Indiana health officials have confirmed 10 cases of hepatitis A, including one restaurant worker. In Louisville, KY, officials say two more food handlers there have been diagnosed with the liver infection.

The food handlers could have exposed the public to the highly contagious virus. There is a narrow window of opportunity for exposed customers and fellow employees to receive post-exposure treatment. If it is not administered within two weeks of exposure it is not effective.

In Louisville, two Kroger grocery stores are involved, one at 520 N. 35th St. and one at Sarino at 1030 Goss Ave. Customers and employees who were in the 35th Street Kroger store between March 2 and 19 may have been exposed to the virus. People people who ate at the Sarino Avenue between Feb. 24 and March 15 could have been exposed.

On Thursday, Floyd County, IN, officials said an employee at the Bob Evans in New Albany had been diagnosed with hepatitis A and that people who ate there between Feb. 20 and March 9 could have been exposed.

People who do not have the opportunity to receive the post-exposure treatment should monitor themselves in the coming for symptoms to develop, which can take 50 days in some cases.

Symptoms of Hepatitis A can include fatigue, loss of appetite, stomach pain, nausea and the yellowing of the eyes or skin. Some people who are infected do not develop symptoms.

The outbreak strain in Indiana and Kentucky is the same one that has infected more than 1,200 people in several states, killing more than 40.

The outbreak in Kentucky started in 2017. In November 2017, public health officials there reported 19 cases in Louisville. They said then that some common risk factors included homelessness or substance abuse, according to the Louisville Courier Journal.

However, the virus can easily spread via foods and beverages. Of the states involved in the ongoing outbreak, between one-fourth and one-third of the victims are neither homeless nor substance abusers. Infected people, including foodservice workers and other food handlers, can spread the virus before they develop symptoms.

The virus can also spread through close personal contact and contaminated surfaces. It can survive freezing temperatures for years.

Earlier this month, officials learned that a Kroger employee who worked in the produce aisle of a Kentucky grocery store in February exposed an unknown number of people to the hepatitis A virus.

Consumers were told to throw away produce purchased at the Kroger store at 4915 Dixie Highway Store officials said the employee did not continue working after the hepatitis A diagnosis.

Kentucky’s outbreak of hepatitis A is centered in Jefferson County, which has more than 150 cases, a significant increase in a state that typically sees about 20 cases per year. A health department spokesman said Friday that the city has confirmed 159 cases.

Since November, at least four Louisville foodservice employees have beed identified as having been infected while they were working.

Last week, hepatitis A cases prompted the temporary closure of one Indiana school district campus, which includes three Henryville schools. Staff and students returned to school Monday, the Courier Journal reported Friday.

A health officer said Friday there were 29 cases in Clark County, up from 25 last week.

“It’s almost like one big general outbreak in Kentuckiana,” Dr. Eric Yazel told the Louisville paper, adding that the county was treating the cases with the highest level of precaution.

The hepatitis A outbreak is spreading in Salt Lake County, UT, where it has affected mainly people who are homeless.

County health department officials there are giving the vaccine on the street to reach people who are homeless and substance abusers. The Salt Lake County Health Department has confirmed 144 cases, compared to five in a typical year, according to KUER radio, the local NPR station.

One of the risks for people who are homeless is lack of access to good hygiene, and officials in Utah are working to set up hand-washing stations.

Health department data in Utah shows the outbreak hasn’t peaked.

In Michigan, as of March 14, public health officials had confirmed 783 cases, resulting in 25 deaths and 632 hospitalizations.

Health officials from the state and hardest hit municipalities are working to vaccinate people who are at highest risk, including people who are homeless or incarcerated, drug users and men who have sex with other men.

A number of food handlers in Michigan have been confirmed as infected with the virus, spurring post-exposure vaccination recommendations from health officials.

In Edmonton, Alberta,  health officials are warning people about a case of hepatitis A in a cafeteria worker at an Edmonton hospital.

Alberta Health Services says patients, visitors and staff who consumed food or drink prepared in the cafeteria at the Grey Nuns Community Hospital on certain days between Feb. 26 and March 18 may have been exposed.

It was not immediately clear whether the hepatitis A strain is the outbreak strain that is behind the outbreak in the United States.

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