Since the beginning of 2018, health officials in West Virginia have confirmed nearly 100 cases of hepatitis A virus (HAV), a major uptick in new infections that suggests the state is the latest to be struck by an outbreak that has been making its way across the country over the past year, The Register-Herald reports.

According to health department authorities, some of the cases have been linked to hepatitis A cases in California, Colorado, Utah and Kentucky, which are battling their own interconnected outbreaks. The West Virginia Department of Health also reports that several cases have been among food service workers.

In response, the state has initiated an outbreak response. In a recent press release, officials encouraged all food establishments to review the importance of proper handwashing and glove-wearing techniques with their employees. The state is also sending out additional food establishment signage to aid in those discussions.

West Virginians are also being encouraged to wash their hands, avoid sharing needles, practice safe sex and get vaccinated against the virus if they have not already. Several health department sites are now offering preventive shots, which protect against hepatitis A infection for life.