QUAD CITIES - An outbreak of hepatitis A stemming from a McDonald's restaurant in Illinois has spread to Iowa.

Two cases of hepatitis A have been reported by officials from the Scott County Health Department. That brings the total number of cases to 23.

These two cases are the first from Iowa to be included in outbreak.

There are also cases in Illinois' Rock Island, Henry, Mercer and Warren counties, as well as one in Woodford County, located near Peoria. The majority of the cases are from Rock Island County.

"It's all part of the same outbreak," said Melaney Arnold, a spokeswoman for the Illinois Department of Public Health.

Hepatitis A is the least serious form of hepatitis, but it presents flu-type symptoms and may include jaundice.

The cases are connected with Rock Island County businesses, including a McDonald's restaurant, 400 W. 1st St., Milan. Earlier this month, two food handlers at McDonald's were found to have hepatitis A, and the restaurant was closed for three days for a deep cleaning. Employees also received instructions on how to properly wash their hands, especially after using the restroom. A day care center in Milan also was ordered to be cleaned.

On Tuesday, the Rock Island County Health Department finished a two-day clinic to vaccinate more than 4,000 individuals who ate at the McDonald's during the periods of July 6-10 and 13-14.

One of the McDonald's cases involves a female employee who handled food and who contracted hepatitis A in mid-June. Her case was diagnosed June 17. According to Illinois law, this case should have been reported to public health officials within 24 hours by an employer, doctor, laboratory or hospital. An investigation into why that did not happen is under way.