Los Angeles health officials have declared an outbreak of hepatitis A, making it the third region in California hit by the highly contagious liver disease this year.

San Diego has more than 420 cases and 16 deaths this year, while Santa Cruz County has 69 known cases.

The outbreak was declared after two out of 10 confirmed cases in LA were acquired locally instead of from the other regions.

Hepatitis A is a viral liver disease that can spread through ingesting food and drinks that have come in contact with feces of people who are already infected.

LA has the second-largest homeless population in the nation, and due to hygiene the disease affects this group the most.

Health officials are responding early to the increase in infections to stop the spread from reaching the epidemic level of San Diego County.

LA County has experienced 10 hepatitis A cases, two of which were acquired locally. This is the third region in California this year to experience an outbreak. LA has the second largest homeless population in the US and they are the most at risk to get the disease

The two locally acquired cases in LA County are the most recent infections out of ten cases causing health officials to worry.

'We've met the definition for an outbreak,' department Director Barbara Ferrer told the board on Tuesday. 'As of this morning we've confirmed that we have two community acquired cases.'

Of the other cases, four had been in San Diego and one had been in Santa Cruz during their exposure period. Three secondary cases occurred in a health care facility in Los Angeles County.

Most of those infected in the outbreaks have been homeless or using illicit drugs.

What is hepatitis A and how can it be treated? Hepatitis A is a viral liver disease that can have both minor and severe symptoms for the person infected. It is primarily spread when a person who isn't vaccinated ingests food or water that has been contaminated with feces of an infected individual. The virus is one of the most frequent causes for foodborne infections. Symptoms The incubation period of hepatitis A is normally 15 to 50 days. People can experience: Fever

Loss of appetite

Diarrhea

Nausea

Dark-colored urine

Jaundice

Acute liver failure Who is at risk? Anyone who has not been vaccinated or has never been infected with the hepatitis A virus is at risk. Other factors that increase risk include: Poor sanitation

Lack of clean water

Recreational drug use

Living with an infected person or having sexual relations with one

Traveling to areas with high risk without a vaccination Treatment There is no specific treatment for hepatitis A. It may take some people a couple weeks to a couple months to recover from the symptoms. Doctors recommend everyone to get a vaccination to help prevent the risk of getting infected by the virus. Source: World of Health Advertisement

Several people who provide services to the homeless have also been infected.

Los Angeles County Interim Health Officer Dr. Jeffrey Gunzenhauser said vaccination is the best protection against hepatitis A and outreach teams and clinics are offering free vaccine to the homeless, active drug users and people who work with those groups.

Vaccinations are the best way to prevent hepatitis A infections, but the CDC reported that fewer than 10 percent of adults over the age of 19 are vaccinated in the United States.

And San Diego has vaccinated more than 21,000 people and still seen an increase in those infected.

The homeless are considered at high risk for infection because of poor sanitation.

The latest annual tally found nearly 59,000 homeless people in the nation's most populous county.

This is a 23 percent increase from LA's homeless population in 2016.

With an increase in this population and their susceptibility to getting hepatitis A, health officials in LA are working fast to stop the spread as quickly as they can.

Hepatitis A spreads when someone comes in contact with an infected person's feces, sometimes when hands are not properly washed after going to the bathroom or changing diapers.

The virus is then spread through food or objects.

Previous outbreaks have been caused by specific food that were infected with the viral disease.

Hawaii experienced an outbreak in 2016 from contaminated sushi that infected 300 people.

Another outbreak occurred in Pennsylvania in 2003 from green onions. This hospitalized 124 people and killed three.

LA health officials are working to figure out what triggered their own outbreak, but the close proximity to San Diego concerns them.

San Diego's outbreak is attributed to poor sanitation in the downtown area and a rising homeless population.

The city has resorted to bleaching its streets and extending public restroom hours in efforts to get the outbreak under control.

It also installed 42 hand-washing stations and gave out free vaccinations.

LA County officials might have to turn to similar options if the outbreak continues to rise.

Hepatitis A can also be spread through sex or by sharing drug paraphernalia.

Health officials say the incubation period ranges from 15 to 50 days, and symptoms include fever, malaise, dark urine, anorexia, nausea and abdominal discomfort, followed by jaundice.

In addition to vaccination and thorough hand washing, medical experts said people should avoid sex with anyone who has hepatitis A, and not share food, drinks, cigarettes, towels, toothbrushes or eating utensils.