At least nine counties in Minnesota are experiencing a hepatitis A outbreak, state health officials announced this week.

In a statement Thursday, the Minnesota Department of Health (MDH) said it has declared an outbreak in “multiple counties among people who use street drugs (injection or non-injection), are experiencing homelessness or unstable housing, or have been recently incarcerated.”

So far, there have been 23 cases of hepatitis A across the nine counties — Pine, Hennepin, Kanabec, Mille Lacs, St. Louis, Washington, Chisago, Dakota and Kandiyohi — involved.

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“Thirteen cases have been hospitalized and all have been discharged,” health officials said.

“While initial cases were clustered in east-central Minnesota and had links to each other, more recent cases occurred in counties in other parts of the state. The infection source is not known for some cases, suggesting some community transmission among those in high-risk groups,” they added.

The “highly contagious” liver infection is caused by the hepatitis A virus, according to the Center for Disease Control and Prevention. The virus typically spreads when a person eats or drinks something “contaminated by small, undetected amounts of stool from an infected person,” the health agency said.

Those who contract hepatitis A — not to be confused with hepatitis B or C, which are caused by different viruses — may be sick for “several weeks" and usually fully recover, according to the CDC. It is rare to die from the illness, though hepatitis A can cause liver failure and death, typically in those who are 50 years of age or older.

"Declaring an outbreak is a significant step because it allows us to access additional resources to fight the outbreak.” — Kris Ehresmann

Symptoms include fever, fatigue, dark urine, vomiting, joint pain, and jaundice, among other signs.

While hepatitis A infections do happen in the U.S., it is more common in developing countries where sanitation and hygiene are poor, the CDC says.

The disease is preventable with a vaccine.

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

The state health department announced the outbreak after it began seeing an increase in hepatitis A cases beginning in May.

“These cases had similar risk factors to national outbreaks of hepatitis A that have been occurring since 2016. Nationally, there have been more than 23,600 cases in 29 states. MDH has been monitoring the national outbreaks and conducting enhanced surveillance of hepatitis A since mid-2018 to help quickly identify cases,” state health officials added.