Minnesota Department of Health has declared an outbreak of the viral liver disease hepatitis A among high-risk individuals, including those who use street drugs, are homeless or were recently incarcerated.

There have been 23 cases of hepatitis A across nine Minnesota counties, including three cases in Washington County and one in Dakota County, according to an MDH news release Aug. 8.

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“We have been working with our public health partners to respond to individual cases and prevent future cases,” said Kris Ehresmann, infectious disease director for MDH in the news release. “Declaring an outbreak is a significant step because it allows us to access additional resources to fight the outbreak.”

Hepatitis A is typically spread through person-to-person contact, when someone eats food or touches an object with trace amounts of contaminated stool, according to MDH. The most effective prevention for the disease is vaccination.

More information about symptoms and prevention can be found on the MDH website.