San Diego has been battling with an extremely aggressive outbreak of Hepatitis A, an infection that targets the liver and may result in death in severe cases.

The victims have been mainly homeless people, who have been coming to the city in significantly increasing numbers.

The situation is grave: since November 2016, the outbreak has infected hundreds of people and left 15 dead; the crisis appears to be hitting the city’s homeless the hardest. According to the San Diego Health & Human Services Agency (HHSA), as of Sept. 5, 2017, the current outbreak has infected 398 people and caused 279 hospitalizations.

The San Diego HHSA noted that most of the people infected with the disease are either homeless or drug users, and that the outbreak is being spread between people through contact with a “fecally contaminated environment.” That essentially means that the new victim is usually an unvaccinated person who ingests food or water, touches an object, or uses drugs contaminated with fecal matter from an infected person.

Aggravating things is the fact that San Diego’s homeless population has been skyrocketing: while the number of homeless people across the county increased 5 percent in the past year, according to the Regional Task Force on the Homeless, those living on the streets of downtown San Diego spiked 27 percent. The inland North County area also saw a spike, with 11 percent more homeless than a year ago.

Sanitary street washing has commenced in downtown San Diego, and will continue until the outbreak abates. Meanwhile, San Diego County requested that city move forward with a list of specific sanitation actions designed to help control the spread of the disease.

The county gave the city five business days to respond with a plan for remedying what it called a “fecally contaminated environment” downtown. The county will soon expand its efforts to other cities in the region, where the outbreak has now produced nearly 400 confirmed cases.

The county moved forward last weekend with its own contractor, who installed 40 hand-washing stations in areas where the homeless often gather. There are plans, according to the city’s letter, to add more stations next week.

In addition to regularly pressure-washing dirty city right-of-ways with chlorinated water, the county also asked the city to “immediately expand access to public restrooms and wash stations within the city limits that are adjacent to at-risk populations.”

County health officials already have provided hepatitis vaccinations to 19,000 people, including 7,300 considered to be at-risk of contracting the disease. Now, public health officials are requesting that food handlers obtain vaccinations (if they aren’t already vaccinated).

“This is a proactive recommendation because the ongoing outbreak means that the risk to the general public is higher than normal,” Dr. Wilma Wooten, county public health officer, said. “A person who becomes infected with hepatitis A may spread the disease to others before experiencing symptoms. In an occupation such as handling food, workers may expose more members of the public than workers in other occupations.”

No common sources of food, beverage or drugs have been identified that have contributed to his outbreak, although the investigation continues.

This is critical, as our downtown area is famed for some amazing restaurants.