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People may not neccessarily think about it at first, but infections kill so many people that it isn’t even funny. It’s one of those things that you always have to watch out for. Even the most obsessive hand washer can still get sick because sometimes it’s not about how clean you are, it’s how clean other people are.

It’s now being reported that as many as 2,000 people in Salt Lake County area of Utah may be at risk of contracting hepatitis A after visiting a local 7-Eleven store where an employee who was diagnosed with the virus came to work during their infectious period and took it upon themselves to handle the food.

Utah isn’t the only state facing this issue. Salt Lake County’s ongoing outbreak which began in November of 2017 is part of a multi-state resurgence of the disease over the course of the last year. The outbreak has now affecting primarily California, Kentucky and Michigan, and now Utah.

Hepatitis A is a virus that causes acute liver inflammation and is typically spread through sexual contact, needle sharing, or by consuming food that has been contaminated by infected feces.

The infection manifests with symptoms of abdominal pain, fever, diarrhea, and vomiting, but if it goes untreated, prolonged liver inflammation can result in death.

Salt Lake County health authorities are asking for people who may have come in contact with this contaminated food to please go get vaccinated at your nearest medical facility and The Salt Lake County Health Department is offering free vaccinations to those without insurance.

 Slate Reports: Why the recent hepatitis A outbreak can be traced to Third World produce.

People in Beaver County, Penn., are already familiar with the downside of the global economy.

The steel mills that once employed tens of thousands have long since closed, unable to compete with low-cost labor in Asia. And now the residents of the former steel capital are enduring another effect of expanding world trade—the biggest hepatitis A outbreak in U.S. history: at least 540 cases and three deaths.

Hepatitis A is a virus usually transmitted by human fecal matter on food and is endemic in many poor parts of the world.

Symptoms, which include jaundice, fever, and fatigue, can range from mild to deadly. This outbreak apparently stemmed from green onions—also known as scallions—served on tacos and other dishes at the Chi-Chi’s restaurant in the Beaver Valley Mall.

More than half the green onions consumed in the United States are grown in Mexico. Investigators believe that the batch of onions that made its way to Chi-Chi’s came from three Mexican growers implicated in smaller outbreaks in Georgia and Tennessee that occurred in September.

They also suspect that questionable food-handling practice in that particular restaurant caused the virus to spread to so many people. This incident may seem isolated, but it highlights a rising problem that is only going to grow worse: Produce grown in developing countries is bringing the diseases of those countries to America.

How is this happening? The endless quest for cheaper land and labor pushes even more of our agriculture into other countries. How many oranges still grow in Orange County, Calif., or Orange County, Fla., once full of endless groves and now home to Disneyland and Disney World, as well as vast suburban sprawl? In addition, Americans are heeding the sound advice of health authorities to eat more fresh fruits and vegetables, and they want a variety of choices at any time of year. The result: More crops are grown in hot distant places and then shipped stateside. Indeed, at certain times of the year, more than 70 percent of the fresh produce in the United States comes from Mexico.

The problem, as anyone who has worked on this issue knows, is that many countries that grow produce for the United States—such as Mexico, Guatemala, and the Philippines—have limited sources of sanitary water, including the water used to irrigate the crops. As a result, a great deal of freshly picked produce can pass through streams of untreated waste before making its way to the United States. Plus, field hands often have no toilet facilities or clean water to wash their hands. Of course, many growers in Mexico and other countries strive to keep their fields hygienic, and migrant workers can bring diseases when they come to pick crops in the United States, too.

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