The Middlesex-London Health Unit says there has been a spike in non travel-related Hepatitis A cases in the city over the last few months.

There have been 16 cases so far in 2018, 15 of those since the beginning of October. That compares to three cases in a normal year, most of them travel-related.

The outbreak has mostly been among "under-housed or homeless Londoners, and those who inject drugs."

Dr. Alex Summers, Associate Medical Officer of Health said in a statement, “This situation is a demonstration of the health inequities that exist in our city. The link between most of these cases is that they live on the margins of society, don’t have access to stable housing and struggle with addiction.”

The health unit is asking local community agencies and healthcare providers to watch for the signs and to provide the hepatitis A vaccine for at-risk patients.