The most widespread hepatitis A outbreak in the United States occurred in 2018, in the state of Kentucky. The outbreak is believed to have started in November 2017. By July 2018 48% of the state's counties had reported at least one case of hepatitis A, and the total number of suspected cases was 969 with six deaths (482 cases in Louisville, Kentucky). By July 2019 the outbreak had reached 5,000 cases and 60 deaths, but had slowed to just a few new cases per month.