 kind of a name is Fox. Aloha everyone. Welcome to Talk Story with John Wahey. And I am so pleased today to have as my co-host, Jay Fidel. I am delighted to be here, Governor. You actually got your own show. Well, if I was you, that would make it great. But the reason why Jay is joining me is because we got such an important episode this afternoon. Our guest is actually from the Department of Health. And he is there right now. And unfortunately, he will be talking to us via Skype or telephone or something. Skype audio. Skype audio. We have a photograph of him so you can see what he looks like. Right. So you can do that. Now, before we go too much further, Jay, what we're going to talk about today is I think a subject that is of concern to a lot of people in Hawaii, especially now when everybody's walking around town asking each other, have you been immunized? Immunized. Immunized for hepatitis A, B, whatever. And the general consensus is if you haven't been immunized before, you should be now. We can ask Ron Balaharia about that. And if you have been, you know, do you need to be re-immunized? Well, I know. You know, the last person who asked me that says, have you been immunized? And I said, I'm not yet. You know, I want to learn more about it. And hence, actually kind of today's show, that today's show. And she said, don't touch me. You know, like, stay away from me. So I want to know. Now, that got me excited. You find out how infectious it is. How is this? I mean, what is this about? And what should we be concerned about? So today, as you mentioned, we have online with us Ron Balaharia, who is the branch chief for the Immunization Branch at the Department of Health. Hello, Ron, are you there? Yes, I am. Thank you. Tell us a little bit about yourself, Ron. You're branch chief for the Immunization Branch at the Department of Health. And I was told that you're a proud graduate of our University of Hawaii. Is that a good beginning? Well, tell us how you get to be branch chief. Well, thank you for the introduction. I am the Immunization Branch Chief here at the Hawaii Department of Health. And I actually have a master's degree in microbiology from the University of Hawaii at Manoa. And prior to that, I actually got my undergraduate, my bachelor's in biochemistry at the University of Arizona. I'm an actual native from the island of Guam and went to school and decided to make Hawaii my home. And I basically, after I graduated at the University of Hawaii Master's, I went back to Guam and I was the Immunization, basically program manager there for ten years. After that, I decided I wanted to still continue on with immunizations, but then I decided that I wanted to work for a bigger group. So I decided to work for the Centers for Disease Control in Atlanta, Georgia. Everybody knows and referred to CDC. And so I was a contractual employee for them as an immunization liaison for the U.S. Associated Pacific Islands. So I lived here and was stationed here in Hawaii, but I was able to go to Palau, to Guam, to the Northern Mariana Islands. So you were all over the Pacific dealing with various types of communicable, I guess, diseases? Something that you said? Yes, specifically vaccine-preventable diseases. So these are the diseases that have a vaccine associated with it that if you are vaccinated, that you can prevent from getting these diseases. So if there's no vaccine, then you don't care. You don't want to help. Is that it? You're not involved in lessons of vaccine that can prevent it? Yes, exactly. Okay. All right. So specifically, I wanted to talk to you today about hepatitis. You know, I looked it up and I found out that there are all kinds of hepatitis. I mean, it's like A-D-D-D-E. And there's hepatitis that comes from alcohol, hepatitis that's spread by contact, they're viral hepatitis, they're biological. Tell me a little bit about what I'm talking about. Okay. So hepatitis, the word hepatitis actually means inflammation of the liver. And the actual diseases that we're going to be talking about today are what we call the viral hepatitis series. So you have A, B, C, D, and E. And of those five viral hepatitis that I just mentioned, two of them are and actually most people will hear about hepatitis A, hepatitis B, and hepatitis C. Those are the normal three that everybody hears about. Of those three, two of them are what we call vaccine preventable. What we mean by that is that we actually have vaccines that can be vaccinated or injected to an individual so that they don't come down with these two diseases of hepatitis A or B. We do not have a vaccine for hepatitis C at this point in time, but A and B are the only two that we currently have of the five that I just mentioned. Which is the hepatitis where you can take a drug after you get it and be cured, but the cost of the drug is hundreds of thousands. Which is that? So hepatitis C is what you're referring to where there's medication for that particular, but because it's not vaccine preventable, I really don't have a lot of expertise in that particular area, but it is one of the five viral hepatitis that's out there. What causes hepatitis? A, for example. So the five that we're talking about are viral hepatitis, meaning there's a virus that causes the disease. So for hepatitis A, it's caused by hepatitis A virus, hepatitis B, hepatitis B virus, et cetera. So these particular viruses invade and or cause inflammation of the liver. And that really there's various routes and or ways that these viruses can make people sick. And so with the current outbreak that we are experiencing right now with hepatitis A, it's what we call fecal oral transmission. Wait a minute, what do we call it fecal oral transmission? That means somebody's eating something nasty. Well, that somebody didn't wash appropriately their hands and happened to be preparing some type of either food or drink or something that they've touched, and then the individual then ingested that virus through some means. And so that's why it's one of the most important things in our website that we say for people to try to protect themselves besides being vaccinated is to wash their hands thoroughly, especially after using the bathroom, when you've changed children's diapers, when you're trying to prepare food for other people yourself, you always want to make sure that you constantly are washing your hands really, really well. Are you including the scallops issue with that? Because that has nothing to do with fecal. Well, though, the people have ingested that virus, and then that means... And so we don't really know specifically about the scallops that the virus actually was attached or contained in that product. What we do know is that that virus was found to be in the product itself. How it got there, we really don't know. So since we got on that subject, what is the origin of... what is your prognosis regarding the origin of that virus? I don't have that detailed information on that, so it's still right now currently being investigated, and we're really trying to find out a little bit more details of that. As you are all well aware, this process is a lengthy process that we have to go through, and we really have to work with our partners, the FDA with CDC, including ourselves, in really trying to do the investigation on this, and we really want to make sure if we are able to identify that we identified correctly and not misidentified things. Let me throw something in here. We had essentially two rounds of hepe in the last few weeks. One was at a restaurant, not the sushi place, at another restaurant, and the implication of the news story was that workers had not washed. Well, wash their hands when they touched the food. The implication was that that was a fecal kind of vector. But then you get to the one most recently, which had a lot of cases, that was about scallops. It was not fecal. Or it was not fecal at that time. So what's the distinction there? I can see the washing hands situation. How does the scallops get to carry this? You know, John, it could be that the scallops were not washing their hands. Yes, I think so. You know, it could very well be. But we must mean that there's somewhere along the line where somebody didn't comply with some kind of regulation. Yeah, and again, we don't know the details of that. Again, we're looking, trying to look back in time of what may have happened. And again, because it is currently still being investigated, we really don't have a clue right now as to what is the actual answer for that particular question. But it's something that is being looked at. Here's my concern about it. You get this, the one where washing hands was at least implied in the news that the source. They get another one and they say that it was the scallops. And that means that the scallops were the source. Are there any more sources out there? But the strange thing is that both of these happen in fairly close proximity, you know, within a week or two of each other, maybe three. And it's an outbreak now, but it's two separate kinds of vectors. That's an incredible coincidence, isn't it? What do you say to that, Ron? So just to clarify, the prior to Genki Sushi that was identified in the press release, all the other establishments that were announced, they just happened to have an employee that came down with disease. So that individual could have eaten someplace like Genki and got sick, but the product itself that they were at and the product that was being sort of where they were at is not the actual source of the actual outbreak. So there's a very clear distinction between an individual getting sick because they ate something and just happened to be a worker at an establishment or at a place that serves. And then how their proper hygienic type of conditions and or practices, that's a whole another question. Right, so it's possible that the scallops got the virus from somebody locally, from somebody working here that was working in there as well as giving it to somebody else. Or the people at the other restaurant, the first restaurant got the same virus from the scallops and then they transferred that around. So how extensive, I mean how communicable is this hepatitis A at the moment? Is that something that travels easily from person to person? So it is infectious, but it doesn't travel as easily. It's not like measles or pertussis that are, you cough it out, it becomes airborne and then people that breathe in that air can then get sick. So it's not that easily transmissible like those other diseases, but it can. It's not the measles in other words. I'm sorry? It's not like the measles or something. It's not like measles exactly. So with measles you can actually be in a room, cough if you are sick and then leave the room and three hours later if somebody happened to come in and breathe in that same air and they haven't been vaccinated or protected against measles, they can actually come down with the disease. So it's not the same as with hepatitis A. In hepatitis A you have to ingest that material that has been tainted or exposed to the hepatitis A virus. Okay, Ron, we're going to take a short break right now and before we do I want to tell our listeners that they can call us at 415-871-2474. So that's 415-871-2474. So we're going to take a break. We'll be right back to talk with Ron about what we can do about protecting ourselves and our families and even helping the Department of Health contain this disease. Aloha. My name is Josh Green. I serve as Senator from the Big Island on the Kona side and I'm also an emergency room physician. My program here on Think Tech is called Health Care in Hawaii. I'll have guests that should be interesting to you twice a month. We'll talk about issues that range from mental health care to drug addiction to our health care system and any challenges that we face here in Hawaii. We hope you'll join us. Again, thanks for supporting Think Tech. Aloha. I'm Kaui Lucas, host of Hawaii is my mainland every Friday here on Think Tech Hawaii. I also have a blog of the same name at kauilukas.com where you can see all of my past shows. Join me this Friday and every Friday at 3 p.m. Aloha. Hey, how are you doing? Welcome to Abachi Talk. My name is Andrew Lening. I'm your co-host and we have a nice program here every Friday at 1 o'clock on Think Tech Studios where we talk about technology and we have a little bit of fun with it. So join us if you can. Thanks. Aloha. Welcome back everybody to Talk Story with John Waihe. Today we have a most interesting subject. We're discussing hepatitis, hepatitis A in particular and perhaps we'll get on to some of the other hepatitis. But if any of you, like me, are curious about this subject, well, like me and Jay, please call in at 415-871-2474. So, Ron, we are talking to Ron Balahadia, who is the branch chief at the immunization branch at the department, the Hawaii State Department of Health. So, Ron, we talked about how the disease is carried and it's virus-based and actually has a lot to do with hygiene, how we keep ourselves. Now, since there is an outbreak out there, tell us how we can get immunized. I'm having a terrible time with that. You've got to ask that question, Jay, because you can pronounce the word. Well, Ron, you can too. You know what I mean. I definitely know what you mean, yes. In order to get immunized and we're lucky that this particular virus, we do have a vaccine for, and as I mentioned previously, we also have it for hepatitis B. But for hepatitis A, the vaccinations, it was actually licensed around 1995 and it was only for those states or areas that had high rates of hepatitis A going on in the community. But in 2006, the advisory committee on immunization practices, which is the body working collaboratively with CDC, the Centers for Disease Control in Atlanta, Georgia, that comes up with the recommendations for vaccinations, made it and expanded the recommendations to include routine vaccinations of children. And so we were getting definitely a lot of our children since 2006 vaccinated. It's done in the doctor's offices and, or especially for the children, are being vaccinated there. For this particular outbreak that we're experiencing, we are also and have expanded and areas that have been vaccinating have been our pharmacy collaborators and they have been making sure that there's enough vaccine and people are able to access the vaccine. Is there enough vaccine, Ron? There is definitely enough vaccine. When the outbreak started out, we actually communicated with our pharmaceutical companies to say this is ongoing right now and are there vaccines available? And they said yes, and they actually helped to redirect some of those vaccines over to Hawaii. So, Ron, what do I do? I go to, you know, I want to be vaccinated. And so what do I do? I go and see my doctor and just tell him, Doc, I need a prescription or does he check me out? Does he do something to me or, you know, make sure that I'm eligible or how do we do it? Yeah, exactly. So, if you're interested, I mean, and especially if you have a primary care provider, your own doctor, go to your doctor and let them know, saying, you know what? There's this outbreak that's going on and I'm really interested in wanting to be vaccinated. And the other thing with that is besides the outbreak, if you do a lot of traveling to international places to different countries, they also have hepatitis A in some of those other countries. It's really good to make sure you get vaccinated, especially if you like to eat a lot of different foods out when you're traveling. But go to your doctor, talk to them, ask them and let them know. And basically have that conversation with your doctor. A lot of your doctor's offices may not carry the vaccine readily in the refrigerators. So what they may do is refer you out to a pharmacy with a doctor's prescription to make sure, you know... I do need a doctor's prescription. I can't just go to, say, Longs or... and walk in there and say, you know, I'd like to be vaccinated. I have to go and see a doctor for a prescription. That raises an interesting question that you do have to do that. You have to get a prescription, but why? You know, for example, if you have a flu shot, you know, you can go down any drugstore and get it. You don't have to have a prescription. Everybody has to look you over. You just get the flu shot. Why do you require a prescription? Shouldn't that rule be changed, Ron? Well, the issue or the big thing that is of concern or at least at this point in time is insurance coverage on what insurance plan that you have and are they going to cover your vaccinations. And so that's the question that a lot of pharmacies are encountering. So it really, there's several things that are ongoing at this point in time when an individual wants to get vaccinated. And some of the pharmacies will require that you actually contact and get a prescription prior to coming to them. So one of the things that I would do normally is on the Department of Health's website, we have a list of available pharmacies. And what we ask people to do is either call your doctor directly or call the pharmacy. But you have to talk to someone and you have to explain your situation of what it is. Either you're an actual contact to an individual that came down with disease and that now you need to be vaccinated or that you're just interested party and that you want to get vaccinated. Based on the scenario, they will then try to fit and make that determination of whether you need a... So this is an insurance issue. In addition to other things, there's just not one thing, but just to make sure that you are covered or else you may have to pay out a pocket. What's the cost of a pocket? If I don't have insurance, what would it cost me? So it varies from some places as low as around $69 to $70 to upwards of $130 to $140 per shot. So again, it would vary depending on which... Without this prescription, then the normal coverage, insurance coverage would attach. Is that what we're... Normally you would just pay your copayment or whatever payment or no payment at all because it's a covered entity. Now I heard that the thing about these vaccinations is that you need to do it more than once. Yes, there's two doses. Okay, and why? And so the main thing is that the vaccine and the studies really that have been determining why there is two doses. So the first dose is actually a very good dose. It actually provides upwards of close to 90-some percent protectiveness, but that's not 100 percent. There's nothing that's 100 percent. And the studies have shown that if you give the second dose six months after the first dose, then you really are going to be protected for upwards of over 25 years. And again, the reason for that is right now when the vaccine came out in 1995, we can't really say a lifetime, but we know that for the body to respond appropriately that it looks like it is, and as time goes on, we'll be able to, with the studies that are going to be done, determine the length of time of protectiveness for these vaccines. But at this point in time with two doses, it looks upwards of over 20 years of protection. And so, Jay asked you a question during our break, which I really like to follow up on. And that is that if I get a vaccination for hepatitis A, does that protect me from the virus for hepatitis B? And no, it does not, because hepatitis A is very specific and is very different from hepatitis B and C and B and E. So it's really important that, and most of our people and actually a lot of our children have received our hepatitis B vaccine, because a lot of that is given right after birth in the hospitals. What's the difference? I mean, really, to a layman sitting here, I have no idea specifically or quickly. What is the difference between the vaccination for hepatitis A and hepatitis B? I mean, why do we need two different kinds? Well, because they're two different viruses. They're two different viruses that affect the body differently and make people sick. So hepatitis A will make you sick, but it doesn't protect you if you've been, if you have that disease, and now you're not susceptible to hepatitis B. So it's very unique. It's like talking about measles and rubella. They're two different organisms. Do we have hepatitis B going on these days? Do you have any cases in the state of hepatitis B right now? Well, we have with hepatitis B. The biggest thing is that we have a program where we're vaccinating all children that are born at the hospital with that particular vaccine. So a lot of our children actually, since 1990 here in the state of Hawaii, were vaccinated. So healthier than we are. So, well, and then other people that may have been, that afterwards their doctor recommended them to get hepatitis B vaccine. But we have a huge cohort of individuals that have been vaccinated against hepatitis B, and our numbers have dropped dramatically since back in that timeframe till now. And we don't see as many hepatitis B in children because of the vaccination program. And so what we're seeing it is in unvaccinated adults that may not have been given the vaccine or protected against that vaccine. The other difference between the two is with hepatitis B, you can have what we call a carrier status where an individual can continuously expose other individuals to hepatitis B. But not have any symptoms. Yeah, where hepatitis A, once you resolve the disease, you will not have a carrier status, and it's all pow, it's all done. But with hepatitis B, we have to make sure we educate people on the possibility of transmission if they are what we consider a carrier. Talking about educating people around, tell us about your website just if you don't mind. And so in addition to having people view this program, they can go and look up on your website what they need to know. Yes, go, definitely go to healthawai.gov. And on there we have a banner that talks about hepatitis, the outbreak that is currently going on. There's a lot of information there. There's posters. There's information on. What is that again? Help, give me the site again. It's health.awai.gov. Health.awai.gov. So they can get all the information they need from there. Ron, our time is up. Wait, before we close, I just want to hit two policy points real quick. Okay. Number one, when I get out of this discussion, is that there's an inefficiency going on with the requirement to go to see a doctor about what is really... Right, absolutely. And I think the Department of Health could change that rule. I think the legislature ought to do it as well. You know, it's an insurance problem. Insurance problem and HMSA should pay for it instead of having to pay for a doctor plus the vaccine. Absolutely. The other thing I get, just to add this last point, is that we have the homeless. And the homeless, by definition, don't do a lot of hygiene. They don't have bathrooms. They don't have time. Hygiene, you know what I mean? They don't have the opportunity. Facilities. And they don't have health insurance either. They don't have access to medical care. Yeah, what's happening real quick? I'm going to stretch our time. Ron, what's happening with the homeless on this issue? So the current cases that we're seeing, we're not seeing it in that population. And that's a lot of our investigations are currently going on. And based on the cases that we're seeing, it's not heading into those particular niches. And so the individuals that we are working with currently, it's basically trying to identify all the possible context that these individuals may have been involved in. You may not see these individuals eating at the various establishments that have already been named or identified. Okay, great. Well, Ron, we want to thank you so much for joining us today. And again, I think this is for people listening. This is a very important issue. I think if there are any legislators listening now or in the future, pay attention to the fact that we're actually raising health costs by insisting that people go to get a prescription as well as paying for a vaccination. And finally, again, learn more about this. Go to the Department of Health website. Thank you, Ron. And keep healthy, everybody. Thank you, Ron. Thank you, John. Thank you.