The county Board of Supervisors voted Tuesday to extend an emergency declaration over the hepatitis A outbreak in the San Diego region.
Dr. Wilma Wooten, the county's public health officer, declared the emergency on Sept. 1. It needs to be renewed by the supervisors every two weeks.
The board also directed staff to prepare a letter to Gov. Jerry Brown and the director of the state Office of Emergency Services requesting California Disaster Act assistance and other help as appropriate. The governor declared a state emergency on Oct. 13.
The outbreak has sickened 516 people in the San Diego area since November, killing 19, according to the county Health and Human Services Agency.
Testing results from another 40 suspected cases are pending, Wooten told the supervisors. Because the disease, which attacks the liver, has a long incubation period, even more cases are likely to be detected, she said.
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 includes the homeless, illicit drug users, 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.
Supervisor Ron Roberts pushed back against criticism that county officials have not done enough to combat the spread of the disease.
"Almost 84,000 vaccinations is an incredible effort that has been undertaken," Roberts 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 those who do experience fever, fatigue, nausea, loss of appetite, yellowing of the eyes, stomach pain, vomiting, dark urine, pale stools and diarrhea.
The county and city of San Diego have taken various 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.
The city has also proclaimed a local health emergency.
Because of the outbreak's connection with the homeless, the city of San Diego has set up a tent camp near Balboa Park, and boosted the amount of safe parking spots for people who live in their vehicles.
Here is a breakdown of Hepatitis A cases from the San Diego County Human and Health Services Agency:
Confirmed outbreak cases–490
Homeless and illicit drug use–162 (33%)
Homeless only–80 (16%)
Illicit drug use only–61 (13%)
Neither –128 (26%)
Confirmed outbreak cases–516
Homeless and illicit drug use–169 (32.8%)
Homeless only–87 (16.9%)
Illicit drug use only–62 (12%)