COLUMBUS, Ohio (AP) — The state health department is recommending that people with certain risk factors receive a hepatitis A vaccine as the number of cases in Ohio has risen.

The Department of Health said Thursday there have been 47 reported cases in Ohio this year, compared with five cases during the same period in 2017.

Hepatitis A is a liver disease typically spread by ingesting even microscopic amounts of fecal matter from objects, food or drinks.

The health department says people most at risk of contracting the disease include those in contact with someone who’s infected with the disease, men who have sex with men, street drug users, and people with blood clotting disorders or chronic liver disease.

High-risk individuals are encouraged to contact doctors or local health offices about receiving the vaccine.