Public health officials declared a hepatitis A outbreak in Los Angeles County Tuesday, saying there are now 10 people infected, two of whom are homeless and contracted the potentially fatal liver disease locally.

The two newer cases can’t be traced to San Diego County, where the infectious disease has affected 421 people, mostly among those who are homeless, said Dr. Barbara Ferrer, LA County Public Health Director during a report to the Board of Supervisors at their weekly meeting. Sixteen of those people from San Diego have died. In Santa Cruz County, more than 60 people have been infected. Most of them are homeless.

“We have now locally acquired infection in Los Angeles County,” Ferrer said. “As of this point, we’ve given over 1,000 vaccines at various outreach events. We really do need people to take seriously that this is a disease that is preventable if you are vaccinated.”

#LACounty health officials declare hepatitis A outbreak in Los Angeles. Of 10 cases, 2 locally acquired. Story soon. pic.twitter.com/kA7OR2c9Sv — Susan Abram (@sabramLA) September 19, 2017

Ferrer said there are 40 to 60 cases of hepatitis A each year in L.A. County. But the two recent cases mark the first time health officials identified the disease among those who are homeless and their infections were locally acquired. Because of that, the disease is labeled an outbreak per state health protocol, she said.

“We have always had hepatitis A in LA County,” Ferrer said, but “we have never had an outbreak.”

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The outbreaks in San Diego and Santa Cruz counties were mostly among homeless people who were believed to be using drugs. Los Angeles County health officials said the disease was being spread person-to-person through close contact or through contact with environments contaminated with feces.

Health officials earlier this month identified a food vendor in Lancaster who had contracted heptatitis A. His case was linked to the outbreak in San Diego.

“I think we get freaked out when we hear the word outbreak,” Los Angeles County Supervisor Sheila Kuehl said. “The amazing increase in cases in San Diego and Santa Cruz has alerted us to the possibility.”

Supervisors asked Ferrer what the public health department will be doing to prevent the disease among food handlers, as well as those in health facilities, and in downtown LA’s Skid Row, where there are few bathrooms. A report produced by a collaboration of groups who advocate for the homeless on Skid Row found that during 9 p.m. to 6 p.m. there are nine public toilets available for 1,777 unsheltered homeless people on Skid Row, “and these toilets are largely inaccessible,” according to the report, called “No Place To Go.”

“Even counting these nine public toilets, Skid Row is short of the United Nations sanitation standard by 80 toilets,” according to the report.

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Ferrer told the board the health department is encouraging more vaccinations to help prevent the spread and working with providers to pass out everything from more information to sanitized hand wipes.

What are the symptoms of Hepatitis A? pic.twitter.com/cBSOK3Kcfh — Los Angeles County (@CountyofLA) September 19, 2017

Hepatitis A is a liver disease with symptoms that include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and a yellowing of the skin or eyes or jaundice.

Ferrer urged anyone working with individuals at high risk of contracting the disease — including health care providers, food-service workers and shelter employees — to get vaccinated.

“The safest thing you can do if you work with a high-risk population or if you are worried … is to get vaccinated,” she said.

Children have been routinely vaccinated since 1999. But many adults lack protection against the virus.

“It is a good idea for everyone to talk to their doctor,” said Dr. Sharon Balter, the chief of the department’s communicable disease control program.

Those interested in receiving free or low cost hepatitis A vaccines can call the county’s Acute Communicable Disease Control department at 213-240-7941 or visit publichealth.lacounty.gov.

City News Service contributed to this report.