South Carolina has declared a statewide hepatitis outbreak after cases surged four-fold.

Hepatitis A has seen a resurgence in recent years across the US. Between 2016 and 2018, there were 300 percent more cases than there had been in the previous three year period, the Centers for Disease Control and Prevention reported last week.

In South Carolina, what began as a single county outbreak has spread to 19 jurisdictions, leading to 59 hospitalizations and even killing one person.

South Carolina is not, in fact, among the nine US states that have seen hepatitis A increases of 500 percent or more - but it does have one of the highest rates of opioid prescriptions of any US states.

And health officials blame the rise in hepatitis A on the opioid epidemic, which has fueled both dangerous needle sharing and homelessness.

South Carolina has declared a statewide hepatitis A outbreak as cases reach 86 across 19 counties with outbreaks, marking a four-fold increases after last years expected number

THE 2019 HEPATITIS A OUTBREAKS IN THE US The period from 2016 to 2018, there were nearly 300 percent more hepatitis A cases in the US than in the previous three years. Cases have spiked by 500 percent in nine states and Washington, DC, with some notable outbreaks making headlines. THE ARIZONA OUTBREAK In May, health officials confirmed the state's outbreak had reached 200 cases. Arizona hasn't seen so many cases in a decade. The outbreak is primarily centered around Tuscon, where it has spread among the city's homeless population. HUNDREDS OF FLORIDA STUDENTS EXPOSED TO HEPATITIS A AT PROM Students from at least two high schools in Spring Hill, Florida were exposed to the virus at their prom. An employee of the venue, Silverthorn Country Club, was diagnosed in the weeks following the schools' dances. None of the students have been diagnosed with the virus, though health officials are encouraging them to get vaccines in case. THE CHOCOLATE-COVERED MARSHMALLOW OUTBREAK Modjeskas, popular chocolate- or caramel-covered marshmallows made by Bauer's Candies were recalled across the US in January. The recall came after an employee working in one of its facilities was diagnosed with hepatitis B. No reports of infections among consumers have been made. Advertisement

Meanwhile, in nine states - Hawaii, West Virginia, Mississippi, Missouri, Arkansas, Indiana, Ohio, Kentucky and Tennessee - plus Washington DC, hepatitis A cases have increased by 500 percent.

Hepatitis A is an entirely preventable viral infection and usually works itself out of the system, but can turn serious or even fatal.

Children are supposed to be vaccinated against it, but it is not clear how far beyond 10 years the shot lasts.

Even so, its prevalence is generally so low that the liver infection isn't a concern to the population.

But that security is less likely to apply to people living in unclean living conditions or misusing drugs.

Hepatitis A is primarily transmitted from person-to-person when one person ingests the contaminated feces of another.

Although the fecal-oral route is the typical pathway by which hepatitis A spreads, because the virus gets into the bloodstream, blood-to-blood contact or even fecal matter-to-blood contact can also allow transference of the disease.

Either of these is most likely to happen when someone uses an unclean or second-hand needle to inject drugs like heroin or fentanyl.

Where the opioid epidemic goes, hepatitis follows.

In South Carolina, 15.5 out of every 100,000 deaths were due to opioid overdoses in 2017.

The state is not actually in the upper echelon for opioid deaths - but it is for opioid prescriptions.

In 2016, 79.3 prescriptions for opioid drugs were written for every 100,000 people in South Carolina.

In 2015, it was a whopping 109 per 100,000, and both years, the state was in the top 10 for most opioid prescriptions doled out.

Hepatitis A cases have come in the wake of opioid prescriptions.

Typically, the state would expect to see about 19 cases a year, state epidemiologist, Dr Linda Bell, told Greenville News.

In the past seven months, they've had 86 - over four times the number expected in 12 months.

Since November 2018, 86 cases of hepatitis A have been reported in South Carolina - and so far each month has only come with an increase,

'We have met the definition of an outbreak in South Carolina based on an increase in the number of cases we’d expect to see in a given time frame,' Dr Bell said.

'This also allows us to take some pro-active measures to prevent the ongoing spread.'

Dr Bell and her office are pushing for improved hand-washing and vaccination to contain the disease's spread.

'It’s important for us to educate people that this is an outbreak, but we are not seeing widespread transmission and we want to prevent that by making sure health care providers are aware of this increase...so they can look for cases and encourage hepatitis A vaccine for prevention,' she told Greenville News.

'If we can increase coverage as quickly as possible, then we can prevent a larger scale outbreak in South Carolina. And that’s our goal.'