Local health officials say nearly 270 people have contracted hepatitis A in Hamilton County since May 2018. In a normal year, there might be just one case.

As of Friday, 2,257 cases have been reported across Tennessee with 13 deaths since December 2017, according to the Tennessee Department of Health. In the state's other larger areas, Knox County has seen 103 cases; Davidson has seen 219; and Shelby with 40 in that time frame.

So far, there are outbreaks in Arkansas, California, Indiana, Kentucky, Michigan, Missouri, Ohio, Utah and West Virginia, according to the Chattanooga-Hamilton County Health Department.

Since the outbreak began, the local health department has been working to distribute free vaccines. As of July 8, more than 10,000 had been administered.

Hepatitis A is a viral infection of the liver that can cause loss of appetite, nausea, tiredness, fever, stomach pain, dark-colored urine and light-colored stools. Yellowing of the skin or eyes may also appear. People can become ill up to 50 days after being exposed to the virus.

It's acquired when a person unknowingly ingests the virus from objects, food or drinks contaminated by small, undetected amounts of stool from an infected person. The virus spreads when an infected person does not wash his/her hands adequately after using the toilet or engages in behaviors that increase risk of infection. Careful hand washing, including under the fingernails, with soap and water, along with vaccination of anyone at risk of infection, will prevent spread of this disease.

Although anyone can get the disease, people most at-risk for hepatitis A infection include those experiencing homelessness, recreational drug users and men who have sex with men.

According to the U.S. Centers for Disease Control and Prevention, others at risk include:

— Travelers to countries where hepatitis A is common;

— Household members or caregivers of a recent adoptee from countries where hepatitis A is common;

— People with clotting factor disorders, such as hemophilia.

People in the at-risk category can visit clinics at Third Street, Birchwood, Sequoyah and Ooltewah without an appointment and ask for the free vaccine.

Vaccines are also available to the homeless at the Homeless Healthcare Clinic on 11th Street in downtown Chattanooga.

For more information on hepatitis A and how to get a free vaccine, visit or call 423-209-8190.

CORRECTION: This story was updated at 10:40 a.m. on Monday, August 19, 2019, to correct the year to 2018 in the first paragraph. In a previous version, it had erroneously stated 2008.