The state repeated its recommendation Tuesday that all Hawaii residents get vaccinated against hepatitis A as the food industry took steps to prevent more outbreaks among workers.

“The Department of Health encourages people to consider getting vaccinated,” said state epidemiologist Dr. Sarah Park. “Anyone who is interested in being immune should be vaccinated.”

Pharmacies are being inundated with people wanting the vaccine as the state continues to investigate the source of Hawaii’s worst outbreak of the contagious liver disease in nearly two decades, which has sickened 135 people.

Alanna Isobe, pharmacy manager at Safeway Kapahulu, has seen a large spike in hepatitis A vaccinations to 50 per day from the typical one a day.

“As the news stories break, we do see a very huge spike the next day or the next hour depending on when the story breaks,” she said. “The Health Department is saying that because it’s an outbreak situation and we don’t know the cause … everyone’s kind of falling into this high-risk area. Typically in the past (a person was) high risk if (there was) international travel to certain countries where it’s very prevalent, but right now, because it’s here, we’re vaccinating as many people as we can.”

Doctors, who were previously more cautious in authorizing the vaccination, are now prescribing it more freely, Isobe said.

“Because we don’t know where it’s starting and the doctors don’t know who’s going to get it next, we haven’t really seen too many doctors saying no,” she said.

State health officials so far have not been able to identify the source of the outbreak, but said this week that they are narrowing it down to a couple of widely consumed products brought to Oahu and have sought help from the Centers for Disease Control and Prevention.

The CDC prioritizes certain groups that should be vaccinated. They include children, homosexual men, illegal drug users, research laboratory employees who work with the virus, people with chronic liver disease or clotting-factor disorders, and household members and others who are in close contact with adopted children from countries where the virus is endemic.

The Hawaii Restaurant Association has partnered with health insurer Hawaii Medical Assurance Association to coordinate vaccination clinics at businesses, regardless of an employee’s health plan.

“Since July when we started to see restaurants in the news about employees who had been diagnosed with the hep A virus, we started researching what were options for employers to get their staff vaccinated,” said Gregg Fraser, the association’s executive director. “We were getting different messages, different prices; some need prescriptions, some don’t. We got very inconsistent information.”

HMAA has pledged to help direct businesses and employees schedule appointments at pharmacies and get prescriptions for the vaccine from doctors.

The Health Department recently identified a seventh Hawaii food handler who contracted the virus. 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.

The negative publicity at food establishments and grocery stores is significantly affecting revenue, Fraser said.

“I’ve heard rumors that the first place of business on the news lost between 75 and 90 percent of revenue,” Fraser said. “It is devastating to some smaller operators.”

Hawaii Medical Service Association, the state’s largest health insurer, said it will cover the hepatitis A vaccine for members when a physician prescribes it and the vaccine is a benefit of the member’s health plan. HMSA said on its website that members without a prescription can get the vaccine even if it’s not medically necessary, but “may have to pay for the vaccine on their own.”

The vaccine, given as two shots taken six months apart, can cost as much as $114.