Maine saw a fivefold increase in Hepatitis A cases last year, with the number of reported cases climbing to 45 after just nine the year before.

The Maine CDC announced Thursday that 12 of them were linked to a foodborne outbreak in Aroostook County.

A quarter of all cases in 2019 had risk factors such as injection drug use or housing insecurity.

Another quarter of them were related to food service employees who went to work after contracting the virus.

Some illnesses in Maine were linked to outbreaks in other states. Officials say there are currently Hepatitis A outbreaks in New Hampshire and Massachusetts.