CINCINNATI -- Greater Cincinnati is in the middle of a hepatitis A outbreak, with nearly 600 cases reported.
The virus affects the liver, but it is preventable with hand-washing or a vaccine.
Dr. Lynne Saddler is used to dealing with major health issues at the Northern Kentucky Health Department. But having more than 200 cases of hepatitis A is surprising.
"Typically, in any given year, we have no cases of hepatitis A, so this is highly unusual," she said.
They've had 75 cases in Kenton County, 54 in Campbell County, 38 in Grant County and 34 in Boone County.
So, why are the number so high?
"Illicit drug use and, to a lesser degree, homelessness," Saddler said. "So, those are the two main risk factors that we're seeing in cases."
There are a multitude of symptoms.
"Anything from nausea, sometimes vomiting, abdominal pain, can be very tired, dark-color urine, pale-colored stool, and of course the telltale sign of any kind of hepatitis is jaundice, or the yellowing of the yes and the skin," Saddler said.
The Ohio numbers show Butler County with 232 cases, Hamilton County with 124, Clermont County with 24 and Warren County with 15.
Hamilton County Health Commissioner Tim Ingram said it's a tough disease, especially when it affects health care or food service workers.
"Hepatitis A spreads through the fecal-oral route," he said. "So, any time there's a breakdown in hand hygiene, especially in those sensitive occupations, people are more at risk."
That's why hand-washing is so important, scrubbing for a good 20 seconds.
"Our mothers have told us this our whole lives, and it is one of the most effect, low-cost public health prevention measures you can take," Saddler said.
A simple shot can also prevent the disease, according to the health department.
"Since 2006, children above age 1 have been required to have the standard immunization protocol for hepatitis A," Ingram said.
Officials said adults should consider getting the shot as well.
"There are no side effects," Saddler said. "It's no worse than getting your flu shot which, by the way, you should also get while you're in the pharmacy or at the grocery store."