YAKIMA, Wash. (AP) – Health officials say a hepatitis A outbreak in Yakima County now involves 11 cases.

The Yakima Health District said Thursday that the cases involve people experiencing homelessness or those who use illicit drugs.

The health district announced the outbreak Nov. 7, when five cases were confirmed in Yakima County.

Since then, various local agencies have done outreach and vaccinated 74 people.

The virus affects the liver and spreads through contaminated feces. It causes symptoms like fever, dark urine, yellow-tinged skin or eyes, fatigue and gastric issues. People pass it along by eating or drinking tainted food or water, or through sex.

On July 30, the Washington State Department of Health announced a multi-county hepatitis A outbreak.

Through genetic testing, it was found that the Yakima County hepatitis A strain that is being observed is related to the hepatitis A outbreak in Spokane.

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