Michigan state health officials are urging people in the Detroit metro area to take special precautions against the hepatitis A virus (HAV), after a spike of more than 800 percent in cases of the liver virus over the last few months, The Detroit Free Press reports.

Since August, two people have died of HAV, and another 105 have been sickened by the virus in Wayne, Oakland and Macomb counties. Hepatitis A is carried in feces and is typically spread through food handled by people who haven’t washed their hands properly. This marks an eightfold increase in new HAV cases compared with last year, according to the Michigan Department of Health and Human Services. 

So far, no common source of the virus has been found. In August 2016, two HAV cases were linked to sewer backups in the city. In October, two additional infections were linked to the prepared food section at the Detroit Whole Foods store. According to the state, about one third of the confirmed cases have been among individuals with a history of substance abuse, and 16 percent were coinfected with hepatitis C virus (HCV). 

To help stop the spread of the virus, Detroit health officials advise adults and children to take precautions against HAV over the next few months, including washing their hands and getting vaccinated. Doctors’ offices and pharmacies are currently stocking the hepatitis A vaccine as are city health departments, which have announced that they will work with people who don’t have insurance to get them protected.

Symptoms of hepatitis A include jaundice (a yellowing of the eyes and skin), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stools. Up to 85 percent of HAV cases require hospitalization, although most people infected with the virus do not die. There is no specific treatment for hepatitis A, but the body is typically able to clear the virus on its own with time and care.