According to press reports, there has been a sharp increase in hepatitis A cases in three Maine counties since February, according to a release sent out by the Maine Center for Disease Control and Prevention (Maine CDC) Friday morning.

It says there were zero cases reported in the counties between January and February of this year, but in the last four months, there has since been an uptick to 26 cases total.

According to the release, in 21 of the 26 cases, there were risk factors of injection drug use or housing insecurity.

Maine has had seven to ten cases of hepatitis A cases per year during the past decade, but last year that number more than tripled to 45 cases total.

“This increase was driven by a restaurant-associated outbreak and cases related to injection drug use or housing insecurity,” the release reads. “Since January 1, 2020, Maine CDC has identified 39 cases of Hepatitis A statewide — recent case investigations, however, have not identified a source of the infections.”

New Hampshire, Vermont, and Massachusetts are also among states that have reported outbreaks of hepatitis A.

Hepatitis A infection is a liver infection caused by the hepatitis A virus and is usually spread through personal contact rather than contaminated food or water. Symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice – according to the release.