With state health officials narrowing Hawaii’s hepatitis A outbreak to a couple of possible sources, a team of workers from the Centers for Disease Control and Prevention has landed in Hawaii to provide additional help with the investigation.
The trio of CDC workers arrived Sunday night, and by Monday was going through the reams of data accumulated by state health investigators working on the epidemic.
State epidemiologist Dr. Sarah Park said Monday that investigators have narrowed the suspected source of the outbreak to a couple of products that are brought to Oahu and widely consumed here.
Investigators are also looking closely at a couple of food distributors, Park said.
“But I can’t comment any further because it would be too premature at this point, because we could be wrong still,” she said. “We feel really good now, but we also are cautious because we know that we could go down this route and it’s all for naught.”
Park said the state Department of Health has begun working with the U.S. Department of Agriculture to look at issues with food products elsewhere and to examine distributors and food establishments locally that might have received the suspected products.
Park described the scope of the hepatitis A investigation in an informational briefing for lawmakers at the state Capitol on Monday.
The state has been hit with 135 cases of hepatitis A, Hawaii’s worst outbreak of the disease in nearly two decades. Of the total, 126 were on Oahu, five on Hawaii island, one on Maui, two on Kauai and one out of state. Nearly 30 percent of the cases have required hospitalization, with a few needing intensive care.
While there are outbreaks of hepatitis A on the mainland — one in South Dakota and another in Virginia — the Hawaii outbreak is a unique strain of the contagious liver disease, Park said.
The victims range in age from 18 to 79. No children have come down with the virus, and a big part of that is because the CDC in 2006 started recommending the hepatitis A vaccination for children, she said.
Interestingly, there are no cases found among Hawaii’s vast military community.
“It speaks volumes about the effectiveness of the vaccine,” Park said.
Park said records indicate that a growing number of people are getting vaccinated in Hawaii despite a few obstacles, including spotty insurance coverage and the expense of each dose, which ranges from $62 to $125.
Park told legislators that she asked for additional help from the CDC to help free up her employees for other pressing projects, including working on plans to prevent Zika and dengue outbreaks and to conduct the annual Stop Flu at School program, which has been delayed.
During the dengue outbreak last year, some lawmakers criticized Park for not asking for help from the CDC. Park said she told lawmakers that her department could handle the investigation as long as they weren’t hit with other problems.
Today, 49 Department of Health employees are working on this outbreak, she said, and her branch is being overtaxed.
“We just came out of the dengue outbreak. We’re exhausted,” she said after the meeting.
But the CDC workers will be available for only a couple of weeks, she added.
Pressed for details about the suspected products outside the meeting, Park declined to reveal any details.
“We have to be really careful, and at this point we have some things that we’re looking at very closely and starting to trace back in more detail to try and essentially get more evidence. That’s what we’re in the midst of,” she said.
Recent national hepatitis A clusters have been linked to foods that range from fresh green onions to frozen pomegranate seeds.
Last week the Health Department identified a seventh Hawaii food handler who contracted hepatitis A. A worker at Tamashiro Market in Kalihi joined workers at Baskin-Robbins in Waikele, the Hawaii Kai Costco bakery, the Chili’s restaurant in Kapolei, the Taco Bell in Waipio and the Sushi Shiono in Waikoloa who had also tested positive for hepatitis A, plus a Hawaiian Airlines flight attendant.
At the informational briefing Monday, Park told lawmakers that no cases have been linked to exposure at restaurants or businesses. She said officials released the names out of caution.
“This cannot be the result of a food handler,” she said. “This has to have been a product that was brought in here.”
Officials, meanwhile, announced another case of Zika in Hawaii. A Kauai person with a history of recent travel to the South Pacific apparently brought the mosquito-borne disease back to Hawaii, but officials said the victim is past the point of being infectious.
Although state officials have confirmed 10 imported cases of Zika this year, Hawaii continues to have no locally acquired Zika cases and no mosquitoes transmitting the disease within the state.
A vector control team from the Kauai District Health Office was sent to the traveler’s residence to survey the area for mosquitoes and determine whether there was a need to treat the area to reduce any mosquito breeding sites, officials said.
“We’re going to see those kinds of cases pop up across the state,” said Keith Kawaoka, deputy director for environmental health.
Kawaoka told lawmakers that the state is drawing closer to developing a response plan to mosquito- borne diseases. The state is also working to hire 20 new vector control workers approved by the state Legislature.
Zika continues to spread around the globe, and imported or travel-related cases are expected to increase this year.
Officials advise travelers to prevent infection by using repellent and by avoiding mosquitoes if possible. Travelers are also advised to prevent mosquito bites when they return from areas with outbreaks of mosquito- borne diseases, as well as to monitor their health and see their health care provider about any illness occurring in the two to three weeks after returning.