Ohio has joined Michigan, Kentucky, West Virginia, and Indiana in declaring an outbreak of hepatitis A. Michigan has the most confirmed cases with 843. Ohio has “only” 79, but that’s twice as many as the state saw all last year. Community health departments are requesting thousands of doses of hep A vaccine in the hope of stemming the tide. Given the proximity of the states, the presumption on the part of health officials is that there’s a spread factor to the cases. If they’re correct, that indicates the need for vigilance in an ever-expanding geographic area. Given that hep A infection can take place from close personal contact, as well as ingestion of tainted food and drink, it may be advisable to ask patients visiting urgent care centers in affected areas if they know anyone with symptoms commonly associated with the virus as added incentive to get the vaccination. Those symptoms include fatigue, low appetite, stomach pain, nausea, clay-colored stools, and jaundice. Ohio officials report that the bulk of their cases have involved people who are homeless, use illegal drugs, already have hepatitis C virus, have been incarcerated, or who have had sex with people diagnosed with hep A.