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Swan's Island Hepatitis A Outbreak a Mystery?

What if you took a really unique vacation by renting a house on Maine’s Swan’s Island for a week last summer.  Swan’s Island is 30 minutes off the coast, served by Captain Henry Lee, a 17-car ferry out of Bass Harbor.

You had a great time on the remote island, maybe taking nearby clams for dinner.  Even during peak season there are no more than 1,000 people on the 7,000-acre island.

Afterwards, you return home to Nebraska, Maryland, Virginia or West Virginia.  You are from one of those states, as are the people who rented the house before or after you.

Once you are home and back at work for two to six weeks, you begin to experience nausea, vomiting, diarrhea, low-grade fever, loss of appetite, rash, tiredness, fatigue, the yellow discoloration of skin and whites of your eyes known as jaundice, your urine is darkish brown like cola, and you have a pain in the area of your liver on the right side just under the rib cage.

You have the liver disease Hepatitis A.  You probably do not put all together until your doctor begins asking you where you were two to six weeks ago.  Most people do not understand the differing incubation periods for foodborne diseases like Hepatitis A.

You got Hepatitis A at the house on Swan’s Island.  So did the people who came before and after you.  All the victims are, like you, from out of state.

One person who rented the house is dead.  Another required hospital care.

For some at the Maine Center for Disease Control and Prevention (Maine CDC), the house on Swan’s Island is at the center of a mystery.

Hepatitis A is uncommon in Maine.  Now Maine CDC has an ongoing investigation underway into the cluster of visitors who all used the same house on Swan’s Island.  They’ve identified nine cases, all out-of-state residents, ranging in age from 13 to 69.

Maine CDC officials have contacted everyone who rented the house over the summer. They have also tested the house’s septic system, which was malfunctioning.   Well water is also being tested, as are nearby clam beds.  The area was closed to shellfish harvesting, at least until test results are returned.

Maine averages just 11 cases of Hepatitis A each year on average.  Its most recent Hepatitis A outbreak before this one involved seven or eight people at the Kennebunk Elementary School.

Swan’s Island is on the coast near Bar Harbor, not far away.

The last person associated with the Swan Island outbreak became ill on Sept. 2nd.  That person prepared food for an Aug. 22nd potluck dinner at a church.   Maine CDC said it was too late for those who attended the dinner to avoid developing symptoms if they were exposed by getting a vaccine or immune globulin shot.

The first case this summer was July 7th.   The fatality was a woman visitor over age 50.

Maine issued a Health Alert about Swan’s Island on Sept. 4th.   Hospitals, physicians, laboratories, school nurses and other health care professionals were “encouraged to consider Hepatitis A infection in persons with recent onset of jaundice, fever, anorexia, fatigue, nausea, dark urine, clay colored stools, and abdominal discomfort.”

Dr. Dora Anne Mills (pictured), who heads Maine CDC, says she does not consider the Swan’s Island cluster of Hepatitis A cases to be a mystery.  Dr. Mills is confident testing will give Maine CDC the answers it needs.

“It is nothing to panic about,” she said.  She does think the outbreak is something Swan’s Island residents need to know about, however.

The Hepatitis A virus is excreted in feces and is transmitted by the fecal-oral route.   “Good hand washing is key to limiting disease transmission,” the Maine CDC Health Alert advises.

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