San Diego has started sanitizing its streets and sidewalks to try to combat a hepatitis A outbreak spreading among the city’s homeless population.

Amid an outbreak across several cities in San Diego County that county health officials say has led to 16 deaths and nearly 300 hospitalizations, workers hosed down areas in San Diego earlier this week with chlorine and bleach, according to the San Diego Union-Tribune. Mayor Kevin Faulconer (R) recently announced that measures to try to curb the spread of the deadly disease would include giving free vaccinations, installing hand-washing stations and power-washing streets in the Southern California city.

“We must continue to work collaboratively to stop this crisis and save lives,” Faulconer said in a statement.

Earlier this month, health officials in San Diego County declared a public health emergency because of a hepatitis A outbreak spreading through the area.

Officials said that since November, 421 cases related to the outbreak have been confirmed in San Diego County, mainly in downtown San Diego and from El Cajon, La Mesa, Santee and some unincorporated areas. Most of the cases were among illicit drug users and the homeless, according to an update Tuesday from the California Health Alert Network.

On Monday, crews cleaned areas around 17th Street and Imperial Avenue in San Diego, “where hundreds of homeless congregate and live in tents and other shelters along city streets,” according to the Union-Tribune. Earlier this year, 5,619 people were reported homeless in San Diego, 3,231 of whom were without shelter, according to the Regional Task Force on the Homeless.

The county said that the disease is spreading “through contact with a fecally contaminated environment.”

Hepatitis A, which is a highly contagious liver infection caused by a virus, is spread person-to-person typically through poor sanitation practices, such as not washing hands after using the restroom.

The Centers for Disease Control and Prevention said that since a vaccine was introduced in 1995, hepatitis A infections have declined by 95 percent. Symptoms include fever, jaundice, joint pain, nausea, vomiting and abdominal pain, as well as dark urine and clay-colored bowel movements, according to the CDC.

San Diego’s recent measures come in response to calls from the county, which declared a public health emergency that was later ratified Sept. 6 to potentially allow the county to request aid.

So far the County and community partners have immunized over 19,000 people, including approximately 7,300 to the at-risk population. There have been 256 mass vaccination events and 109 “foot teams” of public health nurses have gone out 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 with 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 have also distributed over 2,400 hygiene kits to individuals. The kits contain water, non-alcohol hand sanitizer, cleaning wipes, clinic location information and plastic bags.

Meanwhile, the city of San Diego said it would keep 14 restrooms open 24 hours a day in Balboa Park, where many of the city’s homeless stay, according to the Union-Tribune.

Crews will clean the streets again Wednesday and Friday — and then every other week to attempt to control the outbreak.

“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,” Craig Gustafson, senior director of communications for the mayor, told the Union-Tribune. “We’re taking swift action to eradicate this virus from our streets and keep our most vulnerable residents safe.”

Officials with the mayor’s office and the county’s Health and Human Services Agency did not immediately respond to requests for comment.

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