SANTA CRUZ COUNTY, CA – Nine homeless people in their 20s and 30s in Santa Cruz have been diagnosed with Hepatitis A in the last eight weeks, constituting an outbreak of the same strain that recently killed four people in the San Diego area, Santa Cruz County health officials said Tuesday.

Santa Cruz County public health officer Arnold Leff believes the outbreak is connected with a larger one that started in San Diego County last year. In November, two people were diagnosed with the disease in San Diego County, but as of Monday that number had climbed to 160, including four deaths and 80 percent of those infected having been hospitalized, Leff said.

Normally, Santa Cruz County health officials only see one or two cases per year. Since April, five men aged 25 to 36 and four women aged 26 to 30 have been diagnosed. All are unsheltered other than one man who is staying with his mother, Leff said. "It's close to being defined as an epidemic, but for now we're calling it an outbreak," Leff said.

Leff said smaller outbreaks had been reported in Plumas County and in Arizona and New York, but that he had no evidence to believe those outbreaks were related. "When we first got our first two cases, we did not wait," Leff said. "We started a Hepatitis A vaccination program targeted to the most at-risk individuals in hopes of preventing a large-scale outbreak similar to

what they have in San Diego."

The people most at risk of catching Hepatitis A are homeless, drug users, men who have sex with men, people with clotting factor disorders, those who live with or care for Hepatitis A patients and anyone traveling to

countries with moderate to high rates of Hepatitis A.

"Given the four deaths they had and the obvious increase in cases in San Diego, we made an aggressive decision to open up our operation center and to treat this outbreak, even though it was initially small, as an urgent outbreak that we needed to respond to," Leff said.

Hepatitis A can be spread through contaminated food or water or by having sexual contact or sharing drugs with an infected person. Even touching objects handled by someone with Hepatitis A can lead to the virus spreading. To prevent the spread of Hepatitis A, public health officials recommend washing hands frequently, especially after using the bathroom or changing diapers and before handling food, not having sex with anyone who has

