MINNEAPOLIS (AP) — Minnesota health officials say there’s an outbreak in cases of hepatitis A, a virus that can cause severe liver damage.

Twenty-three cases have been identified with 13 patients requiring hospitalization for the virus, which is spread by unsanitary conditions. The state Department of Health is advocating for broader vaccination efforts in high-risk areas, such as jails and homeless shelters.

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The department’s infectious disease director, Kris Ehresmann, tells the Star Tribune that declaring a state outbreak will unlock federal resources, including greater access to an adult vaccine that’s in limited supply.

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Ehresmann says nine counties are reporting recent cases, including Chisago, Dakota, Hennepin, Kanabec, Kandiyohi, Mille Lacs, Pine, St. Louis and Washington.

In the last three years, there have been 23,000 cases of hepatitis nationally, with 233 deaths.

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