Kentucky and Indiana are the latest states with outbreaks of the highly-contagious liver disease virus hepatitis A.

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In Kentucky, health officials say 400 cases have been identified since August and a statewide outbreak was declared in November. Since November, 76 cases have been identified in Indiana, according to health officials, CNN reported.

Both states have an average of about 20 hepatitis cases a year.

There have been three hepatitis A deaths in Kentucky so far this year, but none of the hepatitis A cases in Indiana have resulted in deaths, CNN reported.

Michigan, Utah, Colorado and California have had increases in hepatitis A cases over the past year.

The hepatitis A virus is found in the feces of infected people and is most frequently transmitted by eating food or drinking water handled by someone with the virus who has not properly washed their hands. The virus is also transmitted by sex and by illicit drug use, CNN reported.

There is a vaccine for hepatitis A, but many adults have not received it. A shortage of the vaccine at the beginning of the year hampered states’ efforts to fight hepatitis A outbreaks.

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