Hepatitis A Outbreak



Here in Hawaii, there was a recent Hepatitis A outbreak.

It happened around the end of June or so, into July. It was recently discovered that the outbreak came from raw scallops shipped in from the Phillipines. Unfortunately, this batch of scallops went to Genki Sushi. This sushi chain is relatively common on Oahu and people seem to like it. It has a conveyor belt style (kaiten zushi or kuru kuru sushi) that is pretty common in Japan.

The State Department of Health then shut down Genki Sushi on both Oahu and Kauai. A total of 168 people were affected.

As you can imagine, this led to a decline in eating of raw seafood on Oahu for fear of more Hepatitis A outbreaks. Some small business reported even a 50% drop in business.

A few days ago, there was another Hepatitis A outbreak, this time in Virginia. The culprit this time was strawberries from Egypt. The victim this time was the Tropical Smoothie Café. They have narrowed the window down to August 5th-8th as their dates of concern. All Egyptian strawberries were removed as a precaution. They have also stated that most of their supply comes from California and Mexico.


So, why does this matter?

Hepatitis A has a vaccine.

However, it wasn’t routinely available until 1996 for children living in high risk areas. The vaccination was the given to children with elevating areas of infection in 1999. Nowadays:

“Vaccination is recommended for all children age 12 months or older, for travelers to certain countries, and for people at high risk for infection with the virus.” – Vaccine.gov


So what does this mean?

This means the majority of adults today are not vaccinated.

To be honest, I didn’t even know a vaccine existed until a few weeks ago. My wife was seeing our primary care physician (who we love by the way) for a sick visit. (Don’t worry, she’s fine, she just needed some medication). My primary care physician brought up the recent Hepatitis A outbreak in the news and whether we wanted to be vaccinated.

I said sure, why not, I’ll just go ahead and get the flu vaccine and the Hepatitis A vaccine on the same day since I was there.


How is it given?

The vaccine comes in two types:

Hepatitis A vaccine alone:  Two shots, six months apart.

Hepatitis A and B combination vaccine, given to persons 18 years or older: Three shots, over a period of six months or as three shots over one month and a booster shot at 12 months.

I already received the Hepatitis B vaccine a long time ago because they recommended it to people who may be traveling to endemic areas (like Southeast Asia). If I recall correctly, I think I received the Hepatitis B vaccine (in 3 shots) back when I was 12 or 13.

So I received the Hepatitis A vaccine alone and will need to go back for a booster in 6 months, early in 2017.


Ok, so how did it go?

It’s just like a flu shot except the there is slightly more pressure because of the slightly higher volume. For comparison, a flu shot is 0.5 mL and the Hepatitis A vaccine is 1 mL, so double the volume. I got one in each deltoid muscle (shoulder). Arm was a little sore for the rest of the day, but no other side effects.


What about your wife and kids?

Wife will be going back to get her vaccine and flu shot later.

Daughter was born in 2013 already had her Hepatitis A vaccine when she turned 1 and booster 6 months later.

Son is 11 months and will receive his vaccine next month sometime, and then the booster sometime early next year (like me).


Do you think it’s necessary?

It’s not “necessary” but I think it’s good practice. The chicken pox vaccine didn’t exist when I was a kid, so I got the chicken pox and my mom said I was miserable when I had it. My children will both get the chicken pox vaccine and will never need to experience the chicken pox like I did.

Like any infectious disease, it’s the spread of infection that is the most worrisome. If you are immune, you can help stop the spread and eradicate the virus.

Do it for the people who can’t get vaccine for whatever reason.

It’s the same reason I get the flu vaccine every year.


Has the advent of the Hepatitis A vaccine decreased the number of infections?

“Before the Hepatitis A vaccine became available in the Unites States, more than 250,000 people were infected with Hepatitis A virus each year.”

“In 2014, there were an estimated 2,500 acute hepatitis A infections in the United States.”

A drop from 250,000 to 2500 seems like a pretty significant reduction to me.

Reference


For completeness sake, here are the symptoms of Hepatitis A:

Fatigue
Nausea and vomiting
Abdominal pain or discomfort, especially in the area of your liver on your right side beneath your lower ribs
Clay-colored bowel movements
Loss of appetite
Low-grade fever
Dark urine
Joint pain
Yellowing of the skin and eyes (jaundice)

The list of symptoms is pretty non-specific and overall is pretty similar to the flu. However, my primary care physician said that something which helped to differentiate the two is the complete loss of appetite. People just don’t want to eat at all, like uncharacteristically just “not hungry” and “no desire to eat”.

The dark urine is also important to watch out for, but nonspecific.

Jaundice is very specific, but not that easy to spot unless it’s already really bad.


Wait… I remember from medical school that Hepatitis B and C are the chronic ones, and A “isn’t that bad”.

Me too. I think it’s from Step 1 studying, maybe from First Aid for Step 1 or something. You are correct, Hepatitis A doesn’t become chronic, and usually does not cause long-term liver damage. However, in rare case, it can cause acute liver damage and even result in fulminant liver failure which would necessitate a liver transplant. This usually occurs in people who already have some degree of liver disease and then this tips them over the edge. However, the possibility is still there.


Other than getting vaccinated, what can I do for prevention?

Well, Hepatitis A is spread via: Reference

Person to person contact

  • Infected person does not wash his or her hands properly after going to the bathroom and touches other objects or food.
  • Parent or caregiver does not properly wash his or her hands after changing diapers or cleaning up the stool of an infected person.
  • Someone engages in certain sexual activities, such as oral-anal contact with an infected person.

Contaminated food or water

  • Hepatitis A can be spread by eating or drinking food or water contaminated with the virus. This is more likely to occur in countries where hepatitis A is common and in areas where there are poor sanitary conditions or poor personal hygiene.
  • In the United States, chlorination of water kills hepatitis A virus that enters the water supply.

So the long and short of it is, practice good hygiene and safe sex.


TL;DR

Two Hepatitis A outbreaks recently, Hawaii and Virigina.

Hepatitis A has a vaccine. Since it wasn’t readily available until around the early 2000s, most adults are not vaccinated.

I got vaccinated and I hope you do too. Let’s try to eradicate Hepatitis A.

Hepatitis A symptoms are similar to the flu. However, people just don’t want to eat at all, like uncharacteristically just “not hungry” and “no desire to eat”.

Dark urine and Jaundice are other symptoms to remember, but “dark urine” is pretty nonspecific and jaundice is difficult to see early on.

Hepatitis A is not chronic like Hepatitis B or C. However… in rare cases it can result in fulminant liver failure.

Practice good hygiene and safe sex to prevent the spread.

 

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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