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JACKSON, Miss. (AP) — Mississippi health officials say the state, like others nationwide, is seeing an outbreak of contagious liver disease Hepatitis A, urging people to get vaccinated.

State Epidemiologist Dr. Paul Byers says 23 cases of the disease have been confirmed in Mississippi since April. Over the nine previous years, Mississippi averaged about five cases a year.

Hepatitis A spreads through food or drink contaminated with feces of an infected person, personal and sexual contact with an infected person, and sharing objects with someone who is infected. Symptoms include nausea, diarrhea, and vomiting; yellowing of the skin and eyes; and stomach pain, low appetite and fever.

Byers says the state Health Department has investigated all cases to identify others who have been in contact and vaccinate them.