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Yakima County has 18 confirmed cases of hepatitis A, a number that likely will increase in the weeks and months ahead.

The cases are all tied to people experiencing homelessness and those using illicit drugs, according to the Yakima Health District.

The health district, in partnership with the Union Gospel Mission and Yakima Neighborhood Health Services, has vaccinated 129 people since the outbreak was reported in early November. Health officials also have been working closely with the Camp Hope homeless encampment and offering vaccines at clean needle exchanges.

Health officials expect the number of cases will continue to increase. Because the incubation period for hepatitis A is 15 to 50 days, someone can be infected and not know they are spreading it, said Melissa Sixberry, director of disease control for the health district.

“We’ve been told if the outbreak is less than six months you are doing a great job,” she said. “We will see cases through springtime.”

Not only do health officials talk to people who are infected, they also work to reach out to others they came into contact with to encourage vaccinations, said Lilian Bravo, director of public health partnerships at the Yakima Health District.

Genetic testing found the hepatitis A strain in Yakima County is related to a hepatitis outbreak in Spokane County. As of Nov. 22, the Spokane Regional Health District confirmed 64 cases of hepatitis. Sixberry said Spokane and King counties still have active outbreaks.

Hepatitis A is a liver disease usually transmitted when someone unknowingly ingests the virus from touching objects or consuming food contaminated with stool from someone who is infected. It also can be spread by close, personal contact.

Symptoms include yellow skin or eyes, dark urine and-or pale stool, loss of appetite, fever, diarrhea, fatigue, vomiting and abdominal pain. Cases often result in overnight hospitalizations.

The best protection is the hepatitis A vaccine and frequent hand-washing, health officials say. Anyone can get the vaccine by contacting their doctor.

As of Nov. 21, there were 124 hepatitis A cases in Washington state, 66 hospitalizations and two deaths, according to the state Department of Health. The state first announced a multi-county outbreak on July 30. Other states also have reported outbreaks, primarily among persons experiencing homelessness and people who use illicit drugs.

More information is available from the Yakima Health District, the state Department of Health and the Centers of Disease Control.