Food Safety News and the Roanoke Times report that the patient count in a hepatitis A outbreak linked to Virginia restaurants continues to grow, with 44 people now confirmed as infected. One of the patients has required a liver transplant and one has died.

The cousin of the transplant patient reports the operation took place this past weekend. The outbreak patient’s husband and daughter were also infected, according to the cousin.

The patient who died, James Hamlin, and his wife Victoria frequently ate at one of the implicated Famous Anthony’s restaurants, according to the Roanoke Times. James died on Oct. 8 at age 75. “His daughter, Dana Heston of Cave Spring, said Hamlin was a strong and healthy man. He worked out three times per week — lifting weights, riding a stationary bike and walking. He did not have any serious medical conditions,” according to the Times. Victoria Hamlin was also infected, but is recovering.

More than half of the patients — 26 as of Oct. 15 — have been so sick that they had to be admitted to hospitals. That is a higher rate of hospitalization than is usually seen in hepatitis A outbreaks.

The outbreak is associated with three Famous Anthony’s restaurant locations in the Roanoke, VA, area. An employee who worked at all three locations is believed to be the source of the infections. No other details about the employee, including health status, have been released.