(CNN) Kentucky and Indiana have become the latest states to experience hepatitis A outbreaks.
The Kentucky Department for Public Health has identified 400 cases since August and declared a statewide outbreak in November.
Seventy-six cases have been identified in Indiana since November, 69 of them in 2018 alone, according to the state's Department of Health.
No cases have resulted in deaths in Indiana, but there have been three in Kentucky this year.
Both states see an average of about 20 cases of hepatitis in a typical year, health officials said.
While both states are taking measures to address the problem, the number of cases continues to rise. In Kentucky, almost 120 cases were identified in March and another 80 in April. In Indiana, 39 cases were diagnosed in March, and about 13 cases a week were diagnosed in April.
Hepatitis A is a highly contagious live disease. The virus is found in the feces of people with the disease and is most frequently transmitted by eating food or drinking water handled by someone who has not properly washed their hands. It's also transmitted by sex and by illicit drug use.
The most common symptoms include nausea, vomiting, fever, fatigue, loss of appetite and jaundice, or yellowing of the skin or eyes. It can take 15 to 50 days for symptoms to appear; however, an infected person is most contagious during the two weeks before their skin turns yellow.
According to the US Centers for Disease Control and Prevention, the hepatitis A virus is very hard to kill and can live for months outside the body. Hand sanitizers are not effective against it, so frequent handwashing is crucial in controlling any outbreak.
In both Indiana and Kentucky, officials said they have seen an increased number of hepatitis A cases among people who are homeless and those using drugs. Indiana has also seen increased number of cases in people who had been incarcerated.
Michigan, Utah, Colorado and California have seen increases in hepatitis A cases over the past year.
Testing shows a connection between some of the outbreaks. In Kentucky, several cases of hepatitis A show a virus strain that is genetically linked to the outbreaks in California and Utah, according to a state Department for Public Health report. In Indiana, the genotype found in two hepatitis A cases matches the genotype in ongoing outbreaks in Arizona, Kentucky, California, Michigan and Utah, according to the state Department of Health.
A vaccine for hepatitis A was created in 1995, but many adults have not been vaccinated. A shortage of the vaccine, which can prevent infection from the virus, at the beginning of the year affected states trying to fight these outbreaks.
Both Kentucky and Indiana are trying to get a handle on the outbreaks. While doctors are identifying cases, state officials are working to provide both the public and health care workers with information and resources to fight the spread of the virus.
Indiana's health department is providing hepatitis vaccines to high-risk groups, like people who are homeless or use drugs. Officials have distributed 5,000 vaccines to these populations in the past few months, said Pam Potones, deputy state health commissioner.
Indiana didn't require vaccination for school entry until 2014, so many adults may not be unvaccinated, Potones said.
Kentucky's health department is recommending that the vaccine be a requirement for school entry in the upcoming year. It is also providing vaccines to at-risk populations through public health initiatives like syringe exchange programs and community vaccination events, according to Kentucky Cabinet for Health and Family Services spokeswoman Barbara Fox.
Though a food transmitter has not been identified in the outbreaks in Kentucky or Indiana, food is one of the most common ways the virus is spread. Indiana's health department has provided information to every food establishment in the state on how to prevent outbreaks and what to look for in people who may have the virus.