UPDATE: One person in Tennessee has died from Hepatitis A and now health officials are warning Tennesseans about what they say is an outbreak.

Health officials will only say the person who died lived in East Tennessee. Falling behind Nashville, Chattanooga is the state's second most-impacted city with a total of 43 cases, two of which were confirmed on Wednesday.

Over 450 Hepatitis A cases have been confirmed across Tennessee.

Health officials cannot pinpoint why Chattanooga is seeing more cases than other parts of the state, but say they expect to see the number grow.

"We have to go two or three months without a case before we think we are really out of the woods here,” says Connie Buecker who is the Communicable Disease Control program manager for the Chattanooga-Hamilton County Health Department.

Buecker says it could be some time before Hamilton County is out of the woods. She tracks diseases for the Hamilton County Health Department and is currently focused on Hepatitis A.

It’s a contagious disease that attacks the liver and is most commonly spread when you eat or drink something contaminated with fecal matter.

"I don’t know that I’ve heard a great explanation about why this is happening like this. What we have seen is that the homeless population has some risk. We are also seeing a lot in drug users, illegal drug users, and men who have sex with men,” stated Buecker

Normally, Hamilton County only deals with 0-to-1 case per year and this year, Buecker has seen more than 40 since May.

Buecker also says Hepatitis-A can also be contracted by not washing hands after going to the bathroom or handling diapers before preparing food.

Buecker says the best thing you can do is to prevent it is get the vaccine. The vaccine is usually administered in two-doses and in most cases is free.

The vaccine is required for all Tennessee children entering kindergarten, but Buecker says adults who are part of at-risk groups should consider it too.

“People do die and when you could have prevented it with a shot and you just don't do it because it might hurt. It’s not going to hurt nearly as much as getting sick or hurt,” said Buecker.

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PREVIOUS STORY: The Tennessee Department of Health is continuing an on-going investigation into a hepatitis A outbreak in Tennessee.

According to the TDH, the most heavily impacted areas are Nashville and Chattanooga. 

“We will continue to respond aggressively, vaccinating high-risk populations, educating and working with partners in and out of Tennessee to seek additional ways to stem this outbreak," said TDH Commissioner John Dreyzehner, MD, MPH. 

TPH says hepatitis A is a vaccine-preventable disease that affects the liver. 

The virus is transmitted via person-to-person interaction through contact of contaminated feces or consumption of contaminated food or water. 

The TPH says that "the most at-risk groups for hepatitis A include recreational drug users, men who have sex with men and people experiencing homelessness."

The current hepatitis A outbreak is associated with recreational drug use.

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 “We urge anyone in the high-risk groups to get vaccinated as soon as possible, and will continue to work with state and local partners to provide hepatitis A vaccine to people at high risk for infection and educate people on how to prevent the spread of this disease," said TDH Assistant Commissioner for Communicable and Environmental Diseases and Emergency Preparedness Tim Jones, MD.

Other than receiving the hepatitis A vaccine, washing your hands with soap and water after using the bathroom, before eating and before preparing/serving food. 

High-risk individuals are encouraged to get the vaccine. 

More information on Tennessee's hepatitis A outbreak can be found here

For more information on TDH services and programs can be found here