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CARIBOU, Maine — The Maine Center for Disease Control confirmed June 21 that the nine cases of hepatitis A infection reported in Aroostook County are linked to the first instance of the virus found in a Caribou restaurant worker May 17.

“All nine cases are linked to exposures at a restaurant in Caribou,” a June 21 advisory read. “There is no ongoing risk to the public from eating at this restaurant, nor is there any ongoing risk to the public as a result of the original case.”

They also sent an update on June 18 informing the public that six cases had occurred within the past month, however their recent health advisory indicated that three new cases had occurred since then.

Four of these cases have been publicly reported, however the agency did not specify where the five new cases occurred.

Dr. Regen Gallagher, chief medical officer at Cary Medical Center, also said these cases are “more than likely connected.”

In Aroostook County, the first case of the virus was identified in a Caribou food service worker May 17, and while there is no longer a risk associated with going to the restaurant, the CDC warned that those who purchased food at the eatery between April 24 and May 2 are “outside the window for which prophylaxis is recommended” and that they should watch for symptoms.

The CDC has reiterated that there is an extremely low risk of contracting the virus to any members of the public who did not purchase food at the restaurant between the aforementioned dates.

While Maine is not experiencing an outbreak of the virus, 22 states in the country are. According to national CDC statistics there have been a total of 20,133 cases, 11,595 hospitalizations and 19 deaths as of June 14.

New Hampshire, which borders Maine, has had 79 cases since November 2018, according to the New Hampshire Department of Health and Human Services, a significantly high number compared to their annual average of six to seven cases.

Following the May 17 incident, one case was confirmed at Caribou High School on June 11, another case was confirmed at a Presque Isle Restaurant over the weekend and a fourth was identified at Fort Kent Elementary School on June 15. Two more at unspecified places were confirmed Wednesday.

CDC Communications Director Jackie Farwell said on June 18 that while there is currently no public health risk, the organization recommends that “all food service workers get vaccinated for hepatitis A” and that the public take preventative measures, which includes practicing good hand hygiene — including thoroughly washing hands after using the bathroom, changing diapers and before preparing or eating food.”

Cary’s Gallagher said that though she has not seen all of the patients diagnosed with the virus, the hospital is aware that some who have since tested positive did eat at the Caribou restaurant between April 24 and May 2.

While local medical facilities gave out close to 1,000 vaccinations shortly after the CDC first announced the virus, Gallagher said that the vaccination would not be effective for those who visited the restaurant from April 24 to May 2.

“This could happen at any establishment in the country,” Gallagher said, “as evidenced by the Presque Isle case,” adding that those who are concerned about the virus should practice good hand hygiene while preparing food and schedule a vaccination with their health provider.

According to the CDC website, some symptoms of the virus include “fatigue, low appetite, stomach pain, nausea, and jaundice.”

The CDC also said vaccination is the best way to prevent the virus as “antibodies produced in response to hepatitis A infection last for life and protect against reinfection.”

This story originally appeared on The County.