A growing injection drug use epidemic in Appalachia has caused a surge in hepatitis B virus (HBV) cases across the region, according to new data from the U.S. Centers for Disease Control and Prevention (CDC) and reported by USA Today.

CDC data shows that between 2009 and 2013, acute hep B cases rose 114 percent in Kentucky, Tennessee and West Virginia, even as HBV incidence remained stable nationwide. Injection drug use was a factor in 75 percent of the new cases since 2010.

Unlike hepatitis C, hep B can be prevented with a vaccine. The shot, which was approved in the early ’90s, is recommended almost universally today. However, federal surveys show that vaccine coverage for hep B remains low among adults nationwide.

Local health agencies also report that nine out of 10 people who are abusing prescription drugs or heroin in the region are injecting them intravenously, and that many of them are not using clean needles.

The CDC warned that new cases in Appalachia may seriously impede the federal government’s strategy to eliminate nearly all HBV transmissions nationwide by 2020. An estimated 2.2 million Americans are living with chronic hep B.