MONTPELIER, Vt. (AP) — Vermont is reporting a statewide outbreak of hepatitis A, joining 30 other states, including New Hampshire and Massachusetts, that have seen a marked increase in the number of cases, the Vermont Health Department said Thursday.

The outbreak was in its early stages, and health officials had been anticipating it based on what's happened in other states, said Health Commissioner Dr. Mark Levine.

"We are working closely with health care providers to ensure that Vermonters are vaccinated, and with our community partners to get the word out to people who are at high risk of infection, some of whom can be difficult to reach.”

Hepatitis A is a liver infection caused by a virus with symptoms that can range from a mild infection to a more serious illness, including liver failure and death, health official said. It's generally spread by person-to-person contact, the health department said.

In 2019, Vermont had 12 cases of acute hepatitis A virus infection, compared with the previous five-year average of three cases per year, the department said. Of those cases last year, 58% of the people were hospitalized.