View video of the entire meeting. Since Nov. 22, 2016, 15 people have died, all of whom had underlying medical conditions. Additionally, 279 of the 398 reported cases have been hospitalized. About 65 percent of the cases have been among people who are homeless, use illicit drugs or a combination of those two factors. The county has implemented a three-part strategy to combat the outbreak that includes immunization, sanitation and education efforts. So far the county has immunized more than 19,000 people, including about 7,300 in the at-risk population. There have been 256 mass vaccination events and 109 “foot teams” of public health nurses who have gone into areas with heavy homeless populations to offer vaccinations. The public health officer has also issued new recommendations that people who handle food and health care workers get vaccinated. Last week, 40 handwashing stations were placed in areas around the city of San Diego that are known to have high concentrations of homeless people. Steps are also being taken to sanitize areas where significant numbers of homeless people are living. Sanitation may help decrease the Hepatitis A virus in the environment, which may lower the likelihood of the virus spreading. County staff also distributed more than 2,400 hygiene kits to individuals. The kits contain water, non-alcohol hand sanitizer, cleaning wipes, clinic location information and plastic bags. An education ad campaign was started in mid-August in trolleys and bus stations in San Diego. That campaign is expanding into North County. Public Health has also made more than 50 presentations to local community partners, providing them with prevention information and educational materials on vaccinations and proper handwashing hygiene. Hepatitis A is most commonly spread person-to-person through the fecal-oral route. Symptoms of Hepatitis A include yellowing of the skin and eyes, fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stools. Symptoms usually appear over a number of days and last less than two months. However, some people can be ill for as long as six months. Hepatitis A can sometimes cause liver failure and even death. For general information on hepatitis A, visit the HHSA hepatitis website where data are updated routinely. A hepatitis A fact sheet is also available. (To sign up for a free subscription to Food Safety News, click here.)The current Hepatitis A outbreak in California underscores the need for foodservice workers to be vaccinated against the virus. San Diego’s County Board of Supervisors did the right thing this week in declaring a local health emergency. County Public Health Officer Dr. Wilma Wooten is recommending the vaccination for anyone who handles food, as well as health care workers. The county board took action at a special meeting Tuesday, ratifying a Sept. 1 emergency declaration issued by Wooten. Without action from the board, the health officer’s declaration would have expired after seven days. The emergency status should help raise public awareness. It also makes it possible for the county to ask for mutual aid if necessary. The meeting included a presentation by public health officials and public comments.