LANSING, Mich. — Michigan has activated the State Emergency Operations Center to help coordinate its response to an outbreak of hepatitis A that may be spreading beyond the southeastern portion of the state.

Wednesday’s announcement from Lt. Gov. Brian Calley came a day after the Michigan Department of Health and Human Services said it activated the Community Health Emergency Coordination Center.

Since August 2016, officials have received reports of 457 confirmed cases, including 18 deaths, in Huron, Ingham, Lapeer, Livingston, Macomb, Monroe, Oakland, Sanilac, St. Clair, Washtenaw, and Wayne counties. The disease attacks the liver and causes symptoms including abdominal pain, nausea, diarrhea, fever and jaundice.

The department says it’s urging vaccinations for the highest risk individuals, including persons with a history of substance use and men who have sex with men.