Efforts to battle Oahu’s hepatitis A outbreak and prevent the spread of Zika to the islands are being hampered by confusion over vaccinations and delays in hiring vector control employees, Department of Health officials said Monday in a briefing for Hawaii legislators.

Sarah Park, state epidemiologist, said during the hearing that the Hepatitis A outbreak has infected 135 unvaccinated adults. The vast majority – 126 cases – have been on Oahu, while eight more are on neighbor islands and one infected visitor is back on the mainland, she said.

None of those cases have involved military personnel, Park said, because service members are required to be vaccinated. The Hepatitis A vaccine was developed in 1995 and became a standard practice starting for children born in 2006, Park said.

Studies since then have shown that the vaccine works for at least 20-25 years, she said, and could last a lifetime.

The DOH suspects the source of the outbreak is a food product predominantly sold on Oahu, but could be sold on neighbor islands to a lesser extent. Park declined to name the specific products DOH is reviewing.

Symptoms for the disease can take one to two weeks to show, and sometimes even longer. Many Hepatitis A outbreaks go unsolved because it’s difficult for victims to recall everything they’ve eaten for the past several weeks, Park said.

Patients often get exhausted answering questions during the lengthy interview process, Park said.

Hawaii’s current outbreak involves a “sub-type,” Hepatitis 1A, that is different than anything in the Centers for Disease Control and Prevention’s database, Park said. There are two other Hepatitis A outbreaks in the U.S. right now.

In the frantic scramble to address Hepatitis A, there have been misunderstandings.

Park said food businesses with infected employees have suffered financially, although it’s unlikely customers are in danger.

There’s also been confusion with workers at some vaccination clinics  saying they only take certain types of insurance, Park said. Some clinics require a prescription for the vaccine, while others have a physician on hand to accommodate walk-ins, she said.

Vaccines have to be imported to the islands, Park said, and in the event that supplies are restricted, vaccines are limited to populations at high risk for more serious infection.

Park said the Hepatitis A outbreak has caused a spike in adult vaccinations. Before the outbreak and during the week of June 13, 136 adults were vaccinated. During the week of July 18, 1,725 adults were vaccinated, Park said. More children were vaccinated as well.

About seven DOH staff members have been working on the outbreak since its onset, Park said. Employees from other departments like the Sanitation Branch and Disease Investigation have joined the effort.

Now, 49 staff members are working on the outbreak. But Park said that with the heavy workload, staff members are beginning to tire out.

She’s asking for even more help from another branch that usually deals with sexually transmitted diseases. Nurses are also being recruited, Park said.

Vector Control Hiring Delays

During the hearing, Park said the Health Department was equipped to fight dengue fever, but only if no new threats popped up. Now, it’s a balancing act between dengue, Hepatitis A and the threat of a Zika outbreak, she said.

Keith Kawaoka, DOH’s deputy director of environmental health, said aerial spraying of mosquitoes is an option being considered.

DOH is working with counties to develop individualized response plans to mosquito-borne illness, Kawaoka said, noting a new case of imported Zika was confirmed Monday.

This year, lawmakers approved $1.27 million to fund 20 additional positions for the DOH Vector Control Branch. During the recession in 2010, the state cut funding to the branch. Before the October 2015 dengue outbreak, Hawaii had 25 vector control positions, eight of which were vacant.

Kawaoka said he hoped to fill the new positions by the end of the year.

Sen. Suzanne Chun Oakland wasn’t pleased about the delay and pressed Kawaoka for more details.

“I think there’s a much faster way to (fill those jobs),” Chun Oakland said.

Kawaoka pointed to the branch’s slashed budget and said the DOH has been busy trying to revise old job descriptions.

“Those particular 20 positions have not (been filled) because (the Vector Control Branch) is pending reorganization, so it’s internal stuff that we have to get done administratively before we can actually start hiring those individuals,” DOH Director Virginia Pressler told Civil Beat after the hearing.