On March 18, the California Department of Public Health first announced an outbreak of the Hepatitis A virus. Seven months later on Oct. 13, California Governor Jerry Brown declared a state of emergency. Reported cases of Hepatitis A had more than tripled in the state, and 19 people have died.

Nearly 600 hepatitis A cases, mostly concentrated in downtown San Diego, have been reported since the beginning of the outbreak, likely caused by person-to-person transmission. This is up from an average 160 cases per year in California, said Dr. Gil Chavez, state epidemiologist at California Department of Public Health. More than 500 of the cases were reported in San Diego County.

California’s state of emergency status allowed it to purchase more vaccines, Chavez said. The CDC has delivered 80,000 doses to California since October 13.

“We’ve seen hepatitis A from time to time, but it was very unusual seeing people so close together,” said Dr. Robert T. Schooley, an infectious disease doctor and vice chair of medicine at University of California at San Diego.

The death rate is four times higher than average levels. The outbreak is concentrated among the homeless community, and Schooley attributes the higher death rate to a lack health of insurance and basic sanitation, and higher rates of untreated chronic illnesses.

“They’re not looking at press releases and the evening news. They don’t have the liberty to go to the nearest public health center or community clinic,” said Dr. Wilma Wooten, director of public health services at the San Diego County Health and Human Services Agency.

The virus is spread person-to-person through infected fecal matter or contaminated food, and an infected person can be contagious up to two weeks before showing signs of infection and one to two weeks after symptoms begin.

Symptoms include nausea, fatigue, abdominal pain, fevers, loss of appetite, joint pain, or yellowing of eyes and skin. Treatment is targeted at improving symptoms, which can lead to hospitalization and occasionally death.

Prevention: Infection can be prevented from hand washing and the hepatitis A vaccine. CDC recommends the vaccine, available at clinics and some pharmacies, for all children over one year of age and people with compromised immunity. The virus has declined by 95 percent since the vaccination became available in 1995.