New Hampshire health officials say they’re seeing an outbreak of hepatitis A cases in the state.

The Department of Health and Human Services said Tuesday that since November 79 people have been diagnosed with the disease, compared with an average of six or seven annually in recent years. One person in Merrimack County has died.

Beth Daly, chief of the Bureau of Infection Disease Control, said the disease is spread by unknowingly getting the virus in your mouth after touching or eating items that are contaminated with small amounts of stool from an infected person. Hepatitis A is preventable with a vaccine.

Symptoms of hepatitis A, which causes inflammation of the liver, include fever, nausea, abdominal pain, dark urine, clay-colored bowel movements and jaundice.

Eighteen states have declared an outbreak.