatic failure (FHF). Community-based surveys had lower pooled CFR (12·2%, 95% CI 9·2–15·6) and heterogeneity (25·8%, 95% CI 20·1–32·0) than hospital-based surveys. Univariate analysis showed that hospital-based surveying (P = 0·007), and patients in the third trimester of pregnancy or with FHF (P < 0·05), were significantly associated with CFR. Intrauterine fetal mortality (27·0%) was statistically higher than neonatal mortality (3·9%).
Control measures for HEV infection would reduce feto-maternal mortality in Asia and Africa.
Case-fatality risk of pregnant women with acute viral hepatitis type E: a systematic review and meta-analysis
Epidemiology and Infection, Volume 144, Issue 10, July 2016, pp. 2098-2106, DOI: http://dx.doi.org/10.1017/S0950268816000418
Qualitative and quantitative analysis of HAV in 271 raw and treated wastewater samples from five sewage treatment plants (STPs) during 13 months was performed. Moreover, the efficiency of three secondary wastewater treatment processes (conventional activated sludge, extended aeration, and oxidation ditch activated sludge) was evaluated.
Data obtained demonstrated that HAV is endemic in Tunisia and circulates with high prevalence in both raw (66.9%) and treated (40.7%) wastewater. HAV circulates throughout the year in the coastal areas, with the highest rates found during summer and autumn, whereas in central Tunisia, high levels were shown in autumn and winter. Total virus removal was not achieved, since no difference in mean HAV loads was observed in effluents (6.0 × 103 genome copies [GC]/ml) and influents (2.7 × 103 GC/ml). The comparison of the HAV removal values of the three different wastewater treatment methods indicates that extended aeration and oxidation ditch activated sludge had better efficiency in removing viruses than conventional activated sludge did.
Molecular characterization revealed that the vast majority of HAV strains belonged to subgenotype IA, with the cocirculation of subgenotype IB in wastewater treatment plants that collect tourism wastewater.
Detection and molecular characterization of Hepatitis A virus from Tunisian wastewater treatment plants with different secondary treatments
Why is the FSAI reiterating its advice to boil imported frozen berries for one minute? As a result of recent outbreaks of norovirus in Sweden and hepatitis A virus in Australia, both of which have been linked to the consumption of imported frozen berries, the FSAI is reiterating its advice to continue to boil imported frozen berries for one minute before consumption. This is particularly important when serving these foods to vulnerable people such as nursing home residents. The outbreak in Sweden occurred in a nursing home in the beginning of May, causing 70 people to become ill with norovirus. Three deaths are reported to have been potentially linked to this outbreak. Contrary to national food safety advice in Sweden, the frozen imported raspberries were served uncooked in a dessert. Microbiological analysis confirmed the presence of norovirus in the frozen berries.
Could contaminated imported frozen berries be on sale in Ireland? There is no indication that batches of berries implicated in the recent Swedish and Australian outbreaks have been imported into Ireland. These outbreaks, however, demonstrate an ongoing risk in the global imported frozen berry supply chain.
How do I know if frozen berries are imported? If the label does not state the country of origin, you should assume that the berries are imported. The shop where you purchased the berries may be able to provide this information.
Will retailers be displaying notices about the requirement to boil imported frozen berries?
Retailers selling imported frozen berries need to ensure that the berries they use are sourced from reputable suppliers operating effective food safety management systems and comprehensive traceability systems. As the food chain can be quite complex, it is necessary for food businesses at each stage of the food chain to seek assurances regarding the effectiveness of the food safety management systems in place from their suppliers. If such assurances are not available, the FSAI recommends that the retailer displays a notice advising customers that the frozen berries should be boiled for one minute before consumption.
How do I know that the berries used by food businesses (e.g. smoothie bars, cake manufacturers, etc.) are safe to eat? Food businesses using imported frozen berries need to ensure that the berries they use are sourced from reputable suppliers operating effective food safety management systems and comprehensive traceability systems. As the food chain can be quite complex, it is necessary for food businesses at each stage of the food chain to seek assurances regarding the effectiveness of the food safety management systems in place from their suppliers. If such assurances are not available, the FSAI recommends that the berries should be boiled for one minute before being used in foods.
What if I have some berries in my freezer at home – are these safe to eat? If the berries are imported you should boil them for one minute before consumption. Boiling for one minute will destroy viruses, if present.
Are fresh berries safe/ok to eat? There is no evidence to suggest that fresh Irish or fresh imported berries are a risk. Fresh berries should be washed before consumption which is in keeping with the advice for all fresh fruit and vegetables.
Can I eat the berries I grow in my own garden? Yes, this issue only relates to frozen imported berries and so this advice does not apply to berries grown in your own garden and frozen after picking.
Why are imported frozen berries more of a risk than other types of berries? Across Europe, more outbreaks have been linked to imported frozen berries than to other types of berries. Freezing preserves viruses such as norovirus and hepatitis A.
Are all frozen berries a risk? This safety advice refers to imported frozen berries, such as raspberries, strawberries, redcurrants, blackberries, blackcurrants and blueberries. However, as a precaution, we are advising that all imported frozen berries should be boiled for one minute before consumption.
Are tinned berries also a risk? No, tinned or canned berries have not been identified as a risk.
What if I have eaten frozen berries recently, without boiling them? The time from consumption of contaminated food to the onset of illness with hepatitis A, ranges from 15-50 days, with the average being 28 days. In the case of norovirus, symptoms usually appear around 12 to 48 hours after consuming contaminated food. If you think that you have consumed frozen berries and may be ill as a result, you should seek medical advice. This applies in all cases if you believe that any food you have eaten has made you ill.
Should I stop buying frozen berries? No, there is no need to stop buying frozen berries. Frozen imported berries should be boiled before eating until further notice.
I have given my toddler/child puree made from frozen berries, should I be worried? If you are concerned about your toddler/child, you should seek medical advice but you should not be concerned about giving them berries that have been boiled. Boiling for one minute will destroy viruses, if present.
What is hepatitis A and what are the symptoms? Hepatitis A infection is an acute disease of the liver caused by the hepatitis A virus. There are five main hepatitis viruses, referred to as types A, B, C, D and E. Illness usually starts about 28 days after exposure to the virus, but it can start anytime between 15 and 50 days after infection. The most common symptoms are fever, loss of appetite, nausea, fatigue and abdominal pain, followed within a few days by jaundice. The disease often fails to show the noticeable symptoms or is mild, particularly in children below five years. Jaundice occurs in 70-80% of people aged over 14 years and less than 10% of children younger than six years. Symptoms may last from one or two weeks to a number of months. Prolonged, relapsing hepatitis for up to one year occurs in 15% of cases.
How is hepatitis A virus spread ? Hepatitis A is a human virus that is primarily spread from person-to-person via the faecal-oral route. The virus is shed in the faeces of infected people. It may also be spread through food that has been contaminated by infected food handlers or by contaminated water. People who have the virus are most infectious in the week or two before onset of symptoms and may be infectious up to one week after onset.
What is norovirus and what are the symptoms? Norovirus is one of the most common causes of gastroenteritis. Symptoms include – nausea (often sudden onset), vomiting (often projectile) and watery diarrhoea. Symptoms begin around 12 to 48 hours after becoming infected. The illness is usually brief, with symptoms lasting only about 1 or 2 days. Most people make a full recovery within 1-2 days, however some people (usually the very young or elderly) may become very dehydrated and require hospital treatment.d
How is norovirus spread? Noroviruses are very contagious and can spread easily from person-to-person. Both the faeces and vomit of an infected person contain the virus and are infectious. People infected with norovirus are contagious from the moment they begin feeling ill to 2/3 days after recovery. Some people may be contagious for as long as 2 weeks after recovery. It is important for people to use good handwashing and other hygienic practices after they have recently recovered from norovirus illness. In addition, noroviruses are very resilient and can survive in the environment (e.g. on surfaces) for a number of weeks.
How might berries become contaminated with norovirus and hepatitis A virus? Contamination could occur on the farm, through use of sewage-contaminated agricultural water or through contamination by infected workers. Cross-contamination could occur post-harvest along the supply chain, through contact with contaminated surfaces of machines, equipment and facilities during freezing, mixing and packaging processes.
When did the FSAI first recommend boiling of imported frozen berries? The FSAI first issued this advice in 2013, during the investigation of an outbreak of hepatitis A virus in Ireland which was linked to imported frozen berries. The outbreak turned out to be part of a multi-state outbreak, with over 1,000 cases reported in 12 EU countries.
What was the source of contamination of the frozen berries in the 2013 hepatitis A virus outbreak? The multi-state investigation did not identify the source of the contamination. The investigation concluded that contamination could have occurred at the freezing processor or at the primary production stage. It highlighted the importance of compliance with Good Hygiene Practice (GHP) and Good Agricultural Practice (GAP) and cautioned that contaminated product related to the outbreak could still be circulating in the food chain.
What was the evidence that linked imported frozen berries with the 2013 multi-state hepatitis A virus outbreak in Europe? Contaminated batches of mixed frozen berries/berry-containing products were identified in Italy, France and Norway and were recalled from the market. This evidence together with epidemiological and environmental investigations from the affected countries identified frozen berries as the mostly likely vehicle ofinfection for this outbreak and suggested that it could be a single outbreak linked to a common, continuous source of contamination. At the request of the European Commission, the European Food Safety Authority (EFSA) coordinated the tracing activities of affected Member States. This work involved collecting data on the source of each berry delivery from retail sale back to the farmer to see if a common source or sources of contamination could be identified. Bulgarian blackberries and Polish redcurrants were identified as the most common ingredient in the food consumed by affected people. However, this might be explained by the fact that Poland is the largest producer of redcurrants in Europe, and Bulgaria is a major exporter of frozen blackberries. While no single point source of contamination was identified, twelve food operators were identified with links to cases and batches in five of the countries affected.