Michigan has 14 times more hepatitis A cases than it did last year at this time, say epidemiologists with the state Department of Health and Human Services.
The outbreak, which is mainly in southeast Michigan, has sickened 457 people. Of those, 370 have been hospitalized and 18 have died.
The outbreak is complicated. There's no single source such as food contamination - and many groups of people are at risk, including homeless people, drug users, people who are neither, and now there are more cases among men who have sex with men.