San Diego health officials have implemented many measures to combat the city’s deadly hepatitis A outbreak, including power-washing the streets with a bleach solution and vaccinating more than 19,000 people. On Saturday they added yet another emergency measure: bathrooms with 24-hour security. 
 
 Four new portable restrooms and a handwashing stations were added to an area of the city that has a high population of homeless individuals, city officials announced in a statement. The facilities will be cleaned at least two times per day and will be watched over by full-time security. 
 
 “The installation of more public restrooms is important to stop the spread of hepatitis A,” Jonathan Herrera, the City’s Senior Advisor on Homelessness Coordination, said in a statement. “This is one of the many steps the City is taking to assist the County of San Diego in addressing this public health emergency.” 
 
 In addition to the four new restrooms, there’s also 16 more throughout the downtown area of the city, all of which are displayed on this map. Officials plan to install more public restrooms throughout the city. 
 
 The outbreak of the highly contagious virus has impacted hundreds of people. As of the latest count on September 12, there have been 421 cases reported of hepatitis A resulting in 292 hospitalizations and 16 deaths. The patients' ages range from 5 to 57, the Los Angeles Times reports. The majority of those who have been impacted are “homeless and/or illicit drug users,” according to the Health and Human Services Agency. 
 
 A plan to install three new homeless shelters in the coming months is also being discussed, Mayor Faulconer announced earlier in the week. 
 
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 “Each facility would have 100 or more beds, showers, meals and supportive services to help people transition off the street and into permanent housing,” the statement reads. 
 
 On Friday, officials warned that anyone who ate at World Famous, a popular restaurant on the Pacific Beach boardwalk, during these specific dates and times may have been exposed to the virus. 
 
 Hepatitis A is a liver infection typically contracted from contaminated food, water, or from close contact with someone else who has the virus. After being exposed, symptoms usually take a few weeks to appear and can include fatigue, nausea, dark urine, and joint pain. 
 
 Health officials are urging the public to get vaccinated for the virus, especially those who have been exposed and who have not been previously immunized for hepatitis A. 
 
 Free hepatitis A vaccinations are available at the San Diego Central Library on September 19 from 2 p.m. to 5 p.m. Vaccinations will also be administered at North Central Public Health Center, located at 5055 Ruffin Road in San Diego., on Saturday, September 16 from 10 a.m. to 2 p.m. ||||| Crews from the company Clean Harbors began power-washing sidewalks and street areas with a bleach and chlorine solution in downtown San Diego on Monday as part of an effort to stop the spread of hepatitis A among homeless people. 
 
 The area cleaned Monday included sidewalks around 17th Street and Imperial Avenue, where hundreds of homeless congregate and live in tents and other shelters along city streets. The cleanings will continue in other downtown areas on Wednesday and Friday and repeat every other week. 
 
 A hepatitis A outbreak has left 15 homeless people dead and hospitalized nearly 300 others over the past 10 months. A lack of adequate access to restrooms, showers and hand-washing stations is believed to have contributed to the spread. 
 
 Besides starting the washing program Monday, the city announced it was extending the hours of 14 restrooms in Balboa Park, which will be open 24 hours a day starting Tuesday. 
 
 “By disinfecting our sidewalks and making additional public restrooms available 24/7, we’re following the direction of County health officials to address the unsanitary conditions that have helped fuel this outbreak,” said Craig Gustafson, senior director of communications for Mayor Kevin Faulconer. “We’re taking swift action to eradicate this virus from our streets and keep our most vulnerable residents safe.” 
 
 On Friday, Gustafson said Faulconer expected to announce this week a plan to set up multiple large tents to provide temporary, immediate shelter relief for hundreds of homeless people. Those tents will be equipped with restrooms, hand-washing stations and showers, he said. 
 
 The sidewalk washings and extended restroom hours this week were in response to a letter sent by county health official Aug. 31 asking the city to move forward with a list of specific sanitation actions to help control the spread of hepatitis A. 
 
 The county gave the city five business days to respond with the plan for remedying what it called a “fecally contaminated environment” downtown. 
 
 On Monday, county Communications Director Michael Workman said health officials still were evaluating the city’s response to the request. 
 
 The county also has taken steps to address the outbreak and plans to expand its efforts to other cities in the region soon. 
 
 County health officials already have provided hepatitis vaccinations to 19,000 people, including 7,300 considered to be at-risk of contracting the disease. The county also hired its own contractor to install 40 hand-washing stations in areas where the homeless often gather, and it has plans to install more this week. 
 
 The city has identified three downtown areas to be cleaned every other week. Monday’s areas included the sidewalks along Imperial Avenue below the Interstate 5 overpass, where the city had installed jagged rocks in an attempt to deter homeless people from camping in April 2016. Homeless people still used the site, prompting a need to wash the area. 
 
 The Monday cleaning area also includes streets north of National Avenue, south of F Street, west of 22nd Street and east of 10th Avenue. It also includes several blocks north of F Street and south of B Street between 10th Avenue and 17th Street. 
 
 On Wednesdays, crews will move west and clean streets north of Broadway, south of Fir Street, west of 10th Avenue and east of Pacific Highway. 
 
 On Fridays, crews will clean streets north of Harbor Drive, south of Broadway, west of 10th Avenue and east of Pacific Highway. ||||| (CNN) An outbreak of hepatitis A has sickened 421 people and killed 16 in San Diego County between November and September, officials say. Additionally, 292 of the 421 have been hospitalized as a result of the viral infection, which causes inflammation of the liver. 
 
 Over the previous five years, the county recorded just 28 infections per year on average. 
 
 "This is an outbreak of unprecedented proportion, and we have not seen an outbreak of this nature as relates to hepatitis A before," said Dr. Wilma Wooten, public health officer and director of public health services for the county's Health and Human Services Agency. 
 
 Most of the infections, 65%, are occurring among people who are homeless, who use illicit drugs or who experience a combination of those two factors. 
 
 The remaining cases include 23% in people associated with the homeless population, such as friends, and 12% in people who are lacking records and are most likely homeless, according to Wooten. 
 
 Hepatitis A is typically spread when people eat contaminated food or water; more rarely, the virus is transmitted person-to-person through the "fecal-oral route," she explained. 
 
 "Basically, if an individual is infected with hepatitis A and they use the bathroom and don't wash their hands, and then they can spread or contaminate the environment: door handles, ATMs or whatever they touch," Wooten said. Other people who touch the same objects and fail to wash their hands before eating, smoking or touching their faces can become infected as well. 
 
 Symptoms of hepatitis A , which include fever, fatigue, nausea and abdominal pain, usually last less than two months, although some people can be ill for as long as six months, according to the Centers for Disease Control and Prevention. Although there are no special treatments, doctors recommend rest, adequate nutrition and fluids. Most people recover completely and do not have any lasting liver damage. 
 
 Wooten declared a state of emergency for the county, home to about 3.3 million people, on September 1. 
 
 "The local emergency was declared to increase and heighten awareness of the seriousness of the outbreak," she said. 
 
 Vaccinations, bleach and more 
 
 To combat the outbreak, public health officials have adopted a three-part strategy: vaccination; sanitation, which includes hygiene; and education. 
 
 Since June, the San Diego Police Department has been offering free hepatitis A shots through its homeless outreach and other programs. 
 
 "We've vaccinated over 21,000 individuals," Wooten said. "The majority of those are the at-risk population or individuals who have association with the at-risk population." 
 
 The San Diego Central Library will host free vaccination clinics on the third Tuesday of each month beginning September 19. 
 
 The city of San Diego -- one of 18 incorporated municipalities and one unincorporated municipality that make up the county -- has "the largest number of homeless individuals downtown," Wooten said, "so we deployed or put out hand-washing stations" about two weeks ago. 
 
 "The homeless community was very thankful and appreciative. We're looking at other locations where they can be deployed." 
 
 "We're also encouraging municipalities to look at other things they can do, like increasing access to public bathrooms," Wooten said, adding that bleach is needed to kill the virus when cleaning restrooms. 
 
 "The city of San Diego is also looking at mobile showers and also strategies to help people wash their clothes," she said. "All of those things have been considered to help with personal hygiene as well as sanitation of the streets." 
 
 Craig Gustafson, senior director of communications for the city of San Diego, wrote in an email that "the City hired a vendor to begin using a bleach cleaning solution on public right-of-ways on Monday. The cleanings will occur three times a week (Mondays, Wednesdays and Fridays) every other week in the downtown area." 
 
 The education outreach includes flyers posted and pamphlets available in public places, including municipal buildings and libraries. 
 
 The state of emergency "could lead to additional state and federal funding to reimburse for costs related the outbreak," Gustafson said. 
 
 Cases elsewhere in California 
 
 Separately, Santa Cruz County "has reported 69 cases in 2017," Jorge De La Cruz, a spokesman for the California Department of Public Health, wrote in an email. State public health officials consider this an additional outbreak. 
 
 many infected people have been difficult to contact due to homelessness or illicit drug use. Two challenges involved in the investigation of the Santa Cruz outbreak, according to the county health department website , are the fact that hepatitis A has a long incubation period -- 15 to 50 days -- and thatmany infected people have been difficult to contact due to homelessness or illicit drug use. 
 
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 "To date, no common source of food, beverage, or other cause has been identified; as a result, the source of the outbreak remains undetermined," the website says. 
 
 "Outside of San Diego and Santa Cruz counties, 126 cases of hepatitis A have been reported to date (in California) in 2017," De La Cruz wrote, adding that the total number of cases in the state as of Thursday was 631. 
 
 On Tuesday, the Los Angeles County Department of Public Health said it has confirmed 10 cases of hepatitis A among homeless people. 
 
 Dr. Jeffrey Gunzenhauser, the county's interim health officer, said in a statement, "our outreach teams and clinics are offering free vaccine to persons who are homeless, active drug users, and those who provide services and support to those individuals." The most recent cases in Los Angeles appear to be locally acquired, according to the department. 
 
 Wooten said that "underlying medical conditions like hepatitis B or hepatitis C or both, or other chronic liver disease" may be contributing to the high hospitalization and death rates among the homeless in San Diego. 
 
 "Going forward, we are doing everything we can do and working with all of our partners, and I can't predict how long this will last. We will be working on this anywhere from another six to 12 months, potentially," she said. "If we get our arms around it sooner, we welcome that."
– San Diego is ramping up its battle against a deadly hepatitis A outbreak by opening up new public bathrooms around the clock and adding security cameras, per NBC7 and Newsweek. Officials announced about 20 permanent and portable bathrooms would be open citywide targeting the homeless population, Newsweek reports. They will be cleaned twice daily and monitored via security cameras. The city's homeless coordinator calls the additional bathrooms an "important step to stop the spread of hepatitis A," a liver infection transmitted when people don't wash their hands after using the bathroom. The city is also considering three new 100-bed shelters to help the homeless "transition off the street and into permanent housing," per Newsweek. About 65% of those infected have no permanent home, per CNN. The city declared a public health emergency on Sept. 1 after the epidemic sickened hundreds, with victims from ages 5 to 57, per the LA Times. So far, 16 people have died and 292 have been hospitalized. Since symptoms can take weeks to appear, the extent of the epidemic is not yet known. Workers have vaccinated 21,000 people, mostly the "at-risk population," added hand-washing stations, and began spraying streets with bleach. Mobile showers may come next, per CNN. Health authorities have identified no common sources, such as contaminated food, for the outbreak. But they issued a warning on Friday that anyone who ate at World Famous restaurant on certain days may have been exposed, per NBC. Symptoms include nausea, joint pain, fatigue, and dark urine. (Hepatitis C infections are on the rise nationwide.)