Following outbreaks on the West Coast and in the South, the Midwest is experiencing one of the worst outbreaks of hepatitis A virus (HAV) in the country. Ohio and Indiana have both reported a sharp uptick in cases of infection with the liver virus, a recent broadcast from WOSU public radio reports.

Since November, Indiana’s State Department of Health has reported 148 cases of hepatitis A, and Ohio has reported 79 new cases this year, more than double its usual rate.

According to health workers on the ground, drug use, homelessness and incarceration appear to be major drivers of the crisis. Since the virus spreads mainly via fecal-oral contact, people with improper access to sanitation facilities, clean water or stable housing are typically at the greatest risk of infection.

Health departments across the country are recommending that anyone who may have been exposed to the virus, who is homeless, who uses drugs or who has been incarcerated receive two doses of the hepatitis A vaccine to prevent infection. Meanwhile, prisons across the Midwest are quarantining inmates who test positive for the virus as an extra precaution. 

To learn more about hepatitis A and where it’s spreading, click here.