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Preventing Hepatitis A on Molokai

By Catherine Cluett Pactol

The Hawaii Department of Health (DOH) is investigating an increasing number of Hepatitis A cases on Oahu, and Molokai residents are advised to take preventative action. Hepatitis A is a contagious liver infection caused by the hepatitis A virus that can be found in the stools of infected people and spread by eating contaminated food or drinking water or through close personal or sexual contact.

With more than 150 confirmed cases on Oahu, many of which are restaurant workers, some Molokai residents are wondering what they should do to prevent the disease. Vaccination is the best form of prevention, but frequent handwashing with soap and water after using the bathroom, changing a diaper, or before preparing food can help prevent the spread of hepatitis A, according to the DOH.

“Because we have not yet identified a source of the Oahu outbreak, residents traveling to Oahu may want to consider getting vaccinated,” said Jonathan “Nate” Hilts, a public health educator and information specialist with the DOH Disease Outbreak Control Division.

DOH staff are conducting interviews with the cases in an effort to identify the source of infection, but officials say they are having trouble pinpointing the source of the outbreaks.

“Identifying the source of infection continues to be a challenge because of the long incubation period of the disease and the difficulty patients have in accurately recalling the foods consumed and locations visited during the period when infection could have taken place,” states the DOH website.

Hepatitis A symptoms can range from a mild illness lasting one or two weeks to a severe illness lasting for several months.  Symptoms include fever, fatigue, nausea, body ache, diarrhea, vomiting and jaundice, or yellowing of skin or eyes. Patients with hepatitis A are most contagious one to two weeks before the symptoms start until at least one week after the start of first symptoms.

“Because of the long incubation period of hepatitis A, it’s important for Molokai residents who travel to Oahu to know the signs and symptoms,” said Hilts.

John Cheetham, a DOH public health nurse on Molokai, said the Molokai DOH office can test for the virus.

“If you’ve eaten at a facility [on Oahu] where it was identified, you should come in for a blood test,” he said. “That test can tell you whether you’ve been exposed within a certain time frame.”

Cheetham said residents should contact their primary care doctor for the vaccination. The local drug store is not offering them currently because of lack of insurance coverage, he said. Under primary care physicians, vaccines for children are normally covered by insurance, as well as adults in high risk categories. Children are normally given their first dose at one year of age. Most commonly, those with high risk are considered people with liver disease and those with blood clotting problems, according to Cheetham.

However, he said right now, many insurance companies aren’t covering adults to receive the vaccine unless they fall into those high risk categories.

“The biggest barrier to [receiving] the vaccine is insurance companies not covering it,” he said, suggesting that if residents cannot get the vaccine through their doctor, they should visit the Molokai Community Health Center (MCHC), which offers care on a sliding scale fee system. MCHC medical personnel did not return calls to confirm if they are offering the vaccine.

“If [residents] have no insurance, we will see them here at the DOH office and we can cover them with vaccine,” added Cheetham.

Vaccines are offered in a two-dose series. The second dose is administered six months after the first.

Vaccine providers are doing what they can to ensure Hawaii receives preventative methods.

“As I understand, providers are working to bring in more vaccine, and distributors are giving Hawaii orders priority,” said Hilts. “DOH continues to provide Hawaii residents with updated information on availability.”

For more information on the virus, visit health.hawaii.gov/docd/dib/disease/hepatitis-a/.


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