An outbreak of hepatitis A that started in north Alabama late last year continues to grow, leading the state Department of Public Health on Tuesday to urge Alabamians to get vaccinated.

The outbreak, which began Sept. 1, is now at 35 cases, the agency said. Jackson County has the majority of reported cases with 22, followed by 12 cases in DeKalb County and one case in Marshall County. The latest case was reported March 3. Other cases that might be related to the north Alabama outbreak have been reported in Cherokee and Marshall counties.

Hepatitis A can be acquired by having close contact to someone with the virus. Other means of exposure include coming into contact with an infected food handler at a restaurant, drug paraphernalia, being employed or incarcerated in jail or prison, homelessness, oral or anal sex or through unvaccinated people who don’t wash their hands.

“Hepatitis A vaccine is recommended for anyone who participates in high-risk behaviors listed above and their contacts, and/or anyone who would like to protect themselves from the risk of infection,” the Public Health department said in a statement Tuesday. “ADPH focuses on vaccinating high-risk persons or uninsured persons. Persons at low risk for hepatitis A who may wish to be vaccinated may contact their healthcare provider or pharmacy. Many health insurance plans cover hepatitis A vaccinations at physicians’ offices and pharmacies.”

Symptoms of hepatitis A may take 15 to 60 days to present themselves and include fever, headache, fatigue, low appetite, stomach pain, nausea, vomiting, dark urine and jaundice. Anyone exhibiting these symptoms was urged to contact their healthcare provider.

The ADPH gave the following tips to reduce the spread of hepatitis A, especially in northeast Alabama:

· Get vaccinated as soon as possible.

· Wash your hands frequently;

Before, during, and after preparing food; after using the toilet; after changing diapers or cleaning up after a person who has used the toilet; after touching garbage; before eating food; before and after caring for someone who is sick

· Do not share drug paraphernalia, cigarettes, food, drinks, eating utensils, towels or toothbrushes.

“Hepatitis A vaccination and proper hand washing will significantly reduce the spread of this virus in these counties and are important measures to protect the community,” said ADPH Medical Officer Dr. Karen Landers in a statement.