San Diego steps up containment battle as hepatitis A outbreak kills 16

— -- Private cleaning crews and public health workers are mobilized on the streets of San Diego in an effort to stop a hepatitis A outbreak that has claimed at least 16 lives so far.

San Diego city and county officials said they are collaborating on solutions to the aggressive outbreak –- with at least 421 known cases in San Diego county, including 292 hospitalizations and 16 deaths, since last November. They have stepped up containment plans, which now include everything from street cleaning and vaccination to distributing flyers and possible temporary housing for the California city’s homeless, who have been hard-hit by the virus.

"We must continue to work collaboratively to stop this crisis and save lives," San Diego Mayor Kevin L. Faulconer said in a statement today.

On Monday, the city of San Diego increased its sanitation measures. The city hired a private contractor to spray the streets with a bleach and water solution to kill bacteria, began installing outdoor hand washing stations and earmarked 14 bathrooms to stay open 24 hours per day to aid the sizable homeless population, who officials say make up the majority of the outbreak's victims.

The hepatitis A virus, which suppresses liver function, is easily spread from person-to-person, usually through fecal matter. Hand washing after bathroom use is paramount in controlling its spread, health officials say. Though it is often resolved with treatment, it can prove fatal for people who have compromised livers from congenital problems, disease or drug use.

San Diego County declared the outbreak a public health emergency on Sept. 1 and has an active campaign to contain the virus including vaccination, increased sanitation efforts and distributing educational materials.

Hepatitis A infections have been steadily declining across the U.S. over the past decades. The last reported figures on hepatitis A infections from the U.S. Centers for Disease Control (CDC), for the year 2014, showed a total of 1,239 cases nationwide.

Immunization is effective against the virus. San Diego County has deployed health workers to vaccinate individuals and run community vaccination events. The county said it has vaccinated approximately 19,000 people so far as part of the campaign.

Symptoms of hepatitis A infection include nausea, anorexia, fever, malaise or abdominal pain and patients may show outward signs like jaundice and pale stools.

The hepatitis A virus has an incubation period of 15 to 50 days, according to the CDC, and can go undetected for some time, which San Diego officials caution may stretch containment efforts over several months.