Kentucky’s Department of Public Health recommended on Monday that all unvaccinated people in six of the state’s counties seek hepatitis A vaccination because of an ongoing outbreak of hepatitis A infections.

Of the 311 cases currently known of in Kentucky, 214 victims live in the Jefferson County/Louisville area. Additionally, Bullitt, Hardin, Greenup, Carter and Boyd counties have each reported five or more cases. To date, one death in the state is attributed to the outbreak, according to the DPH.

Regarding the threat of local transmission, DPH Commissioner Dr. Jeffrey Howard, said in the Monday public alert the department is encouraging everyone to be vaccinated to help stop the outbreak.

The U.S. Centers for Disease and Control began recommending that children receive the hepatitis A vaccine series in 2006. Kentucky officials has gone a step further.

“Effective July 1, 2018, all Kentucky students in kindergarten through 12th grade must receive two doses of the hepatitis A vaccine to attend school, or receive a provisional certificate of immunization, unless their parents claim an exemption,” according to the Monday alert.

Although the majority of the outbreak cases in Kentucky, as well as several other states involved in the outbreak, are homeless people or substance abusers, the Kentucky health alert reported at least 30 percent of the victims in the state are nor in any of the high-risk groups.

In addition to vaccination, to help control the outbreak DPH recommends people wash their hands often, particularly after using the restroom or before preparing or consuming foods or beverages at home or in public. Hand sanitizer should be used only when soap and water is unavailable, according to the DPH.

Signs and symptoms of hepatitis A include yellowing of the skin or eyes, dark-colored urine, fatigue, abdominal pain, loss of appetite, nausea, diarrhea and fever. Microscopic amounts of the virus are found in the stool of people infected with hepatitis A and is typically foodborne or spread through person-to-person contact.

The hepatitis A vaccine should not require any out-of-pocket costs for insured people “as long as policies are compliant with the federal Affordable Care Act,” according to Kentucky’s notice. The hepatitis A vaccine is typically administered to adults in two doses, including an initial vaccination with another shot six months later.

Hepatitis A vaccine is widely available at local pharmacies and health care providers. For additional information on the hepatitis A vaccination, visit the CDC, or the Kentucky Cabinet for Health and Family Services.

Nationwide, the outbreak has sickened 1,200 people , killing more than 40.