(Reuters) – Catholics in North Dakota were warned to watch for symptoms of hepatitis A after a bishop with the disease served Communion at four churches, putting worshipers at risk, state officials said.

Bishop John Folda of the Catholic Diocese of Fargo got hepatitis from contaminated food while in Italy last month for a conference of newly ordained bishops, Aliceyn Magelky, spokeswoman for the diocese, said on Friday.

Folda served Communion during Mass at three churches in Fargo and one church in Jamestown between September 27 and October 7, according to the North Dakota Department of Health. The Mass in Jamestown was at a convention of priests.

“He feels terrible about it,” Magelky said. “He did not know when coming back that he had contracted the virus or he would have refrained from participating in Mass much sooner.”

Magelky said Folda is feeling better and has not been infectious since October 16, but is still not on a full work schedule. Priests who attended Folda’s Mass in Jamestown were notified directly of the bishop’s illness, she said.

Hepatitis A can cause infection of the liver and is found in the feces of infected people, according to the health department. It is most often spread when people with the disease fail to wash their hands thoroughly and then touch other people.

“The risk of people getting hepatitis A in this situation is low, but the department of health felt it was important for people to know about the possible exposure,” Molly Howell, immunization program manager for the agency said in a news release.

The department encouraged people who received Communion from Folda to check with their doctors if they notice symptoms such as fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, pale stools or jaundice.

(Reporting By Kevin Murphy; Editing by Greg McCune and Xavier Briand)