Last week, Florida’s surgeon general issued a statewide public health advisory focused on an ongoing hepatitis A virus (HAV) outbreak after cases of the liver virus skyrocketed across the state, Precision Vaccinations reports.

Celeste Philip, MD, MPH, who is also a state health officer at the Florida Department of Health said in a recent media release that “this health advisory is necessary to protect the public health and safety” of all Floridians. The majority of cases have occurred in Tampa Bay and Orlando, and 77 percent of recent infections have required hospitalizations—an astounding rate compared with hepatitis A outbreaks in other parts of the country.

Since January 2018, Florida health officials have identified 385 cases of hepatitis A, more than three times the previous five-year average of 126 cases per year. Nationwide, approximately 8,000 HAV cases have been reported this year, affecting at-risk populations in Arkansas, California, Indiana, Illinois, Kentucky, Michigan, Missouri, North Carolina, Ohio, Tennessee, Utah and West Virginia.

In response, the Centers for Disease Control and Prevention is recommending that everyone who is homeless or at risk of homelessness (including injection drug users) be vaccinated against the virus. For children and teens through age 18, the state of Florida provides hep A vaccines free of charge.