Kentucky's hepatitis A outbreak has claimed another victim, bringing the outbreak's death toll to 44, according to the latest weekly state report posted Tuesday.

So far, the nation's largest hepatitis A outbreak, declared in November 2017, has sickened 4,288, sending 2,065 to the hospital.

Officials do not release details on victims or the location and dates of the deaths associated with the vaccine-preventable infectious liver virus.

The new report also shows that cases are continuing a downward trend in rural Kentucky.

Dr. Charles Noplis, a psychiatrist focusing on addiction medicine, said many of the Kentuckians who die from hepatitis A are more vulnerable because they have other health issues, such as hepatitis C. Among the general public, he said, death from hepatitis A is rare.

"I would've never guessed the deaths would be this high," said Noplis, who practices at Renew Recovery and sees patients in London, Kentucky. "I think it underscores the biggest issues at hand in the southeastern portion of the state. We need better health care, better education."

Related:Here's what you need to know about hepatitis A in Kentucky

Noplis said he'd like to see more syringe services programs in the region, which can connect people with addiction treatment and disease testing.

The hepatitis A outbreak spread mainly by drug users has hit 104 of Kentucky's 120 counties since it began. In the week ending March 2, 21 counties reported new cases.

The state recorded 34 new cases statewide that week and 56 the week before, compared with a high of 151 cases per week last fall.

The report came one day after Kentucky lawmakers advanced a resolution directing the Cabinet for Health and Family Services to review its response to the deadly hepatitis A outbreak. The measure has not been approved by both chambers of the legislature.

"Kentucky could improve its response to future outbreaks by examining whether action should have been taken more quickly, more resources should have been leveraged to provide vaccine" and whether "access to the vaccine should have been more adequately distributed geographically," the resolution said.

The latest:Review of Kentucky's hepatitis A response gets bipartisan support

That followed a Courier Journal investigation that found the state's former infectious diseases chief lobbied unsuccessfully last spring for a more aggressive and costly state response to the outbreak in rural counties before it swept through Appalachian Eastern Kentucky and grew into the biggest and deadliest in the nation.

Dr. Robert Brawley, former chief of the state health department’s infectious disease branch, recommended $6 million for vaccines and $4 million for temporary workers in thinly staffed local health departments.

He also called for a public health emergency declaration to help pave the way for federal assistance. Others in the department also said they believed a stronger response was needed.

The Department of Public Health, led by Commissioner Dr. Jeffrey Howard, instead sent $2.2 million in state funds to local health departments. Howard declined to declare an emergency. He said in a previous interview that he would be willing to seek more funding if needed.

State public health officials have defended their approach, arguing they used limited budgets to target hard-to-reach rural drug users at county places such as jails, syringe exchanges and drug rehabs, spending $2.2 million in state funds alone, in addition to federal vaccine and money.

But several federal lawmakers have also questioned the state's response. Eastern Kentucky Republican U.S. Rep. Hal Rogers has he was "disappointed by reports that clear warning signs and serious alarm bells were not heeded sooner" as the outbreak spread in Appalachia following vigorous efforts to contain it in Louisville.

U.S. Rep. John Yarmuth, a Louisville Democrat, "remains concerned about the state’s response, especially in light of yet another unfortunate death," his spokesman said Tuesday.

"The people of Kentucky deserve a thorough review and proper oversight of all entities tasked with responding to this public health threat. He hopes that all parties at the state and local levels will continue to work together to determine what went wrong and what next steps can be taken to better address this dangerous situation."

Cabinet officials did not immediately respond to a request for comment on the latest figures in the state's weekly report.

But Howard told the Associated Press this week that he would welcome a department review.

"We in public health and the cabinet are always looking at our responses, so this is nothing new," he said. "We'll just be making a report available to our legislators."

The investigation:Kentucky's 'too low and too slow' response to nation's worst hepatitis A outbreak

Follow Chris Kenning on Twitter @chris_kenning.