HONOLULU (HawaiiNewsNow) - An outbreak of Hepatitis A on Oahu that may be linked to food has expanded to 31 confirmed cases, the state Health Department said.
That's up from 12 confirmed cases last week.
Dr. Sarah Park, state epidemiologist, said the source of the outbreak remains unclear. State health officials had said that they were looking at dozens of possible culprits, including poke.
"The frustrating thing for us is that each new case is a completely separate individual that is not related to any previous cases," said Park. "There's no relationship."
Patients infected with Hepatitis A virus are most contagious during the week before symptoms start until at least one week after the start of the first symptoms.
"Since people are contagious before they feel ill, we are very concerned about the disease unknowingly being spreading to others," said Dr. Virginia Pressler, director of the state Health Department.
One of the reasons the Hepatitis A outbreak is so hard to track is because people have it for a month or more before they start to show symptoms.
"Accurately recalling all of the foods consumed and locations visited during the period when infection could have taken place is challenging for many, especially those who are still feeling ill."
The outbreak has restauranteurs on edge.
"It's alarming for me, as a restaurant owner, to be concerned about possibly where this is stemming from as well," said J.J. Niebuhr, one of the owners of JJ Dolan's, a popular bar and restaurant in downtown Honolulu where the food preparation is all hands-on.
JJ Dolan's has passed its restaurant inspection and has its green pass in the window to prove it. With a virus that can be spread from unwashed hands, following sanitation practices in the kitchen is paramount, Niebuhr said.
"Restaurant inspection, we passed. A bunch of other people have passed," said Niebuhr. "And I think it's become more stringent, which is a good thing."
The infection could also come from a grocery store. In 2013, eight people in Hawaii got Hepatitis A from a frozen berry mix.
"There were already a few cases identified in other states. They'd already found this association," said Park. "So when we started finding cases (in 2013), we naturally asked the question, and boom, we had the link."
Hepatitis A can cause fever, fatigue, loss of appetite, cramps and jaundice. Symptoms usually last several weeks to two months.
The virus can be found in the stool of infected people, and is usually spread by eating contaminated food or drinking water.
A person with Hepatitis A can pass the disease to others within the same household. For this reason, state health investigators are reaching out to individuals who were in contact with those who have or had Hepatitis A.
Hepatitis A is vaccine-preventable. Two doses of the Hepatitis A vaccine, given at least six months apart, are needed for lasting protection.
While a vaccine provides the best protection against hepatitis, frequent handwashing and properly cooking food can help prevent the spread of the virus.
For more information on Hepatitis A, click here.