Two cases of hepatitis A in Colorado have been linked to an outbreak of the disease in San Diego County, it was reported Monday.
The cases were diagnosed over the summer in El Paso County, which includes Colorado Springs, and the Western Slope, encompassing an area of the state west of the Continental Divide, according to the Denver Post.
As of Oct. 20, Colorado had 58 reported cases of hepatitis A, state epidemiologist Rachel Herlihy told the newspaper.
"Of these, two cases have occurred in people experiencing homelessness," Herlihy said. "Both these cases are linked to the ongoing outbreak in San Diego."
The San Diego outbreak also spread to the Phoenix area, where more than a dozen cases were reported earlier this month.
The San Diego County Health and Human Services Agency said more than 500 people have contracted the disease, which attacks the liver, since November. Of those, 19 have died.
Nearly two-thirds of the victims have been either homeless, users of illicit drugs or both, according to Dr. Wilma Wooten, the county's public officer.
Wooten said last week that testing results from another 40 suspected cases were pending, and because the incubation period is so long for the disease, still more cases are likely.
The HHSA said county staff and community partners have administered nearly 84,000 hepatitis A vaccinations, including 70,748 to the at-risk population, which also includes people with chronic liver disease, law enforcement and emergency personnel, people who work with homeless or treatment programs, food handlers and men who have sex with men.
More than 4,600 vaccinations have been provided to inmates at four area jails, Wooten said.
HHSA Director Nick Macchione said the county has so far spent $4 million on trying to curtail hepatitis A, which is usually transmitted by touching objects or eating food that someone with the virus has handled or by having sex with an infected person.
The disease does not always cause symptoms, but for those who do, they could experience fever, fatigue, nausea, loss of appetite, yellowing of the eyes, stomach pain, vomiting, dark urine, pale stools and diarrhea, according to the agency.
The county and city of San Diego have taken several steps to address the outbreak, including the spraying of a sanitizing formula on streets and sidewalks, the placement of portable hand-washing stations and restrooms in areas where the homeless congregate, and the stepped-up immunization campaign.